Organizational Transformation The Dynamics of Change

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Organizational TransformationThe Dynamics of
Change

• Gary R. LaBlance, Ph.D.
• Vice President
• St. Louis Childrens Hospital
• March 18, 2003

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• Most people are in favor of progress,
• its the change they dont like -
• Anonymous

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Delta Table of Revolutions Macro
Trends From To Employee Entrepreneur Career (job
for life) Short-term contracts (portfolio
careers) Career clarity Fog Rising income and
security Maintaining employability Promotions
based on not being dead Promotion based on the
added value you bring Education and
training Life-long learner Organizational
focus Customer/client focus Victim of
change Trend spotter Managing me incorporated
How to survive and thrive in the 21st
century. Ian Wilkinson, 1998
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Delta Table of Revolutions (continued) Health
Care Trends From To Hospital Community Curing
disease Maintaining health Disease -
oriented Population - health oriented Departments
Programs Limited data on effectiveness Outcomes
- based evaluating Supply oriented Demand
oriented (needs - based) Provider - based Client
- based Fragmentation of services Health care
continuum Measure expense Manage
expense Quality assurance Process
improvement Managing me incorporated How to
survive and thrive in the 21st century. Ian
Wilkinson, 1998
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• The times, they are changin
• HIPAA Work load
• Patient Safety Compensation
• Technology Work force
• Reimbursement Information overload
• Professional Autonomy Resources
• Costs

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• Every process is perfectly designed to achieve
  exactly the results it gets.
• Donald Berwick

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• Current systems of care cannot do the job.
  Trying harder will not work.
• IOM Roundtable
• Subcommittee on 21st Century Health System

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• Organizations need to continually reinvent
  themselves in response to an ever changing and
  continuously more complex environment.
• Joseph Bujak

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Approaches to Change Management

• Reactive
• Occur in response to external demands pressuring
  the organization often not planned less time to
  find a solution
• Proactive
• Based on the assumption that change is no longer
  elective, but a way of life future oriented
  staying attuned to the customer
• Susan Salmond

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St. Louis Childrens Hospital1994 - 2002

• Merged with BJC HealthCare
• Medicaid managed care
• Vertically integrated healthcare delivery and
  finance system
• Technology
• Union organizing
• Staff shortages
• New President, Vice Presidents
• Record high patient volumes
• Significant construction

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• Reengineering
• reorganize, restructure, and redesign work
  processes and job functions to bring about break
  through improvements in performance.

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• Reengineering
• We must do what we do
• better
• faster
• cheaper
• to assume market growth
• and financial stability.

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• First we shape our institutions then our
  institutions shape us.
• Winston Churchill

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Parts of all of us Sometimes we may act
like Sniff who sniffs out change early,
or Scurry who scurries into action, or Hem who
denies and resists change as he fears it will
lead to something worse, or Haw who learns to
adapt in time when he sees changing leads to
something better! Who moved my cheese? Spencer
Johnson, MD, 1998
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• Organizational Transformation -
• The empowerment of clinical and
  non-clinical staff to achieve and sustain
  exceptional clinical, operational, financial, and
  satisfaction outcomes by getting the right
  information to the right people at the right time
  so that the right, timely decision may be made
  for the patients and their families.

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• Organizational Transformation...
• People
• Process
• Technology

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Winning Strategies of Corporate StarsHeadhunters
Neff and Citrin found Americas top business
leaders share these six principles

• Live with integrity, lead by example
• Integrity builds the trust in senior
  management that is... critical for
  high-performing organizations.
• Develop a winning strategy or big idea
• A successful leader must go the companys
  roots and build on the things the organization
  truly does best.
• Build a great management team
• Great leaders hired managers whose skills and
  experiences complemented their own, but who
  passion, attitudes, and values were one and
  the same.

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Winning Strategies of Corporate StarsHeadhunters
Neff and Citrin found Americas top business
leaders share these six principles

• Inspire employees to greatness
• Communicate continuously, listen carefully,
  genuinely tolerate failure as a learning
  experience.
• Create a flexible, responsive organization
• The best leaders have redesigned their
  organizations to make sure decisions can be
  made fast.
• Use reinforcing management systems
• Compensation...must be consistent with and
  reinforce the values and strategy of the
  organization.

