Mitigating Staff Resistance to Change through Communication and Engagement February 8, 2018
2 Joan Chaya Director of Workforce Development and Management jchaya@montefiore.org Maria Gerena Workforce Development Manager mageren@montefiore.org Adyna Gamboa Workforce Training Manager agamboa@montefiore.org Jasmine Cruz Sr. Human Resources Specialist jacruz@montefiore.org Daniel Fontanez Project Specialist dafontan@montefiore.org
Agenda 3 Welcome and introductions Understanding the People Side of Change Why have a change management strategy? Development of the Workforce Communication and Engagement Toolkit for Managers Putting together change management and project management Tools for mitigating resistance to change ADKAR case study Activities: Understanding and applying a business change assessment Return on investment (ROI) when focusing on the human factor of change Evaluations & closing
Notable Centers of Excellence Children s Hospital at Montefiore Montefiore Einstein Center for Cancer Care Montefiore Einstein Center for Heart and Vascular Care Montefiore Einstein Center for Transplantation Teaching Research Academic Medical Hospitals Primary & Specialty Care Home Care ~2,200 Faculty ~1,450 Residents & Fellows ~740 Allied Health Students ~2,100 Graduate & Undergraduate Nursing ~200 Home Health Aides ~100 Social Workers Clinical Translational Health Services Community 11 Hospitals 3,236 Total Beds 150 Skilled Nursing Beds 1 Freestanding ED 1 Rehabilitation Hospital Advanced Primary Care Mental Health Substance Abuse Sub-specialty Care Dental School Based Health Centers Mobile Health Home Health Programs Primary Care House Call Program Telehealth Short and long term care Community Health Corporate Functions Information Technology CMO ~30,000 Employees ~3,500 Physicians ~ 4,300 Medical & Allied Health Staff ~4,060 Integrated Provider Association Providers ~3,350 Employed ~5,650 RN/LPN ~4,200 NYSNA ~12,700 1199 850 RNs Workforce Health Education Community Advocacy Wellness Disease Mgmt. Nutrition Obesity Prevention Physical Activity Reduce Teen Pregnancy Lead Poisoning Prevention Finance Legal Strategic Planning Purchasing Compliance Marketing Public Affairs Human Resources Clinical support Network applications Care Management (~ 360K Covered Lives) Disease Management Care Coordination Telemedicine Pharmacy Education 4
Integrated Delivery System Our Locations 3,236 Total Beds Across 11 Hospitals Including 132 beds at the Children s Hospital at Montefiore (CHAM) 86 NICU/PICU beds 150 Skilled Nursing Beds 200 Sites Including Hutchinson Campus Hospital without Beds 1 Freestanding Emergency Department First in New York State 68 Primary Care Sites 21 Montefiore Medical Group Sites 23 School Health Clinics 16 Mental Health/Substance Abuse Treatment Clinics 73 Specialty Care Sites 3 Multi-Specialty Centers 4 Pediatric Specialty Centers 12 Women s Health Centers 10 Dental Centers 5 Imaging Centers 5
The Montefiore Hudson Valley Collaborative 6 Who We Are Montefiore, renowned for its long-standing commitment to community-based healthcare, is leading a group of nearly 250 healthcare providers, community-based organizations, local government officials and more, from across Westchester, Rockland, Orange, Sullivan, Dutchess, Ulster and Putnam counties, to form the Montefiore Hudson Valley Collaborative. Working together, we will champion new models of providing Medicaid beneficiaries with higher quality care, while reducing expenditures through enhanced coordination, community-focused care and education. Our Guiding Vision A more integrated delivery system, better able to take on risk and deliver value. A more sustainable delivery system, care delivered locally and in the right care setting. A more patient-centered delivery system, with expanded access to services tailored to the unique needs of our patients and communities.
Understanding the People Side of Change 7
8 Think about a change you were asked to make?
What was your immediate response when you heard about the change? 9 That sounds like a GREAT idea!! I M READY!! BRING IT ON!
Or was it like 10 I don t have the bandwidth! Are you kidding me? Not again! We re doing what? by when? Didn t we try this before? Another flavor of the month!
