Post on 05-Dec-2014
description
transcript
Leadership Action
Required to Enact
Change
By:
Barbara Julian Garner
July 12, 2013
Barbara Julian Garner 1
Nature and Background of Issues
• Chapter 1:
Barbara Julian Garner 2
Nature and Background of Issues
• Introduction
– Interest in topic
– Definition of terms
• Nature of the Issue:
– Many changes being implemented at Preston Memorial for
all employees
– Non-Clinical employees were being asked to interact with
patients within the clinical setting
Barbara Julian Garner 3
Nature and Background of Issues
• Internal Stakeholders: – Non-Clinical employees
– Clinical employees
– Hospital leadership
– Staff physicians
• External Stakeholders – Patients
– Patients’ family members
– Community at large
– Accrediting Boards
• The Joint Commission
• Medicare
Barbara Julian Garner 4
Nature and Background of Issues
• Issue Background & Context: Examination of the
Beginning of a Cultural Change
– Patient-Centered Care Model
– Six Pillars of Excellence & the No Pass Zone (Studer 2003)
Barbara Julian Garner 5
Pupose of the Study
– Identify challenges to hospital leadership during a
change process at Preston Memorial Hospital
Barbara Julian Garner 6
Research Questions
1. If there were leadership challenges in executing
this cultural change, especially in regards to non-
clinical employees, what were they and why did
these challenges arise?
2. If there were issues with the implementation of
this cultural change, especially in regards to non-
clinical employees, what were the leader lessons
learned?
Barbara Julian Garner 7
Literature Review
• Chapter 2:
Barbara Julian Garner 8
Literature Review
• Chapter 2:
• Leadership Role in Change Management
– Kotter (2007)
– Hiatt (2006)
– Luecke (2003)
– Randall (2004)
• Leadership & Employees Shared Role: Teaming
– Edmondson (2012)
– Ul-Bien & Ospina (2012)
Barbara Julian Garner 9
Literature Review
• Chapter 2:
• Preparation for Change: Dudink & Berge (2006)
Duncan, R.D. (2012)
Hiatt, J.M. (2012)
Kotter, J. (2012)
• Importance of Teamwork Edmondson, A. (2012)
• Engagement of Employees Galunic & Hermreck (2012)
• Barriers to Change Shaller (2007)
Barbara Julian Garner 10
Methodology
• Chapter 3:
Barbara Julian Garner 11
Research Desgin
Barbara Julian Garner 12
Embedded Case Analysis 1
• Non-Clinical Employees
Embedded Case Analysis 2
• Clinical Employees
Embedded Case Analysis 3
• Hospital Leadership
Context of Single Case: The Change Process Related to
Implementing a Patient-Centered Care Model
Research Design: Single Case Embedded Design (Based on Yin 2009)
The Three Embedded Areas of Analysis Reviewed for the Change Process
Single Case Study with Embedded Design
• Case Study: – Allowed the use of varied methods and dives into people’s behaviors
– The interest in the process—How things work and why
– Provided understanding of a program or event of an organization
– Provided understanding to a complex issue
– Added breadth and depth to data collection and assisted in bringing data
together from multiple sources (Yin, 2009)
• Embedded Design: – Allowed for the investigation into non-clinical, clinical, and leadership
employees in the changes related to implementing a patient-centered care
model
Barbara Julian Garner 13
Method
• Explanatory Mixed Method
– Quantitative/Qualitative
• Surveys: Quantitative
• Open ended interviews: Qualitative
• In what ways do the qualitative data help explain the
quantitative method?
Barbara Julian Garner 14
Validity & Reliability
The following procedure was recommended by Creswell (2009)
– 3 peers reviewed inputted data for accuracy
– 2 doctorally prepared professionals were consulted to
expand or deny themes
– Validity was achieved by sending the interviews back to the
interviewees for verification
– Average length of the interviews were 45 minutes
Barbara Julian Garner 15
Data Collection
• Surveys were distributed by the Community Development Director
• Surveys returned in sealed envelopes without any personal
identification. Colored coded for either Non-Clinical, Clinical, or
Leadership
• Interviews were conducted in the researcher’s office
• All questions were answered and interviewees were at ease
• Consent form was explained to and signed by participants
• Audiotaped
• Transcribed
• Transcripts verified by participant
• Themes analysis verified by 3 other reseachers
Barbara Julian Garner 16
Data Processing & Analysis
– Survey data were calculated and bar graphs were used to present data
– Data were used to provide focus for interviews
– Individual verified transcript was read
– In the analysis themes were identified
– Themes were then re-examined for patterns common to all 3 groups
Barbara Julian Garner 17
Data Processing & Analysis
• Rigor
• Ethics
• Limitations
• Delimitations
Barbara Julian Garner 18
Results
• Chapter 4:
Barbara Julian Garner 19
Survey Distribution & Returns
• Total Surveys Distributed
– 105 Non-Clinical Surveys
– 141 Clinical Surveys
– 6 Leadership Surveys
• Total Surveys Returned
– 49 Non-Clinical Surveys
– 60 Clinical Surveys
– 3 Leadership Surveys
• A Likert Scale was used for each question with room for
comments at the end of the survey
Barbara Julian Garner 20
Survey Analysis
• Survey Analysis
– A simple percentage was used
– If a 50% or higher of respondents disagreed or strongly disagreed with
the question, that topic was expanded on in the interview questions.
