Studer Group Presentation to
Georgia Hospital Association- Nurse Leadership Institute
Getting Nurses on Board –It’s not
Empowerment, It’s Engagement and Leading
through Change and Transitions
Pam Beitlich, DNP, ARNP- June 4, 2014
Our Objectives 1. Examine the external changes in
healthcare
2. Understand one model of successful
change
3. Discuss the critical role every nurse
plays in the future of healthcare
Slide 2
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What are:
Two things you can
start tomorrow that
will make you more
effective in
transitioning through
healthcare change?
Slide 3
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So….How’s Your Day Going?
Slide 5
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Everything Starts Here..
 Your Mission
 Your Vision
 Your Values
 Organizationally and Personally
Slide 9
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Studer Group Mission and Vision
Mission:
To make healthcare a better place for
employees to work, physicians to
practice medicine and patients to
receive care.
Vision:
To be the intellectual resource for
healthcare professionals, combining
passion with prescriptive actions and
tools, to drive outcomes and maximize
the human potential within each
organization and healthcare as a whole.
The Our Foundation
Slide 11
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Execution Framework
Evidence-Based LeadershipSM
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Healthcare Flywheel®
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Building a Culture of High Performance
The External Environment
Slide 14
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Significant Changes in Healthcare
Over the Last Decade
 Transparency/Public reporting/Consumer
 Technology
 Research
 Integration
 Additional Market Changes
 Episodic vs. Continuous Change
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Healthcare over the Last Decade
 Disruptive Change – Payment
Page 16
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Over the Next Decade, Hospital Margins
Are Expected to Decline Sharply
Hospital operating margins
2.2%
2011
2013
2015
With proposed
reimbursement cuts,
2.2% will become a
16.8% deficit.
Page 17
2017
2019
2021
-16.8%
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The Value Equation -
Slide 18
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What is Reform really about?
Healthier population
Lower Use
Lower Prices
Higher quality
$/N
2013
Time
Reference: Seeing Beyond Reform: Governance and the Emerging New Healthcare; James Orlikoff, President; Orlikoff & Associates, Inc.; 4800 S. Chicago
Beach Drive; Suite 307N; Chicago Il 60615-2054; 773-268-8009; j.orlikoff@att.net
Slide 19
Len Nichols, George
Mason University
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Being a leader in healthcare
today is like continuously
walking up a down escalator.
If one stands still they go
backwards.
Slide 20
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The New Health Age -
“We live in a moment of history where change is
so speeded up that we begin to see the present
only when it is already disappearing.”
-R.D. Laing
Slide 21
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Reimbursement changes, technology
changes, procedures change, medications
change, events and people change. The
most important skill is to create a culture that
has the agility and ability to adapt to the
changes.
Slide 22
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Change today happens Quickly..
No longer short periods of change, followed by
long plateaus of stability

Continual, unrelenting series of changes, with
little time for self-renewal

Keeping energized, optimistic and inspired in the
face of change demands specific skills

