$ ;u|o = ;1 om9

W H I T E P A P E R

The Art of Execution:Moving the Organization from Planning to Performance

Authors: Pamela Damsky, Cynthia Bailey and Myra Aubuchon

The Art of Execution: Moving the Organization from Planning to Performance

Page 1

The Art of Execution:Moving the Organization from Planning to PerformanceImplementation is often depicted as the natural next step or phase in a project, with the assumption that strong

leadership teams have the requisite project management skills to just “get it done.” While this may be true, it

also minimizes the very real challenges and risks that can delay, if not derail, successful execution and hinder an

organization’s ability to achieve lasting change. What does it take for an organization to effectively transition from

planning to performance, in a way that advances its capabilities and positioning? Leading providers are recognizing

that a proactive, disciplined and comprehensive approach to change management is key to moving beyond short-

lived gains — to achieve lasting cultural change that transforms the organization, drives performance and sets the

path for ongoing, sustainable success.

A proactive, disciplined and comprehensive approach to change management is key to moving beyond short-lived gains.

The Challenge of ExecutionProviders dedicate substantial time, money and energy to the design and development of performance improvement initiatives, ensuring that these plans reflect organizational priorities and are supported by a leadership team aligned around a common vision and set of objectives. In some cases, however, organizations assume that assigning the right leaders and providing resources is all that is required to ensure effective execution. The reality is that these initiatives can (and often do) fall short of their visions and fail to fully achieve their goals, particularly when there are multiple initiatives underway at multiple levels of the organization.


Page 2

No matter how thoughtful the plans or detailed the design, implementing and sustaining change are difficult. It is crucial that leadership commit time and focus to considering what it will take to make meaningful, lasting change in the organization, prior to launching an improvement initiative. Assessing the organization’s readiness for change and likely areas of resistance, and developing strategies ahead of time to address potential challenges and effectively manage change, are vital to effective execution. When leadership is mindful of the elements of change management and disciplined in incorporating them into the performance improvement process, there is a higher likelihood of achieving richer, more synergistic and sustainable results.

A Framework for Managing ChangeIn our experience, deploying an intentional and methodical approach to change management sets up the organization for successful execution and ongoing improvement. The framework below can help leadership identify and assess the key dimensions of change management that impact the organization’s ability to execute its vision and advance toward its desired future state:

CLARITYWhat you are trying to accomplish and why you are trying to accomplish it

CULTUREHow the values and behaviors of the organization are reflected in the support of the change

CAPABILITIESThe people, processes and technologies to execute the journey and to operate in the “new” model

COURSEA path that addresses the realities faced along any journey

CALIBRATIONA defined performance measurement system


Page 3

CLARITYWhile organizational improvement processes often begin with a visioning phase, clarity of the ultimate goal of the initiative and the path to achieve it can become muddled over time, particularly during a multi-month or multi-initiative change process. In the face of day-to-day challenges and continuous transitions, it is easy to lose sight of “bigger picture” objectives and the original case for change, making effective execution more difficult. A clear understanding of what the end state will look like — how recommended changes will affect roles, work and day-to-day interactions between clinicians, administrators and staff — is essential for effective execution. Leadership must be realistic and tangible regarding how proposed changes will impact individuals and why it is worth going through the transition. It is essential that front-line clinicians and staff understand (and are regularly reminded of) the potential benefits to the organization, the department and the individual, and of the ultimate purpose to better serve patients and the community.

CULTUREAn organization’s culture plays a significant role in how well it executes new initiatives. Because culture is often viewed as intangible or hard to define, it is not uncommon for leadership teams to avoid addressing it directly. In our experience, strong leaders can greatly influence the internal culture of an organization and impact the likelihood of successful execution. It is important to acknowledge upfront the current culture, including: existing communication mechanisms, decision-making processes, tolerance for risk, the degree of empowerment at all levels, and how the culture will impact the implementation of a desired future model. For example, an organization with a top-down decision-making model may struggle to fully engage or empower its physicians or administrative managers to lead the new initiative and shepherd it through implementation. Fostering more autonomous and accountable staff may require changing the process of engagement and reinforcing desired behavior in every interaction and communication. For instance, recognizing champions, tracking progress and acknowledging success (and failure) early and often builds the momentum and sense of shared-mission essential to effective execution and lasting change.

