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Best Practices in Supervision: Supervisors as Change Management Experts
Anthony Salerno, PhD
May 21, 2020
Agenda
‣ The Manager vs Leadership Role
‣ Leadership and Quality Improvement
‣ Basics of Change Management
‣ Illustration of Change Management in the Time of Covid-19
The Leader-Manager Challenge‣Leadership is not the same as management
‣Leadership is not better than management
‣Leadership and management are distinct, complementary and necessary in a changing environment
Am I a Manager?
Am I a Leader?
Modern Supervision: Integrating Leadership and ManagementManagement Functions• Coping with complexity• Order and consistency• Procedures and policies• Staffing (roles and
responsibilities)• Documentation• Fiscal viability• Risk management
Leadership Functions• Coping with change• Adapting to shifting
conditions, expectations and environments
• Anticipating changes• Initiating changes
Leadership vs Management
Coping with change• Adapting to shifting
conditions, expectations and environments
• Anticipating changes• Initiating changes
Coping with complexity• Order and consistency• Procedures and policies• Staffing (roles and
responsibilities)• Documentation• Fiscal viability• Risk management
Leadership vs Management
• Setting a direction to meet new challenges
• Develop a vision for the future
• Engage others in developing strategies to successfully meet changing conditions
• Establish daily, weekly and monthly goals
• Steps/actions team members need to take
• Organize meetings to ensure needed steps and actions take place
• Allocate human and other resources to meet goals
How Leaders vs Managers Communicate
Leaders• Motivating and Inspiring• Communicating how
change is both inevitable and necessary
• Communicating for BUY-IN
• Mobilizing commitment• Build consensus
Managers• Reinforcing rules• Monitoring and
identifying and pointing out deviations from policy and other organizational problems
• Confront people who are not meeting expectations
Leaders as Change Agents‣You are a leader when your role involves • contributing to a change process that includes executive
leadership (you are part of a leadership level team)• Implementing a new policy, practice or procedure•Solve a recurring problem•Participating in organizational Strategic Planning• Intentionally and systematically improving one or more
quality indicators•Adapting to a shock change
Poll Question: To what degree does your organization expect you to be a planner, implementer and evaluator of planned change‣ A. Strong expectation
‣ B. Moderate expectation
‣ C. Just a little
‣ D. No expectation that I facilitate the change process
How prepared are you with having the knowledge and skill to facilitate a change process?‣ A. I definitely have the knowledge and skill
‣ B. I have some knowledge and skills
‣ C. Just a little
‣ D. I’m mostly flying by the seat of my pants
Change Management: What Supervisors Need to Know
Catalysts for Change: Why Change? ‣ Leadership values and vision ‣ New information or knowledge aligned with mission‣ Incidents (adverse events)‣ Complaints from internal or external customers‣ Regulatory/statutory requirements‣ Accrediting requirements‣ Market forces‣ System reputation‣ New payment and oversight system‣ Widespread societal and systemic disruption - Covid-
19
Major Accelerations of Change‣ Do not happen in a vacuum‣ Are relational; utilizing people’s insights, creativity,
imagination, and wisdom‣ Happen when a group of people come together and
learn together and dare to think new thoughts and then pass them on‣ Have a common goal that resonates for the majority
Change is Not EasyTo keep up with payers, regulations, customers and competition, organizations must react to external pressures for change, as well as accommodate their own desire to change. This combination can be overwhelming.Forty years ago, in his groundbreaking book called ‘”future shock,” Toffler* described the various problems that arise when people deal with more change than they can metabolize.• Resistance: the inability of the people being affected to adequately assimilate
what is being implemented• Superficial/short term change: instead of fully accomplishing the true
purpose for the change, they only have the absorption capacity for short-term/superficial application.
• Encroachment: Overload in one effort can spread and affect other important change
• Credibility: ”When important changes are announced that don’t materialize, the leaders who sponsored these initiatives inadvertently teach people not to listen to them. They reinforce the cynics who don’t believe the change is possible or that the particular leaders are up to the task. Either way, leadership credibility suffers”
*Future Shock by Alvin Toffler New York : Random House, ©1970.
Main Points about the Engagement of the Workforce in Change*‣ Change is inevitable but forces exist in organizations to
maintain the status quo
‣ Understanding the human response to change enables leaders to engage the workforce in a way that is more likely to promote a successful change
‣ Engaging the workforce to support an innovation or a change in organizational expectations is not a nice thing…It is a critical thing
*Woodward, H. and Woodward, M.B. (1994). Navigating Through Change. NY: McGraw Hill.