Business Week/November 15, 1999
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The Essential Components of Organizational
Transformation

• Mission
• Strategic plan
• Organizational alignment
• Me Incorporated
• Staff involvement
• Accountability
• Reward and recognition

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• Mission Statement
• Organization based
• vs
• Customer based

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• Do whats right for kids
• The first time - every time.

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• The best leadership frames the organizations
  mission and values in ways that members find
  transcendent the goals of the business are
  transmuted from the dross of ordinary work into
  higher goals that are worthy of heroic efforts
  and even sacrifices.
• Judith Bardwick

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• A focus on quality outcomes will ultimately lead
  to improved financial and operational performance.

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Organizational Structure
The first responsibility of a leader is to define
reality. The last is to say thank you. In
between, the leader is a servant. Max de Pree
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Strategic Plan

• Service and satisfaction
• Patient - reducing the hassle factor - staff
  satisfaction
• Clinical outcomes and processes
• Healthcare quality - patient safety, timeliness
  and coordination
• of care - effectiveness
• Operational efficiency
• Cost reduction - revenue enhancement
• Regulatory compliance
• CMS - State - JCAHO - Leapfrog - HIPAA
• Environment of care
• Technology - worker safety

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Strategic Plan

BJC Key Result Areas 5 year hospital goals Annual
hospital, division, and department goals Annual
employee goals
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Organizational alignment

• BJC Patient Care Committee of the Board of
  Trustees
• SLCH Quality Committee of the Board of Trustees
• Childrens Medical Executive Committee
• Financial Incentives
• Performance Appraisals

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Staff Involvement

A survey of senior executives showed that
although 90 stated that employees are their
companys most important resource, they ranked
strategies involving employees at the bottom of
their list. B.P. Noble
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• Everyone is President and CEO
• of Me Incorporated.
• Ian Wilkinson

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Core Competencies of Me Inc.

• Master the process of change
• Life-long learner
• Time lord
• People
• Communication
• Planning
• Economics
• Trend spotting
• Networking
• Ian Wilkinson

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Human Resource Strategies must focus on

• Recruitment, selection, and training must be tied
  to the future needs of the organization
• Personal and career development goals of each
  employee should be related to organizational
  goals.
• Strategic goals should be used to identify
  important dimensions of performance to measure.
• Rewards should be based on measured performance.
• Donald Davis

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Staff Involvement

• Communication
• Town hall meetings
• Employee open forums
• Childrens Chat
• Charting the Course
• BJC Scores website
• SLCH Score website

• Team based activities
• Department-based process improvement teams
• Quality Committee of the Board of Trustees
• SCORE reconnects
• Presentations/publications

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Accountability

• Job descriptions
• Performance appraisals
• Peer review - reconnects

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Reward and Recognition

• Presidents Award
• Quality Award
• BJC Today
• Travel to professional meetings
• Pizza parties
• Movie tickets
• Letter from President

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• The better people are at solving problems the
  more problems they find.
• Rosalie McDermott

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12 Principles of Organizational Transformation

• 1. Understand the external environment
• 2. Enlist peoples passion and energy to support
  your mission and strategy
• 3. While charismatic leadership may grab the
  headlines, it is steady and consistent leadership
  that actually results in change
• 4. To change an organizations culture, you must
  first change peoples behavior

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12 Principles of Organizational Transformation
(cont.)

• 5. Let service to customers drive your structure
• 6. If you implement the right processes to
  support people in their work, that will help
  create the climate of alignment you need for
  success
• 7. Managers must give employees what they need
  to succeed or, in some case, get out of the way
• 8. Teamwork is essential to success

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12 Principles of Organizational Transformation
(cont.)

• 9. A productive employee is a happy employee -
  not the other way around
• 10. Strive for a good fit between the skills
  people have and the every day jobs they do
• 11. Employees are people too
• 12. Beware of the false indicators of success.
  A broad and balanced approach is the only way to
  successfully sustain organizational performance
• Trahant, Burke, and Koonce

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• Organizational transformation is
• successful when change becomes
• the way we do things around here

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• Gary R. LaBlance, Ph.D.
• Vice President
• St. Louis Childrens Hospital
• One Childrens Place
• St. Louis, MO 63110
• [phone]
• garyrl_at_bjc.org