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30 Year Retrospective on Culture Change in Healthcare
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Perspectives on Perspectives on Healthcare Culture ChangeHealthcare Culture Change
Michael O. Bice©Michael O. Bice©
What Do We Mean When We Say What Do We Mean When We Say ““Corporate Culture? Corporate Culture? ““
Corporate CultureCorporate Culture– Shared Attitudes, Habits, Values, Social Shared Attitudes, Habits, Values, Social
ConventionsConventions– Stew of Rules, Mores, and Traditions Stew of Rules, Mores, and Traditions
Which Shape the Work ExperienceWhich Shape the Work Experience– ““The Way We Do Things Around Here”The Way We Do Things Around Here”
What Do We Mean When We Say What Do We Mean When We Say ““Culture Change?Culture Change?””
Organizational TransformationOrganizational Transformation– CoreCore Competence Change Competence Change
Drivers of Culture ChangeDrivers of Culture Change– Creating Successful New VenturesCreating Successful New Ventures– Managing Mergers & AcquisitionsManaging Mergers & Acquisitions– Coping With Innovation & ChangeCoping With Innovation & Change– Overcoming New Competitive PressuresOvercoming New Competitive Pressures
Leadership Leadership Organizational Organizational TransformationTransformation
Culture Change ModelCulture Change Model
Preparation
Principles
HR and OD Interventions
Managing Barriers
Managing the Middle
PreparationPreparation
Culture Change=White Water Raft RideCulture Change=White Water Raft Ride
Study OrganizationStudy Organization’’s Historys History
Describe Baseline CultureDescribe Baseline Culture– Values and BeliefsValues and Beliefs– Heroines and HeroesHeroines and Heroes– Rituals Rituals – CeremoniesCeremonies– Stories and Story TellersStories and Story Tellers
PreparationPreparation
Build a Case for ChangeBuild a Case for Change– Current or Anticipated PainCurrent or Anticipated Pain– Intellectual and Emotional ArgumentsIntellectual and Emotional Arguments
Vision: Sensible and Appealing Picture of Vision: Sensible and Appealing Picture of the Futurethe FutureCraft a Vision for the FutureCraft a Vision for the Future– Six Way Test: Imaginable; Desirable; Six Way Test: Imaginable; Desirable;
Feasible; Focused; Flexible; and Feasible; Focused; Flexible; and Communicable (Kotter)Communicable (Kotter)
Principles of Organizational Principles of Organizational ChangeChange
NONO Vision Realized Without Culture Vision Realized Without Culture Change Change
Commitment of Leadership Commitment of Leadership CommunityCommunity
Continuity of Leadership Continuity of Leadership
Flexible Execution PlansFlexible Execution Plans
Management Interventions Management Interventions (Human Resources)(Human Resources)
Human Resource PhilosophyHuman Resource Philosophy
RecruitmentRecruitment
OrientationOrientation
LearningLearning
RewardsRewards
Management Interventions Management Interventions (Organizational Development)(Organizational Development)
Organizational RedesignOrganizational Redesign
CommunicationCommunication
Innovation EnhancementInnovation Enhancement
Managing NormsManaging Norms
Managing ValuesManaging Values
Human Resource PhilosophyHuman Resource Philosophy
Largely Untapped Reservoir of TalentLargely Untapped Reservoir of Talent
Treat Employees Like Your Best CustomerTreat Employees Like Your Best Customer
PerPermission Statementsmission Statements
RecruitmentRecruitment
Warren Buffet Story: Integrity, Intellect, Warren Buffet Story: Integrity, Intellect, and Energyand Energy
Rule of ThumbRule of Thumb– % GO% GO– % GO, BUT% GO, BUT– % NO% NO
OrientationOrientation
Leader’s Role During OrientationLeader’s Role During Orientation
Utility of Peer PressureUtility of Peer Pressure
Forge Company TypesForge Company Types
LearningLearning
Foundation of Values, Trust and Foundation of Values, Trust and Empowerment Empowerment
No Learning Without Difficulty and No Learning Without Difficulty and FumblingFumbling
An Investment, Not An ExpenseAn Investment, Not An Expense
RewardsRewards
Performance Appraisal ShortcomingsPerformance Appraisal Shortcomings
Importance of Psychic Income Importance of Psychic Income
Growing compensation GAP between Growing compensation GAP between Leadership and direct caregiversLeadership and direct caregivers
Organizational RedesignOrganizational Redesign
Management Layers Management Layers Block, Distort, and Block, Distort, and FilterFilter
Low Corporate Overhead is a Low Corporate Overhead is a Competitive Advantage Competitive Advantage