You need to learn how to respond quickly and
flexibly to new demands

Slide 23
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Myths
 Patients: They have unrealistic expectations
 Staff: Leaders job is to get everyone on board
 Physicians: It is impossible to get physicians
aligned
 Leadership: Engagement of people and patient
experience are soft skills
 Data: Low “n” – means the data isn’t useful
 Easy: Seems common sense so it is simple
Slide 24
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Observations
 No victim thinking
 Control our own destiny
 People need you
 You not only save lives but you save healthcare
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Execution Triangle
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Top Ten Challenges in Execution
1. Leaders / Others
underperforming and still
receiving a good evaluation
2. Change not connected to
why
3. Lack of necessary urgency
4. Leaders do not have the
skills to assure a solid
implementation
6. Push Back by leaders,
staff and physicians
7. Not familiar with what
“right” looks like
8. Lack of frequency
9. Inability to transfer best
practices
10. Poor processes
5. Too many changes -- too
soon
Slide 27
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High Performance Organization - 2013
Assesses
Organizations in
Six Key Areas
 4 years of data
2009-2013
 35,633 leader
responses
 More than 500
healthcare
systems
Page 28
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"Culture outperforms strategy
every time; and culture with
strategy is unbeatable."
-Quint Studer
Page 29
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Building a Culture of High Performance
Leading Change
Slide 30
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Critical Elements of Successful Change
 Compelling reason for change to achieve
something better
 Leadership commitment to support the change
 Active engagement of staff
 Alignment with mission, goals, resources
 Connections and collaboration across
boundaries (silos)
 Effective communication techniques that inform
and inspire to elicit an emotional response
-VanDeusen Lukas et al (2007), Kotter, 2002)
Slide 31
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Most Change Efforts Fail
 Total Quality Management programs:
–About two-thirds “grind to a halt
because of their failure to produce
the hoped-for results”
 Reengineering
–70% failure rate
Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail.
Harvard Business Review. 73(2): 59-67.
Slide 32
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“Highly successful organizations know how
to overcome antibodies that reject anything
new. But first, a process of change must
happen that uses both the head and the
heart.”
Slide 33
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Change and Emotions -
“It’s not so much that we’re afraid of change or so
in love with the old ways, but it’s that place in
between that we fear…It’s like being between
trapezes. It’s Linus when his blanket is in the
dryer. There’s nothing to hold on to.”
- Marilyn Ferguson, Futurist
Slide 34
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When Changing Behavior, both thinking
and feeling are Essential
Thinking Differently
1. Analyze - Give the data and the
evidence
2. Think – Data and analysis
influence how we think
3. Change – New thoughts can
change or reinforce changed
behavior
Slide 35
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Behavior changes when we Feel…
Feeling differently 1. See – help people “see” by
creating surprising and
compelling visual experiences
2. Feel – seeing something new
hits the emotions
3. Change – emotionally charged
ideas change behavior
Slide 36
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Key Skills for Leading Change

Why, What and How

Burning Platform

Critical Mass

Creating the Right Amount of Tension

Success Steps

Don’t Declare Victory
Slide 37
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Leader’s Role is Multi-faceted..