CAPABILITIESEarly assessment of organizational strengths and opportunities, and a comprehensive analysis of required competencies, can go a long way toward setting the organization on the path of effective execution. Ensuring that the right people, processes and technology are in place to support the new model once implemented is as important as the plan design yet, it is often an afterthought. Determination of required skillsets and resources, and a plan for building them out as needed must be part of the early design phase and may include: training, development and coaching for new roles; modifying supporting processes and structures; and retooling information systems to address technology gaps in information, communication and decision-making support.

COURSEEstablishing and communicating a clear path for how a new initiative will roll out through the organization is critical to ensure people know what to expect and what is expected of them. However, even with a well-defined roadmap, stumbling blocks and barriers are likely to emerge. When organizations are caught by surprise or unprepared to manage these inevitable challenges, execution can flounder. Leadership must maintain a clear and objective perspective regarding possible risks, and be prepared to course-correct as needed. While it is impossible to foresee or predict all potential future obstacles, organizations can create systems, structures and processes to address these challenges


Page 4

and support reconciliation of competing priorities or needs (e.g., establishing a process for successfully navigating the budget for an improvement initiative that requires a multi-year investment commitment). At the same time, there must be a system in place to determine when resistance actually reflects a flaw in the plans or new circumstances, requiring adjustments to the initiative. No course forward is perfectly smooth; flexibility — and even the willingness to walk away if warranted — may be required to achieve the broader goals of the organization.

Even with a well-defined roadmap, stumbling blocks and barriers are likely to emerge. When organizations are caught by surprise or unprepared to manage these inevitable challenges, execution can flounder.

CALIBRATIONClearly defining and articulating success in the form of tangible near- and long-term performance targets, and developing a system to measure progress toward those goals, are critical components of effective execution. In our experience, target identification by itself is not sufficient. A performance measurement system that demonstrates interim progress and tracks short-term achievements is essential to maintaining organizational motivation and momentum throughout implementation. Process and outcome measures at the overall and unit levels help drive performance and highlight progress and barriers along the way. For example, a measure that tracks the number of messages handled by the ambulatory care team versus the physician may support changes to the care team role and demonstrate how the administrative burden on the physician is changing over time. The process of determining what and how to measure must begin early, as it will both reflect and drive the priorities and decisions throughout the improvement process.

Two foundational elements underlie how the organization manages change and moves forward together:

1. Conversations — the way in which the organization communicates (e.g., the ability to promote two-way dialogue that ensures individual engagement and targeted interaction and exchange); and

2. Courage — the way in which the organization faces and deals with challenges or barriers (e.g., the willingness to take on the tough issues and move forward with resolution and resilience). It is important for leadership to periodically review and test the change management tactics that have been deployed to ensure that the right conversations are taking place, and that the difficult issues that are surfaced are successfully addressed.


Page 5

Identify Change Leaders and Establish Oversight Process at the outset to lead the change management effort, communicate the case for change, identify potential barriers and obstacles, and oversee and monitor progress. The leadership team(s) should include physician and administrative leaders with the competency, authority and enthusiasm to effectively engage their colleagues and build support for the change process and desired outcomes.

Create Engagement and Adoption Plans that are tailored to the needs of each stakeholder group. Needs are likely to range from communication and information, to creating an understanding of new expectations and training. They may also include more difficult elements such as the alignment of incentives or organizational oversight. Engagement and Adoption plans will address some needs, while other issues are raised to the appropriate audience via the leadership team.

Develop Operational Readiness Assessment Plans to ensure specific changes are incorporated into the daily fabric of the organization. This is a critical step that highlights numerous unintended consequences and potential barriers that may arise. Successful initiatives test complex process, technology and people changes with operational user groups to identify what is needed to operationalize/implement them, and to codify and incorporate additional implementation steps, including: unforeseen training needs, system modifications, additional process testing, and expanded role and responsibility discussions as needed.