Governance Culture ChangeGovernance Culture Change
CommunicationCommunication
NO Beats UncertaintyNO Beats Uncertainty
Walk Your TalkWalk Your Talk
Keep Your Message Simple: Avoid Keep Your Message Simple: Avoid Techno Babble and MHA-SpeakTechno Babble and MHA-Speak
Tell Stories; Give Examples; Paint a Tell Stories; Give Examples; Paint a PicturePicture
Innovation EnhancementInnovation Enhancement
Focus on CustomerFocus on Customer
Constant, Incremental ImprovementsConstant, Incremental Improvements
Exposure to People and Ideas that are Exposure to People and Ideas that are Foreign, Uncomfortable and ThreateningForeign, Uncomfortable and Threatening
Managing NormsManaging Norms
Unwritten Rules: Unwritten Rules: Positive and Positive and NegativeNegative
New Vision New Vision
Requires New Requires New
NormsNorms
BaselineBaseline
CultureCulture
Desired Desired
CultureCulture
ConformConform PerformPerform
HoardHoard
InformationInformation
Share Share
InformationInformation
AvoidAvoid
ConflictConflict
Confront Confront ConflictConflict
Managing ValuesManaging Values
Leaders Promote & Protect ValuesLeaders Promote & Protect Values
GAP Between Values on Paper and GAP Between Values on Paper and Values in PracticeValues in Practice
Litmus Test? Hold to Values When Times Litmus Test? Hold to Values When Times are Toughare Tough
Intervention RecapIntervention Recap
Human ResourcesHuman Resources– PhilosophyPhilosophy– RecruitmentRecruitment– OrientationOrientation– LearningLearning– Rewards Rewards
Organizational DevelopmentOrganizational Development– Organizational RedesignOrganizational Redesign– CommunicationCommunication– Innovation EnhancementInnovation Enhancement– Managing NormsManaging Norms– Managing ValuesManaging Values
Barriers to ChangeBarriers to Change
Leadership BurnoutLeadership Burnout
Reluctant Leadership CommunityReluctant Leadership Community
Insular CultureInsular Culture
Cycle of CynicismCycle of Cynicism
Physician RebellionPhysician Rebellion
Barriers to ChangeBarriers to Change
Loss of Trustee Sponsorship and SupportLoss of Trustee Sponsorship and Support
Middle Management ResistanceMiddle Management Resistance
Loss of Key Player(s)Loss of Key Player(s)
Events Outside Management ControlEvents Outside Management Control
Suffering Associated with Major ChangeSuffering Associated with Major Change Consider Mourning Ritual(s)Consider Mourning Ritual(s)
Managing the MiddleManaging the Middle
Basic Truth of Management is That Basic Truth of Management is That Nearly Everything Looks Like a Nearly Everything Looks Like a Failure in the MiddleFailure in the MiddleToolkitToolkit
– Celebrate Short Term WinsCelebrate Short Term Wins– Get Close to the CustomerGet Close to the Customer– MentorMentor– Run ScaredRun Scared– Culture AuditCulture Audit
Regional Medical Center Culture Regional Medical Center Culture Audit FindingsAudit Findings
OLD CULTUREOLD CULTURE
People: CommoditiesPeople: CommoditiesSocial EnterpriseSocial EnterpriseWeight of HistoryWeight of HistoryCynicismCynicismControl BehaviorControl BehaviorEntitlementEntitlementTotem: ElephantTotem: Elephant
NEW CULTURENEW CULTURE
People: Valued AssetsPeople: Valued Assets
Business EnterpriseBusiness Enterprise
Promise of the FuturePromise of the Future
TrustTrust
Enable BehaviorEnable Behavior
AccountabilityAccountability
Totem: EagleTotem: Eagle
Final ThoughtsFinal ThoughtsNo Vision Realized Without Culture No Vision Realized Without Culture ChangeChange
Leadership Community, NOT Heroic Leadership Community, NOT Heroic LeaderLeader
Treat Employees Like Your Best Treat Employees Like Your Best CustomerCustomer
Need for Energy, Passion, Sacrifice, Need for Energy, Passion, Sacrifice, Creativity and CommitmentCreativity and Commitment
Final ThoughtsFinal Thoughts
Assess Readiness for ChangeAssess Readiness for Change
Be Clear Where You Are Taking People Be Clear Where You Are Taking People and Why and Why
Walk Your TalkWalk Your Talk
Barriers to Change Are POWERFULBarriers to Change Are POWERFUL
Leadership Requires Disturbing People, Leadership Requires Disturbing People, But at a Rate They Can AbsorbBut at a Rate They Can Absorb
Final ThoughtsFinal Thoughts
Centrality of Values and BeliefsCentrality of Values and Beliefs
DonDon’’t Overlook Personal Transformationt Overlook Personal Transformation
Kubler-Ross and BridgesKubler-Ross and Bridges’’ Insights Insights
Communication Should Be Frequent, Communication Should Be Frequent, Consistent and ReliableConsistent and Reliable
Change is Ongoing, Endless, and ForeverChange is Ongoing, Endless, and Forever