11 How can a person s reaction to a change impact the project success or failure?
12 It s easy to say...
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14 Change Management is necessary because... We change for a reason Organizational change requires individual change Organizational outcomes are the collective result of individual change Change management is an enabling framework for managing the people side of change
Organizational change can be represented as three states of change 15 Current State Transition State Future State How things are done today? How to move from current to future? How things will be done tomorrow?
16 In reality, each impacted employee has his or her own current and future state Organization Current State Transition State Future State How I do my job today? How I will do my job after the change is implemented? Individual Current State Transition State Future State
MHVC Change Management Strategy To empower organizations with tools and competencies to prepare their employees for change. 17 Clarity Change management methodology and evidence based data for success Sustainment Support systems and opportunities for change managers to network Commitment Senior leadership buy-in Capability Change management competencies for managers at all levels
18 Workforce Communication and Engagement Toolkit for Managers
Key Communicators and Change Agents 19
20 Keep it simple! No acronyms! Guidelines and Talking Points Customizable talking points for multiple audiences What are examples of best practices in communication? How do I manage employee questions about DSRIP? WIIFM What are ways to communicate how DSRIP is impacting my organization? How do I select a communication champion?
Workforce Communication and Engagement Toolkit The Workforce Communication Toolkit is an online support tool to help you communicate with your staff about changes in the workplace related to the New York State Delivery System Reform Incentive Payment program (DSRIP). The contents of this toolkit are divided into the following categories: 21 Guides Templates Best Practices Online Resources Includes step-by-step guidance on communicating DSRIP in group settings (e.g. Town Halls, Department meetings, DSRIP 101 module, etc.) Downloadable templates for each DSRIP project. These templates are designed to provide a brief overview of each project in a one page format. You may customize these with more or less detail depending on your needs. Examples of best practices in DSRIP communication from your colleagues within the MHVC network of partners and other resources. A selection of online DSRIP resources, informational videos, social networking & communities, Frequently Asked Questions, DSRIP 101 Glossary and other resources. Start here to access the toolkit introduction and table of contents Visit us at Montefiore Hudson Valley Collaborative to learn about events, workforce training, Cultural Competency and Health Literacy, Hudson Valley jobs, and MHVC news.
Prosci Change Management Practitioners in the MHVC network 22 There are 21 change management practitioners certified in the Prosci methodology and tools from following partner organizations: Coordinated Behavioral Health Services (CBHS) Children s Medical Group Hudson River Healthcare Hudson Valley Community Services Hudson Valley Mental Health Jawonio MHA Westchester Montefiore Hudson Valley Collaborative Montefiore Medical Center Planned Parenthood Mid-Hudson Rehabilitation Support Services St. John s Riverside Hospital St. Joseph s Hospital White Plains Hospital
23 Putting together Change Management and Project Management
Comparing Change Management and Project Management 24 Focus: Technical side of moving from current state to future state Process: Initiation Planning Executing Tools: Statement of work Project charter Business case Project Management Monitoring/ controlling Closing Work breakdown structure Budget estimations Resource allocation Schedule Current state Transition state Change Management Focus: People side of moving from current state to future state Future state PM Process: Organizational: Preparing for change Managing change Reinforcing change Individual: ADKAR Tracking Tools: Individual change model Readiness assessment Communication plans Sponsor roadmaps Coaching plans Training plans Resistance management Reinforcement CM
Connecting Change Management to Business Results 25 Project Name Purpose Particulars People What is the project? Why we are changing? What we are changing? Who will be changing? What does this look like for your project?
Value of Effective Change Management 26 Increase Probability of Success Manage Employee Resistance to Change Capture the People Dependent ROI Build Change Competency into the Organization
27 What are key contributors to successful change initiatives?
28 Top Contributors to Success 1. Active and visible executive sponsorship 5. Employee engagement and participation 2. Structured change management approach 6. Frequent and open communication 3. Dedicated change management resources 7. Engagement with middle managers 4. Integration and engagement with project management