Impact on the Workforce > Staff are often concerned that a significant change will
negatively affect………….
> The meaning they derive in their work (i.e., will the change in role, function, activities be satisfying and professionally rewarding?)
> Their control over their work life (unwanted demands on time, energy and autonomy)
> Their status in the organization (affect on authority and position in the organization)
A Common Reaction to a Significant Change
“AGITA!”Heartburn of the soul
Supervisors’ Goals/PurposeNot to prevent, solve or cure a problem associated with shock or strategic change but to help people move more freely through the change process
• Skills and knowledge to manage change
• Reduce the “agita”, upset, disruptions, anxieties, dislocation associated with change• Loss of control• Loss of status• Loss of meaning
• Maximize the opportunities that the change may offer (not so easy to see potential for growth and greater personal and professional satisfaction)
Aftershock: Woodward- Helping People through corporate change
Understanding the Impact of Change on the Workforce
It is not unusual for an organization’s leadership to believe that it is engaged in promoting strategic change and for its workforce to experience the innovation as shock change. When this occurs, implementation will be compromised.
Woodward, H. and Woodward, M.B. (1994). Navigating Through Change. NY: McGraw Hill.
Goals of Change Management: Improve One or More Dimensions of Quality• Safety• Efficiency & Cost Management• Coordination• Integration• Equity• Efficacy• Effectiveness• Timeliness• Continuity• Appropriateness• Access• Staff Wellness/Retention/Turnover
During a significant change, what people…
Wantq Empathy (acknowledge that
people have emotional responses to change)
q Information (Clear and reliable)
q Ideas (leadership is thoughtful)q To be involved
q loss of control/autonomy is stronglyrelated to burnout symptoms
q Practical support, resources, tools, time
Often Getq Non-involvement
q Failure to include those affected by change and responsible to implement change.
q Autocratic Behaviorq Cheerleading without
supportq Minimizing
First Law of Change Management
Every system is perfectly designed to achieve exactly the results it gets
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C2002 Institute for Healthcare Improvement
Second Law of Change ManagementTo change the results you must change the…….. SYSTEM
‣Working harder won’t do it‣Getting rid of the rotten apples won’t do it‣Finding scapegoats won’t do it‣Throwing more money at it won’t do it‣Changing the name of the program won’t do it‣Codifying it in policy won’t do it
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The Principles and Practices of Continuous Quality Improvement will do it!
F.O.C.U.S.P.D.C.A.‣ Find a process to improve: Safely opening up face to face contact in
clinics‣ Organize team: Who has the knowledge, role, function, resources,
capacity , and stake in this process. ‣ Clarify the degree to which the current organizational practices align
with the improvement goals. What do we currently do that will align with this goal
‣ Understand the facilitating and impeding organizational processes, practices, policies and people that will affect the accomplishment of the improvement goals.
‣ Select a strategy/solution that meets many of the criteria associated with practical and sustainable success: • In our control, affect many, inexpensive, likely to be implemented
correctly, not too complicated, can see if it works right away
‣ The Plan-Do-Check-Act (PDCA) is a four-step model for carrying out organizational change‣ The cycle can be repeated for
continuous improvement‣ The PDCA can be used to:• Start a new improvement project• Plan data collection and analysis to verify
and prioritize problems• Implement change• Work towards continuous improvement
Source: Child Care State Capacity Building Center
PDCA‣ Planning: developing your implementation plan◦ Action steps◦ Who are involved◦ When◦ Where◦ How will we measure indicators of performance (process and outcome)
‣ Doing: Implementing your plan◦ Begin implementing the plan (who involved and who monitors)
‣ Checking: Measuring and monitoring immediate and longer term process and outcomes indicators‣ Acting: Taking action based on findings (keep, stop,
change, abandon or start over)
Chat: Illustration of FOCUSPDCA
‣Find something to improve• Type in the chat box something you believe will need to
be addressed as programs begin to open
(Consider lessons learned, new discoveries, findings, problems that need to be addressed, future initiatives)
Illustration of FOCUSPDCAOne Example:
‣ Offering choices to clients regarding their preferred means of receiving services (e.g., safely opening up face to face contact in clinics and offering virtual appointments)
Organize a TeamPurpose: To ensure that the right people are in the right place at the right time implementing the right thing in the right way! Change is a team activity. High performance teams are characterized by:‣ High levels of trust‣ Productive conflict‣ High levels of commitment‣ Accountable to each other‣ Attend to results that are knowable
Organize the Right Team‣ Committed leadership with responsibility and authority
to guide the change process‣ Involve those most affected by the change‣ Involve those expected to carry out the change in day
to day activities‣ Involves those with experience or knowledge related to
the change‣ Involve those who can provide resources to support
the ongoing program development process.‣ Involve those whose values, interests, beliefs and
orientation aligns with the change (champions)
Clarify current organizational alignment with re-opening face to face contactPurpose: To ensure that the Change Team identifies the degree to which current organizational practices, regulatory requirements and billing practices align with the changes. ‣ Provide a baseline measure of the organization’s current
alignment with the change
Understanding Facilitating and Impeding Organizational FactorsPurpose: To ensure that the team takes into account organizational barriers and strengths associated with implementation of the change.
