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Managing TransitionsManaging TransitionsHelping your People to Support ChangeHelping your People to Support Change
Demi Haffenreffer, RN , MBAHaffenreffer and Associates, Inc.www.consultdemi.net
Today’s TopicsToday’s TopicsChange
◦What is possible & is it necessary?Transition
◦The three stagesYour role in leading and
supporting your staff◦Some Baldrige leadership criteria
Assessing your transition readiness
Exercises and case studies
Some questions for you to Some questions for you to discussdiscuss
How is your current CQI program operationalized?◦What are your key measures?◦What is your staff’s understanding of
Quality?◦How are they measured?◦Are your measurements based on
regulatory compliance?◦How and when are they analyzed?◦Who develops and implements QI plans?◦What are your results?
What is your current change project?
The present and the The present and the futurefuture CQI program is
primarily involved in auditing
Staff fear CQI audits
Structured activities Facility belongs to staff Organizational charts Staff make all decisions
for residents Task oriented jobs Nurse is the boss
CQI program is based on root cause analysis that assists in identifying if a problem exists; the cause; and strengths.
Staff are excited by opportunities to improve – no fear – no failure – only feedback
Spontaneous activities Facility is home to res. Flattened structure Residents/families make
decisions Care delivered to res.
needs & desires Team work – nurse is a
consultant
The present and the The present and the futurefuture Staff float Nighttime care includes
every two hour rounds Restrict mobility – keep
safe Tray service All meals at set hours Surveyor job is to
determine compliance Follow OBRA rules to
pass survey Make decisions based on
fear of citations Residents who have died
are hidden & rushed out
Consistent assignments Residents sleeps until they
wake up Keep me safe – let me
move Dining Staff/residents can make
meals & choose when to eat
Risk is part of life – no one has all the answers
Use OBRA to create autonomy & independence
Make decisions based on resident need & desire
All staff/residents are given opportunity to mourn the death of a resident
WE ARE THE PROBLEM!!WE ARE THE PROBLEM!!
“When people who are actually creating a system start to see
themselves as the source of their problems, they invariably
discover new capacity to create results they truly desire.”
PresenceSenge, Scharmer, Jaworski &
Flowers
“In order for change we need to
connectmore
with OURSELVES
& leave our other
selves behind.”
Demi Haffenreffer
TransitionTransition1. Passage from one form, state,
style, or place to another.2. A transition or change, as to a
spiritual existence at death3. Differs from change
1. Change focuses on outcomes – transition is a process
2. More people focused3. Transition’s starting point is the ending
– focuses not on the change but on the letting go of the old reality before the change took place
StagesStagesLetting go of the old ways and
the old identity people hadGoing through an in-between
time when the old is gone but the new is not fully operational – “neutral zone”
Coming out of the transition and making a new beginning – this is when change occurs
Helping your peopleHelping your people
You change first!Plan & organizeHelp them to let go – manage the
endingsLead them through the neutral
zoneLaunch the new beginning
You Change First - You Change First - LeadershipLeadership
“Let him that would move the world, first
move himself”
Socrates
Become Self-AwareBecome Self-AwareDiscover SelfBecome a real human being
◦Do your people know who you are?Discover your world viewWhat’s in your briefcase?Test your integrityMatching your vision / values
with that of your organization
Leading - PlanningLeading - PlanningWho are your leaders?How do they lead?What behaviors & attitudes will need
to change?Who will lose what under the new
system?Talk to them – involve staff at all levelsTeach your leaders about transitionVisit other organizationsWho are your champions?Where is your commitment &
motivation?
Case StudyCase StudyNew Heights Rehab. Facility decided to
flatten its organizational structure by developing self-led process improvement teams; self-scheduling; & renamed all positions. Policy and Procedure manuals were updated; staff trained; & the program implemented one month ago. The purpose of this change was to implement other person-centered measures. You have been hired to assist with this implementation.
What will you do?What will you do? Explain the changes in posted
memos Get to know employees & figure
out how behaviors & attitudes will affect the change
Analyze who will loose what Redo the compensation package Sell the change Change the environment Create a slogan & a logo Train teams in conflict resolution
& how to be team members If this system does not seem be
working be ready to change it and implement another.