29 What are obstacles to successful change initiatives?
30 Top Obstacles to Success 1. Lack of active and visible sponsorship 4. Employee resistance 2. Lack of change management resourcing 5. Lack of buy-in from project teams 3. Manager and supervisor resistance
31 What to Do Differently Next Time? More Communication Communicate with more people at all levels Include face to face Increase relevancy Communicate Earlier Connect with the project sooner Begin in-person meetings earlier Better Communication Strategy Using succinct, consistent and an accurate set of core messages Include a robust implementation plan More Attention to Senior Leadership Evoke more support and ownership from senior leaders More Dedicated People Working on Communications Assign expert resources to producing and implementing communications *Combined results from 2009, 2011 and 2013
32 Tools for Mitigating Resistance to Change
The Five Building Blocks for Successful Change A Awareness D Desire K Knowledge A Ability R Reinforcement
The Five Building Blocks for Successful Change Change Begins with Understanding Why Awareness What is the nature of the change? Why is the change needed? What is the risk of not changing?
The Five Building Blocks for Successful Change Change Involves Personal Decisions Desire What s in it for me (WIIFM)? A personal choice A decision to engage and participate
The Five Building Blocks for Successful Change Change Requires Knowing How Knowledge Understanding how to change Training on new processes and tools Learning new skills
The Five Building Blocks for Successful Change Change Requires Action in the Right Direction Ability The demonstrated capability to implement the change Achievement of the desired change in performance or behavior
The Five Building Blocks for Successful Change Change Must Be Reinforced to Be Sustained Reinforcement Actions that increase the likelihood that a change will be continued Recognition and rewards that sustain the change
39 The Five Building Blocks for Successful Change Awareness What is the nature of the change? Why is the change needed? What is the risk of not changing? Desire What s in it for me (WIIFM)? A personal choice A decision to engage and participate Reinforcement Knowledge Understanding how to change Training on new processes and tools Learning new skills Actions that increase the likelihood that a change will be continued Recognition and rewards that sustain the change Ability Achievement of the desired change in performance or behavior The demonstrated capability to implement the change
40 The Consequences of Not Managing Change Without Awareness and Desire you will see: Employees asking the same questions over and over Lower productivity & higher turnover Hoarding of resources and information Delays in implementation Without Knowledge and Ability you will see: Lower utilization or incorrect usage of new systems Employees worry whether they can be successful in the future Greater impact on customers and partners Sustained reduction in productivity Without Reinforcement you will see: Employees revert back to old ways of doing work Ultimate utilization is less than anticipated The organization creates a history of poorly managed change
41 Diagnosing Gaps with ADKAR ADKAR describes the building blocks and sequence for successful change When changes are failing, ADKAR can be used to identify which element is the root cause for the change not being successful
Individual Change Management Outcomes When you create: You hear: A Awareness I understand why D Desire I have decided to K Knowledge I know how to A Ability I am able to R Reinforcement I will continue to
43 Organizational Change Management Five levers for organizational change management Communication Sponsorship Coaching Training Resistance management Using the right tools, you can move the organization through ADKAR You can t train desire You can t communicate ability
Relationship of Change Management Activities to ADKAR Who? ADKAR Elements The most influential players How? The most effective activities 44 A Awareness of the need for change Sponsors Sponsorship, Coaching, Communication D Desire to support and participate in the change Sponsors, Sponsor coalition, Direct supervisors Sponsorship, Coaching, Resistance management K Knowledge of how to change Project team, Training team, Human Resources Training, Coaching A Ability to implement required skills and behaviors Direct supervisors, Project team, Human Resources, Training team Training, Coaching R Reinforcement to sustain the change Sponsors, Direct supervisors Sponsorship, Coaching
Assessing the results of change management activities 45 ADKAR phases of change Change management levers Assessing results (examples) Awareness Communication Employee feedback Desire Sponsorship Supervisor feedback Knowledge Training Training feedback Ability Coaching Performance feedback Reinforcement Resistance management Audits and compliance 6/3/16
Mapping Change Management Activities to MHVC Workforce Tools 46 Change management levers MHVC Workforce Tools and Resources Communication Workforce Communication and Engagement Toolkit for Managers Workforce meetings with partners Sponsorship Leadership Steering Committee Workforce Transformation Subcommittee Project workgroups Coaching Training Resistance Management Change management cohort Workforce meetings with partners Learner Central Change Management Practitioner Certification Change management cohort Supporting partners with internal initiatives Workforce meetings with partners