‣ In what way will our policies, capability of our workforce, capacity of our workforce, financing, prevailing culture of our programs, organizational priorities, leadership priorities/commitment facilitate or impede progress?
Understanding Facilitating and Impeding Organizational FactorsPurpose: To ensure that the team takes into account organizational barriers and strengths associated with implementation of the change
‣ In what way will our policies facilitate (+) or impede (-) making progress on our goals?
‣ In what way will the capability of our workforce?‣ In what way will the capacity of our workforce?‣ In what way will our financing and billing process?‣ In what way will the prevailing culture of our organization?‣ In what way will other organizational priorities?‣ In what way will leadership priorities/commitment?
Selecting strategies and actions steps to design the overall implementation plan Purpose: To ensure that teams select strategies that • build upon strengths•minimize barriers • practical in light of day to day realities• sustainable
What’s a really good improvement strategy?� Not expensive� Can tell if the idea is working or not� Affects many� Can be done in a reasonable timeframe� Is in the control of the organization� Aligns with regulations, fiscal requirements and law.� Unlikely to cause other problems (unintended consequences
dilemma)� Practical in light of other organizational priorities� Reasonable in light of staff demands on time and energy� Tools and resources available � Aligned with other efforts (conservation of energy)
PlanPurpose: To ensure that teams identify all the critical components of a well-designed plan:Who, what, where, when, how, why?Set up a plan so you if you fail, you fail right away
Tools that may help: SMART Goals Sheet
ACTION STEPS
WHO INVOLVED IN THE IMPLEMENTATION OF THIS STRATEGY
TIMEFRAME
WHO MONITORS OUTCOME
QUALITATIVE and/or QUALITATIVE DATA AVAILABLE & TOOLS
DoPurpose: to ensure that the team tries out the change in a modest but meaningful way and has a way of monitoring the initial implementation steps.‣ The Do part is the actual implementation of the change
process. ‣ The team selects a time and place to begin.
CheckPurpose: To ensure that the team has…..‣ developed performance indicators related to both
immediate and longer-term process and outcomes indicators that are observable and measureable in a practical and reliable manner. ‣ a way to determine the effectiveness of the initial trial
of the plan‣ monitored the process to ensure that problems are
identified and addressed quickly.
ActPurpose: Ensure that the team has a way to ACT on the findings of the initial plan. Based on the results of the Checking phase the QIT continues with the plan as designed (successful implementation) or brainstorms solutions and restarts the PDCA process when you have encountered problems with implementation. • Continue with the implementation (this is working for us)• Change/modify aspects of the implementation• Abandon/Stop the process (this is not working for us)• Start over and explore what is not working and what other domain and/or
approach is likely to be more successful.• Once the organization has found a practical and effective improvement
approach, the organization may decide to establish a formal policy to sustain the related change
Poll Question: Did you learn about or were reminded of at least one idea that will support you in facilitating change‣ A. Absolutely yes
‣ B. Mostly yes
‣ C. Somewhat
‣ D. Not really
Q&A
Upcoming Webinars‣ Understanding the Process of Bereavement: Responding to
the Loss of Clients and Staff During These Difficult TimesTuesday, May 26 - 1:00 PM
‣ Conversations with Dr. Tony: Advancing Integrated Care: Primary and Behavioral Health Integration Amidst COVID-19 and Beyond
Wednesday, May 27 - 12:00 PM
‣ Coping with Crisis During COVID-19 Series: Part 1: Crisis and Safety Planning via Telehealth for Suicidal Ideation and Self-Harm
Thursday, May 28 - 1:00 PM
Contact Us…Anthony Salerno, PhD
For questions about CTAC trainings, [email protected]
Please complete the feedback survey when you leave the webinar!
www.ctacny.org