Bring in a motivational speaker Provide them with info on pros &
cons of new system Plan ceremonies and
celebrations
Talk to individuals about the transition and what it does to people
Develop teams – plan social events
Rewrite job descriptions Visit other organizations who
have done something similar Break the change into smaller
stages Pull the best people together as a
model team to show everyone else how to do it
Change individual targets to team targets & give bonuses
Appoint a change manager Design temporary systems Create a disciplining system Get rid of the individual
sabotagers Set up a hot-line
Help them to let goHelp them to let goTeam meetings – give information
◦ “You can’t quarterback from the stands” – Nancy Fox
Losses◦ Accept the importance of losses◦ Expect overreaction◦ Acknowledge losses◦ Expect grieving
Compensate for lossesDefine what is over and what is notTreat the past with respectLet them take a piece of the old with themShow how endings ensures continuity of
what really matters – expect the best
Leading them through theLeading them through the“Neutral Zone”“Neutral Zone”
“When we’re learning something new, we can feel awkward, incompetent,
and even foolish. It’s easy to convince ourselves that it’s really
not so important after all to incorporate the new – so we give
up.”Presence
Senge, Scharmer, Jaworski & Flowers
ProblemsProblemsAnxiety increases and motivation
fallsIncreased absenteeism –
decreased productivityOld problems get worseMixed signals and messagesPeople become polarizedSabotage
What will you do?What will you do?
It has been two months since the change at New Heights; absenteeism is up; a number of errors have occurred in care and services; some of the old ways have crept back in; groups are starting to form & managers are maintaining their old ties; communication is declining; the new system is failing and teams want to go back to the old organizational structure.
What will you do?What will you do? Explain the changes in posted
memos Get to know employees & figure
out how behaviors & attitudes will affect the change
Analyze who will loose what Redo the compensation package Sell the change Change the environment Create a slogan & a logo Train teams in conflict resolution
& how to be team members If this system does not seem be
working be ready to change it and implement another.
Bring in a motivational speaker Provide them with info on pros &
cons of new system Plan ceremonies & celebrations
Talk to individuals about the transition and what it does to people
Develop teams – plan social events Rewrite job descriptions Visit other organizations who have
done something similar Break the change into smaller
stages Pull the best people together as a
model team to show everyone else how to do it
Change individual targets to team targets & give bonuses
Appoint a change manager Design temporary systems Create a disciplining system Get rid of the individual sabotagers Set-up a hot line
SolutionsSolutionsInterventions – Intervene at these
points:◦Behavior◦ Justification for the behavior◦Cultural communications◦Hiring – members who “fit” the new culture◦Organizational culture as a whole◦Remove those who deviate from the culture
Normalize – Create slogansCreate temporary systemsStrengthen intragroup connectionsConsider a transition monitoring team
SolutionsSolutionsEncourage brainstorming of
solutions, experimentationSuspend your normal ways of
thinking
The New BeginningThe New Beginning
“Just because everything is different
doesn’t mean thatanything has changed!”
Irene Peter American
Writer
ExerciseExercise
1. Rearrange yourselves in groups according to your birth date month.
2. Rearrange yourselves according to your birthdates
The New BeginningThe New BeginningRemember not all are going through
these stages simultaneouslyRebuild and maintain trustClarify and communicate the purposeUnderstand that with CQI change is a
normal processCreate a Plan – Reinforce the new
◦Be consistent◦Ensure quick successes◦Symbolize the New Identity◦Celebrate
Assessing your Assessing your organization’s readiness for organization’s readiness for changechangeWhere are you today?
◦ How do individuals interact?◦ How are tasks accomplished?
Group norms (myths, rumors, stories)◦ Standards of behavior
Stated values and formal philosophies◦ In what ways does the organization
support these?Rules for getting alongOverall climate (calm, learning,
supportive, fear based, disorganization, someone is out to get us)
Assessing your Assessing your organization’s readiness for organization’s readiness for changechangeEmbedded skills
◦How to groups interrelate◦Special competencies◦Subcultures? Leaders within these
subcultures?Artifacts (dress, furnishings,
architectural, assigned parking, location of offices)◦Does the overall environment support
person-centered care?Who are the heroes/mentors
◦Who do staff look up to other than residents?
Other resourcesOther resourcesBridges, W. (2003). Managing
Transitions: Making the Most of Change. Cambridge, MA: Da Capo Press.
Dana, B. (2006). Developing a Quality Management System (2nd edition) - AHCA
Fox, N. (2007). The Journey of a Lifetime: Leadership Pathways to Culture Change in Long-Term Care. Eden Alternative.
Senge, P. M. et al (2004). Presence: An Exploration of Profound Change in People, Organizations, and Society. Random House: NY.