– Each group’s survey contained a comment section
• Some survey questions did not add to the understanding of the
issues and were not used in the interviews. These can be found
in Appendix F
• The data collected were used to answer research questions
Barbara Julian Garner 21
Survey Results
Barbara Julian Garner 22
86%
91%
75%
80%
85%
90%
95%
100%
Non-Clinical Clinical
Percen
tag
e
N=109 Respondents Agree or Strongly Agree
I Understand the Need for the Six Pillars of Excellence
Survey Results
Barbara Julian Garner 23
82%
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
N=49 Non-Clinical Agree or Strongly Agree
I Support the No Pass Zone
Survey Results
Barbara Julian Garner 24
68%
100%
0%
20%
40%
60%
80%
100%
120%
Non-Clinical Staff Leadership
PE
RC
EN
TA
GE
N=52 RESPONSES OF DISAGREE & STRONGLY DISAGREE
Non-Clinical Employees Feel Comfortable Entering a
Patient's Room
Survey Results
Barbara Julian Garner 25
Survey Comments
• Constant Positive Themes
– PMH Employees supported the changes that were implemented
– PMH Employees understood the changes
• Constant Negative Themes
– Preparing employees for the changes
– Addressing the fear of employees with the changes
Barbara Julian Garner 26
Interview Information
• Interviews were voluntary and offered to all employees
• Interview Participants:
– 6 Non-Clinical Employees
– 5 Clinical Employees
– 3 Leadership
Barbara Julian Garner 27
Research Questions & Discoveries
1. Part A: If there were leadership challenges in executing
this cultural change, especially in regards to non-clinical
employees, what were they?
– Preparation for changes
– Feeling a part of the change
– Lack of engagement
– Communication about the changes
– Fear of the unknown
Barbara Julian Garner 28
Common Themes
Barbara Julian Garner 29
Preparation for the Changes -
13
Inclusiveness in the Change
Process 12
Explanation for the Lack of Engagement - 11
Communication on changes being implemented - 10
Fear of the Unknown - 9
0 2 4 6 8 10 12 14
1
Coded Interviews - Common Themes
Other Issues
Barbara Julian Garner 30
Employee/Patient Safety 2
Patient Acceptance and
Training - 2
Improved Employee
Identification 1
0 0.5 1 1.5 2 2.5
Coded Interviews - Other Issues
Employee Identification Patient Acceptance Patient Safety
Interview Findings
• Fear of the Unknown:
NC1 explored the idea that the fear for the non-clinical employee was how that
patient feels about a non-clinical employee coming into his/her room: NC1
imagined wondering “What are you [non-clinical employee] doing in my room
if you can’t help me and why are you in my room?”
C5 stated: “It is kind of the fear of the unknown…I think that the non-clinical
staff does have some issues with the No Pass Zone because they don’t know
and they are scared.”
Barbara Julian Garner 31
Interview Findings
• Communication About The Changes:
NC6 explained the idea of a breakdown in communication as follows: “There
was not only a breakdown in communication between leadership and non-
clinical employees, but there was also a breakdown in communication within
the leadership team. The leadership team was not on the same page and there
was a conflict between them on how all the changes were presented… I was in
the room when this was all presented and you could feel the tension in the
room… There is a communication breakdown that we continue to have
problems with. It is the expectations of people, and again I have said since the
day I got here; the expectations for clinical and non-clinical need to be clearly
defined and they are not. They are blurred and merged.”
Barbara Julian Garner 32
Interview Findings
Avoidance of the No Pass Zone:
11 of the 14 interviewees admitted to avoiding the patient care
area so as not to engage in the process.
Barbara Julian Garner 33
Interview Findings
• Lack of Inclusiveness:
NC3 stated: “I haven’t really been invited to give input or anything. That [being
asked] would be nice. ”
C4 stated: “I feel there is a separation of how much clinical and non-clinical employees
have been involved. Clinical, especially nursing, have been involved more than non-
clinical, and that is what I mean by a separation. ”
Barbara Julian Garner 34
Interview Findings
• Preparedness
NC3 stated: “It is intimidating if you are non-clinical because you don’t know what to
do… I wouldn’t know where to go to look for a nurse… Are they at the nurse’s
station?”
C1explained that clinical employees who are not on the patient care floor also need
training: “We could have done a better job preparing our people. I couldn’t tell you
where the call light is…I know how to do a certain procedure, but I just don’t know
how to get in and out of the room.”
HL1 felt more training needed to be done with both clinical and non-clinical
employees: “I think they [all employees] know bits and pieces, but I am not sure they
know how to put it all together. They can regurgitate the information but they can’t
connect the dots. I think both clinical and non-clinical employees need more training
on all the changes we are asking them to make.”