ADKAR Green Hotel Case Study 47
48 Hotel Towel ADKAR 6 5 4 3 2 1 0 A D K A R Series 1
Activity Business Change Assessment 49
50 The Change: Integrating Primary Care into BH Settings
51 ADKAR: How do you rank? 1 2 3 4 5
Score your ADKAR 52
What does your ADKAR profile look like? 53 6 5 4 3 2 1 0 A D K A R
54 What are Barrier Points? 54 The first score of 3 or less in the ADKAR model is referred to as the barrier point to change. The barrier point must be the first area addressed in order for change to be successful. 6 5 4 3 2 1 0 A D K A R Determine where the ADKAR focus is needed Create an Action Plan to alleviate the barrier point
Barrier Point Action Plan 55 Barrier Point Action Steps (examples) Awareness Desire Knowledge Ability Reinforcement Review communication plans at all levels within the organization, Make sure to reach target audiences, Engage direct supervisors ( middle managers ) What s In It For Me (WIIFM), Communicate the personal consequences of not changing Identify gaps, Focus on education and training Allow time to develop new skills and behaviors, Provide ongoing coaching and support, new measures and expectations for performance should be clearly defined and communicated to everyone Ensure that support systems are in place to keep people from reverting back to old behaviors, Implement reward systems that reinforce the change
56 Return on Investment (ROI) of Change Management
Why does actual ROI differ from expected ROI? 57 High Changes that have no people change have high certainty in the expected ROI Certainty of expected ROI or benefit from change Changes that are highly dependent on people change have low certainty Low Low High Amount of change to how people do their jobs people change
58 Change Management and Uncertainty Certainty of expected ROI Effective change management allows you to decrease the uncertainty associated with changes that impact how people do their jobs improving the ROI of your projects that impact people Amount of change to how people do their jobs people change
59 ROI of change management model For any given organizational change, there are three human factors that impact the amount of expected improvement from a solution: Factor 1 Speed of adoption Factor 2 Ultimate utilization Factor 3 Proficiency These are realities of a project s implementation They define and constrain the value a project delivers
The Human Factors that Determine the Financial Return or ROI 60 Speed of Adoption Ultimate Utilization Proficiency How quickly are people up and running on the new systems, processes and job roles? How many employees (of the total population) are demonstrating buy-in and are using the new solution? How well are individuals performing compared to the level expected in the design of the change?
61 Factor 1 Speed of adoption Expected (baseline) Based on explicit or implicit assumptions Project implementation phase and plan Phased roll out? Actual How quickly people get on board Passive resistance Active resistance Through effective communication and project launch Through sponsorship and coaching
62 Factor 2 Ultimate utilization Expected (baseline) Perhaps implicitly assumed 100% May have done scenario analysis Participation Actual How many people opt out of new way Can result in any breakdown of ADKAR Reinforcement and resistance management play big roles
63 Factor 3 Proficiency Expected (baseline) Assumed ongoing improvement from the solution Comes as a result of new processes, interactions with technology, behaviors, structures, etc. Actual Determined by competence of each individual who is doing their job a new way Can be reduced as a result of resistance
64 Financial Correlation Conclusion Understanding the expected financial return of a project, you can begin to asses the project dependency on three human factors to help determine the likelihood achieving that expected financial return Speed of Adoption Ultimate Utilization Proficiency Each human factor will impact the financial return realized. With no change management, the likelihood of achieving ultimate utilization, speed of adoption and proficiency expectations tied to financial return goes down significantly.
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Data Supports the Connection Percent of Study Participants Who Were On or Below Budget 66 81% 70% 62% 48% (n=356) (n=1054) (n=1434) (n=267) Prosci 2016 Benchmarking Data Date from 2007, 2009, 2011, 2013, 2015
Data Supports the Connection Percent of Study Participants Who Were On or Ahead of Schedule 67 71% 52% 32% 14% Prosci 2016 Benchmarking Data Date from 2007, 2009, 2011, 2013, 2015
68 Correlation Conclusion Research supports the connection: Better change management means better realization of benefits Of the 245 research participants who reported having excellent change management effectiveness, 94% met or exceeded project objectives Start collecting your own data on your own projects: Define success metrics (what are the benefits you are trying to achieve? Measure for benefits realized Measure for change management effectiveness on each project
69 Thank You! Questions?