Activate a Communications Plan to effectively communicate the case for change, the overall benefits of the change, and the specific aspects of the change that will impact different individuals and groups. A comprehensive plan articulates the key messages, forums and frequency for communicating with each stakeholder group. It will include opportunities for input and feedback to ensure communication is bi-directional, and that issues and questions can be raised and appropriately addressed.

Create Education and Training Plans to ensure stakeholders are competent in new workflows, processes and technologies, and confident in their capabilities. It is important that training and education plans match the level of training required, and that comprehensive training plans — including curriculum development, practice environment and demonstrated learning opportunities — be developed as needed.

Measure Impact and Demonstrate Results in order to assess if the pace and magnitude of change is appropriate to the readiness of the organization. Documenting the impact of change provides positive reinforcement for the work done to date and provides constructive input for future modifications. It is essential to embed measurement into regularly produced dashboards and information systems to ensure ongoing monitoring of progress and documentation of benefits.

Through our work

with clients, we

have identified

six (often parallel)

activities that help

leadership address

the key dimensions of

change management

and prepare the

organization for

effective execution.

Getting Started: Setting the Stage for Effective Change Management


Page 6

Setting up for Successful ExecutionAs leadership considers the organization’s readiness for change, it is important to accurately assess and acknowledge how much change is being asked of its people. Significant change requires significant preparation — asking the right questions can help leadership identify areas of risk and opportunity:

z What is our desired end state and vision of the future? How much disruption are we willing to tolerate to get there?

z Have we built a strong case for change that can be effectively communicated?

z Do we have a clear roadmap for how we will move forward?

z Can we get where we need to go with existing resources and capabilities?

z What is the degree and nature of cultural change that will be required in the future?

z How will the desired future norms be demonstrated and modeled?

z What are the difficult conversations that we will need to have and how are we preparing for them?

z How will we effectively communicate with all levels of the organization?

z How will we assess our progress and ensure that we remain on course?

Incorporating a robust and comprehensive change management approach, aligned with and in parallel to the organization’s improvement plan, can help leadership address these essential questions. A robust approach will also ready the organization for transformative, sustainable change that will drive performance today and tomorrow.


Page 7

About the Authors

Pamela [email protected]

Cynthia BaileyManager, Chartis PhysicianLeadership [email protected]

Pamela Damsky is a Director at The Chartis Group. Ms. Damsky has almost 30 years of healthcare experience, the majority of which is in advisory services. She brings deep expertise in organizational strategy, alignment, clinical transformation and performance improvement to help organizations succeed today while preparing for new and future environments.

Cynthia Bailey manages the Chartis Physician Leadership Institute and is a member of the firm’s Performance practice. Ms. Bailey has 15 years of healthcare experience including strategy and operations consulting, sales and business development, and public health policy and communications.

Myra [email protected]

Myra Aubuchon is a Principal with The Chartis Group and is the Clinical Performance Excellence leader for the Informatics and Technology Practice. She is an accomplished senior executive with over 25 years of experience. Myra’s breadth of expertise includes developing core business strategies for healthcare delivery systems; planning for strategic growth; connecting organizational goals with enabling IT strategies; and leading change management efforts enabled by deliberate communication plans to support major system investments.

About The Chartis Group

The Chartis Group® (Chartis) provides comprehensive advisory services and analytics to the healthcare industry. With an unparalleled depth of expertise in strategic planning, performance excellence, informatics and technology, and health analytics, Chartis helps leading academic medical centers, integrated delivery networks, children’s hospitals and healthcare service organizations achieve transformative results. Chartis has offices in Boston, Chicago, New York, Minneapolis and San Francisco. For more information, visit www.chartis.com.

Boston | Chicago | Minneapolis | New York | San Francisco

© 2017 The Chartis Group, LLC. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors.

Documents

$ ;u|o = ;1 om9