Barbara Julian Garner 35
Research Questions & Discoveries
1. Part B: Why did these challenges arise?
- Failure to communicate the changes being implemented
- Lack of preparation of employees for the changes
HL3 commented on the survey: “I don’t think we did a very good job with many
things in [with] the No Pass Zone…We did not explain the importance of non-clinical
staff in answering a patient call light…We did not prepare or train them[non-clinical
employees] on what to do. We just told them what to do and to do it.”
Although leadership realized they did not communicate or prepare the non-clinical
employees they did not identify a reason why.
Barbara Julian Garner 36
Research Question & Discoveries
2. If there were issues with the implementation of this cultural change
especially in regards to non-clinical employees, what were the lessons
learned?
- Lack of preparedness of the employees for the changes
- Inclusivity of employees in the change process
- Communication of the change process
- Better framing of the Six Pillars of Excellence as an over arching theme
NC 32: “ There should be more information given to non-clinical employees about
A-I-D-E-T and the 6 Pillars [of Excellence].” From Survey
C15: “I feel that managers need to review A-I-D-E-T with employees and potentially
do some role playing to help non-clinical employees feel comfortable using it.”
NC4: “Maybe we could have been given examples or scenarios that would have helped
us to understand what we need to do.”
Barbara Julian Garner 37
Conclusions & Recommendations
• Chapter 5:
Barbara Julian Garner 38
Results & Findings Summary
• Non-clinical employees supported the No Pass Zone in
theory but not practice.
• Non-clinical and clinical employees understood the need
for the Six Pillars of Excellence.
• Non-clinical employees did not feel prepared for the No
Pass Zone.
• Non-clinical employees stated they were afraid to enter a
patient’s room.
• Non-clinical employees felt a lack of inclusiveness with the
changes.
Barbara Julian Garner 39
Recommendations for PMH Leadership
• Overall Plan for PMH for Future Change
– Understand the rationale for preparedness of those involved in a
change process
– Create a clear vision and common direction
– Provide the preparedness needed for employees to make the change
– Communicate the change and involve people in the process
– Assign or hire a change agent to oversee any profound change projects
• Example New Hospital Building Project
Barbara Julian Garner 40
Leadership Actions Arose During this Study
– Implementation of a pilot hospital wide shadowing program.
– Internal electronic employee engagement survey distributed to all PMH
employees on the changes being asked of them. Survey data is still
being gathered.
– Hospital leadership have started to visit NEO to explain the 6 Pillars of
Excellence.
– A LEAN Project is being developed for identification of infectious
rooms: This training will be for all employees. This researcher has
been asked to be a member of the LEAN Project Team.
Barbara Julian Garner 41
Recommendations for Future Studies
– Do patients want non-clinical employees coming into their
rooms?
– When you ask non-clinical employees to interact with
patients in a clinical care setting how does this impact
employee and patient safety?
– Will patient satisfaction scores improve or decline due to
non-clinical patient interaction in a clinical care setting?
Barbara Julian Garner 42
Contribution to the Theory & Practice of Leadership
The 7 Elements of Organizational Change
Barbara Julian Garner 43
Based on Randall 2004, p.38
Analyze the Organization & Its Need for Change
Create A Shared Vision and Common Direction
Create A Sense of Urgency
Support a Strong Leader Role
Craft an Implementation Plan
Communicate and Involve People
Reinforce & Institutionalize Change
Contribution to the Theory & Practice of Leadership
– Organizational side of change
– Kotter’s Eight Stage Change Model 2002
• Establish a sense of urgency: Inspire people to move
• Build the guiding team
• Get the vision right
• Communicate for buy in
• Empower action
• Create short term wins
• Don’t let up
• Make the change stick
– Prepare employees for the change
– Communicate and involve people
– Create a shared vision and common cirection
Barbara Julian Garner 44
Contribution to the Theory & Practice of Leadership
– The People Side of Change
• It is people who change not organizations
• Successful change occurs when the individual’s change matches the stages of
organizational change (Hiatt 2006)
– The Fear Involved with Change
• Fear of not having the ability to make the change
• Fear that the change will fail
• Fear that the change is inconsistent with his or her values
• Fear that the risks of change outweigh the benefits
• Fear that the change is going to make their jobs more difficult
• Fear that those who are responsible for the change can’t be trusted (Kotter 2002)
Barbara Julian Garner 45
Self Evaluation: A Tool for Future Research
– Being an employee in the organization was a plus and a minus.
– I wish I would have drilled down on some questions. Example: When
leadership failed to give reasons for their admitted failure to
communicate, I wish I would have asked why.
– The importance of asking for recommendations on surveys and in
interviews.
– Employees felt comfortable and safe for interviews. Had minimal
issues with obtaining volunteers.
– Had to constantly remind self not to lead the interviewees and at times
got off track and was too chatty.
Barbara Julian Garner 46
Acknowledgements
My Committee:
Dr. John Barnette
Dr. John Sidor
Dr. Ruth Panepinto
Dr. Kathleen Jackson
DEL Cohort WV01
– David -Bill
– Kathleen -Kimberly
– Stephanie -Dena
Dedicated to my parents:
John & Rose Abruzzino Julian
Barbara Julian Garner 47
Questions & Comments
Barbara Julian Garner 48