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Introduction to Health Care
Homes Webinar Series
Session 3:
Change Management and Creating an Action Plan
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Presenter
Danette Holznagel, RN, CDE, FCN
HCH Planner, MDH
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Objectives
• The participant will be able to describe the basic
principles in change management theory.
• The participant will be able to give examples of technical
and adaptive change in the heath care environment.
• The participant will name at least one strategy to support
a care team in their process of change management.
• The participant will identify the steps to making an action
plan in the Health Care Home certification process.
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Agenda
• Change Management Basics
• Roadmap to Change
• Creating an Action Plan for HCH Implementation
• Q&A
• Wrap Up
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Change Management
Basics
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Leading and Managing Change
Consider:
• Technical and Adaptive change
• Predictability of change
• Skills, behaviors, beliefs, and habits
• Build a case for change
• Understand how to plan, implement, and manage change
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Change Theory
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The Non-Linear Nature of Change
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Understanding Culture Change
Technical
Personal (Adaptive)
• Changes in process,
• Changes in behaviors,
procedures, tools (EMR)
• Requires application of
capabilities that already exist in
the system
• Sustainability
attitudes, and habits
• Need to learn new capabilities
(knowledge, skills) deeply and
broadly
• Sustainability
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Technical Change = Process Improvement
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How Does Change Affect People?
• All change is personal.
• Is there resistance and opposition or is there motivation
•
•
•
•
•
and energy?
Areas to consider:
Resistance and opposition
Motivation and energy
Acceptance
Ambivalence
For things to change, someone somewhere has to
start acting differently.
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Personal Change = Transitions
• Escaping the gravitational pull of status quo
• Surviving the emotional roller coaster of transition
• Creating a change enabling structure
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Status Quo
The pace of change
• Faster – they can influence the change
• Slower – tend to become victims of the change
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Essence of Transitions
Transition is a journey.
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What about resistance?
• Resistance occurs because people are being asked to:
• Change habits, behaviors, beliefs
• Experience loss and uncertainty
• Resistance is a natural, inevitable response, whether the change is
positive or negative.
• Resistance is a process and must be managed – not combated,
solved, or overcome.
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A Change Enabling Structure = Change Management
• Build a case for change
• Foster the understanding of change
• Clarify your expectations
• Anticipate some “change pain”
• Surface resistance early and
constructively
• Celebrate your efforts!
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The Change Roadmap
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The Change Roadmap: Five Key Questions
1. What is the change?
2. How do we organize to manage (lead/support) this
change?
3. Who (and what) will be affected by the change, and
how?
4. What are the supports needed from here to there?
5. How do we navigate along the way?
Identify the change
• Select a change project
• Define the change
• Where do we want to be?
(behaviors, habits, skills)
• Where are we now? (current
state)
• What is the gap? What
needs to be done to get to
the future state?
• Build the measures from
the driving factors and the
triggers supported by the
philosophy.
Build a Case for Change
• Answer these 3 questions
• What is changing?
• What are the benefits of changing?
• What are the costs of not being successful at this change?
• Create a case for the change, from an organizational
perspective, then customize for each level.
• CASCADE the business case
Organize to manage change
• Establish key change roles
and change management
infrastructure
• Assess readiness for
change
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Cast of Characters
The Impact of Change
• Determine the impact of the change:
• On the work
• On the people
• On the formal and informal organizational structures
• Consider:
• What is affected?
• To what extent?
Leverage the change
• Identify the support needed:
• Communication
• Education/Training
• Reinforcement (Recognition and Rewards)
• Personal Support
Communication in the midst of change
• Provide individuals with information they need:
• Awareness
• Knowledge
• Action
• Engage the “heart” (stories)
• Engagement /feedback
Support systems to sustain the change
• Training Strategies
• Knowledge, skills, tools for success
• Nurture until outcomes achieved
• Reinforcement Strategies
• Recognition and Rewards
• Personal Support
• Stages of transition
• Resistance
• Make it easy to do the “right” things and hard to do the “wrong”
things
Navigate the change path
• Utilize business case to motivate and provide sense of urgency
• Identify a clear, commonly held vision of the present state and the
future state
• Use the identified structures, roles, reinforcements, and
measurement system to manage the change
• Celebrate milestones!
MP05
How Will We Navigate Along the Way?
(Continued)
• Ask, “What are we learning from our experiences?”
• Use to understand and modify behaviors, habits,
outcomes
• Questions to guide learning:
• What did we set out to do? (Outcome or goal)
• What did we expect would happen? Why?
• What actually happened? Why?
• What did we learn?
Implementation: Critical Success Factors
Resource List
Switch - How to Change Things When Change is Hard
By Dan and Chip Heath Broadway Books, 2010
Influencer - The Power to Change Anything
By Kerry Paterson, et.al, McGraw Hill, 2008
Leadership on the Line
By Ronald A Heifetz and Marty Linsky, Harvard Business School Press,
2002
Organizational Change: Theory and Practice
By W. Warner Burke, Sage Publications, 2008
Managing Transitions
By William Bridges, Da Capo Press, 2003
The Transtheoretical model of health behavior change
Prochaska, JO; Velicer, WFAm J Health Promot 1997 Sep–Oct;12(1):38–48.
Motivational Interviewing, Third Edition: Helping People Change
Miller William R., Rollnick S 2013 Guilard Press
Model for Improvement: http://www.ihi.org/Pages/default.aspx
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Creating an Action Plan
for HCH Implementation
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Creating an Action Plan for HCH
Implementation
points
1.
Conduct a gap analysis using the HCH certification selfassessment tool.
• Break the tool into standards and evaluate each criteria
• Keep in mind that innovation is our transformation goal and the HCH
standards/criteria are a road map
• There are many ways to show and verify that you have implemented the
standard/criteria.
2.
Identify key people that should be involved in the implementation
and transformation.
• Don’t forget a new source of energy = your patients
3.
Review your HCH self-assessment results with your team.
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Creating an Action Plan- Links
• http://www.health.state.mn.us/healthreform/homes/certification/index.html
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Creating an Action Plan-Assess
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Creating an Action Plan-the standards
4.
Discuss differences and similarities between the intent of the
standards/criteria
*portal screen print
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Creating an Action Plan
5. Identify gaps in performance - look at your gaps and
brainstorm:
• Opportunities
• Barriers and challenges
• What can we do to overcome the barriers?
• What are the steps to get there?
• Who needs to “buy in” and how do we get them onboard?
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Creating an Action Plan- Process
6.
Small Steps
7.
Ask the questions that anticipate the challenges?
• pushback?
• (low-hanging fruit)?
• What do we already have in place?
• Tools/Technology?
• Cost?
• Other competing initiatives/work?
• Education?
• Training?
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Creating an Action Plan-Actionable Goals
8.
Agree to a goal, or a few goals, to get started. Take measureable,
achievable steps.
9.
Agree on your achievable and ideal state.
10. Start a list of action items
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Creating an Action Plan -Communication
11. Report findings to the group, then post the plan!
12. Re-visit your Action Plan at intervals to evaluate progress and set
new goals.
13. Celebrate those small steps of change along the way!
14. Update your certification assessment tool along the way too!
Questions?
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Introduction to Health Care Homes
Webinar Series Schedule
Webinar
Topic
Date
1
The Business Case for HCH
Overview of HCH standards
August 1, 2013
2
Patient- and Family-Centered Care
August 29, 2013
3
Change Management
September 26, 2013
Getting Started on HCH Implementation
4
Quality Improvement
Engaging in Culture Change
October 31, 2013