Motivator


Collaborator

Advisor

Consultant

Planner

Counselor

Evaluator

Educator
Slide 38
Facilitator
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Leading Change
 Operational Framework
 Managing Individual and Change
 Managing Organizations and Change
Slide 39
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Kotter’s Eight-Stage Change Process
Slide 40
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Creating the Climate for Change
1. Create a
sense of
urgency
2. Create the
guiding team
3. Develop a
change vision
and strategy
Help others feel a gut-level
determination to act, now
Put together a group with enough
power and skills to lead the change
Clarify how the future will be
different from the past
Slide 41
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The biggest obstacle
in achieving high performance is not
achieving the needed
urgency for change.
Kotter, John P (2008)
A Sense of Urgency.
United States: Harvard
Business Review Press.
Slide 42
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“People wish to be
settled; but only as far
as they are unsettled,
is there any hope for
them.”
—Ralph Waldo Emerson
Slide 43
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Your Vision - Six Key Characteristics
Imaginable
Desirable
Communicable
Vision
Feasible
Flexible
Focused
Slide 44
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Communicate your Vision - “Signal Loss”
CEO to VP: Today at 11:00 there will be a total eclipse of the sun. This is when the sun
disappears behind the moon for 2 minutes. This is something that cannot be seen
everyday. Time will be allowed for employees to view the eclipse in the parking lot at ten
till 11, when I will deliver a short speech introducing the eclipse and giving some
background information. Safety goggles will be made available at a small cost.
VP to Director: Today at 10 till 11 all staff should meet in the parking lot. This will be
followed by a total eclipse of the sun, which will disappear for two minutes. For a
moderate cost, this will be made safe with goggles. The CEO will deliver a short speech
beforehand to give us all some background information. This is not something that can
be seen every day.
Director to Manager: Today the CEO will deliver a short speech to make the sun
disappear for 2 minutes in an eclipse. This is something that cannot be seen everyday,
so people will meet in the parking lot at 10 or 11. This will be safe, if you pay a moderate
cost.
Manager to Supervisor: Ten or eleven staff are to go to the parking lot where the CEO
will eclipse the sun for 2 minutes. This doesn’t happen every day. It will be safe, but it
will cost you.
Supervisor to Employees: Some employees will go to the parking lot today to see the
CEO disappear. It is a pity this doesn’t happen every day.
Contributed to Swenny's E-mail Funnies by Ajay Ambastha, Mumbai, India
Slide 45
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Creating the Climate
1. How will you create a sense of urgency?
2. Who needs to be on the team? What types of
skills are needed?
3. Consider a graphical depiction of your vision
Slide 46
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Engaging and Enabling the Organization
4.
Communicate
the vision for
buy-in
Make sure stakeholders understand
and accept the vision and strategy
5. Empower
broad-based
action
Remove as many barriers as possible
and unleashing people to do their best
6. Generate
short term
wins
Create visible success ASAP
Slide 47
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Adoption of Change Occurs over Time
- Rogers
Slide 48
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5. Empowering People to Effect Change
 Communicate a sensible vision
 Make structure compatible with the vision
 Provide the training employees need
 Align information and personnel systems
 Confront supervisors who undercut needed
change
Slide 49
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6. Create Visible Successes
 Change takes time. High risk for loss of momentum
and the onset of disappointment.
 Most people won’t go on a long march for change
unless they begin to see compelling evidence that
their efforts are bearing fruit.
 Balance “preparing for” and “implementing”
 PLAN short-term gains, hit them, celebrate them.
Don’t just hope for them.
 Commitments to produce short-term wins help keep
the urgency level up.
Slide 50
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Enabling and Engaging 4) What strategies will you use to communicate
the vision and change strategy?
–Create a surprising, compelling, or visual
experience to communicate
5) How will you empower staff?
6) How will you celebrate short term wins?
51
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Implementing and Sustaining Change
7. Don’t let
up
Maintain momentum. Consolidate
gains and produce more change until
the vision is a reality.
8. Make
the change
stick
Anchor new approaches in the culture
for sustained change.
Slide 52
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7. Consolidate Gains & Create more
Change
 Don’t declare victory too soon – kills momentum. Old
traditions reclaim ground.
 Can take 5-10 years to sink deeply into a culture
 New approaches are fragile and subject to
regression
 Use the feeling of victory as the motivation:
– to expose opportunities for more tuning
– to move people committed to the new ways into key
roles
Slide 53
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Implementing and Sustaining
7. What strategies will you use to maintain early
momentum?
8. How will you reinforce the early adopters and
encourage further adoption?
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Which Phase is Biggest Opportunity?
Slide 55
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Differentiating Competencies 1. Character
4. Interpersonal Skills
 High integrity and honesty
 Communicates powerfully and
prolifically
2. Personal Capability
 Inspires/motivates others to high
performance

Technical /Professional Expertise
 Solves problems /Analyzes Issues
 Builds relationships
 Innovates
 Develops others
 Practices self development
 Collaboration / Teamwork
3. Focus on Results
5. Leading Change
 Drives for results
 Develops strategic perspective
 Establishes stretch goals
 Champions change
 Takes initiative
 Connects the team to the outside
world
- Zenger | Folkman Company, 2006
Slide 56
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Managing Reactions to Change
 Understand how
people react to
change
 Apply strategies for
managing reactions
Slide 57
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Transition – the Emotional Process
 Most people don’t fear change, but the loss that
comes with it
 Stages are characterized with typical reactions –
normal and healthy
 Impact can include grief, denial, anger,
bargaining, guilt, depression and acceptance
 Includes chaos and loss of equilibrium
 Includes regaining balance and a new beginning
 Helps us prepare and plan how to take care of
ourselves
Slide 58
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Change vs. Transition
Slide 59
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Successful Transition Through Change  Letting go of what’s old and familiar
 Sitting with what’s unknown and uncertain YET
avoiding the “learned helplessness syndrome”
 Adjusting to what’s new and unfamiliar
 We all have multiple experiences of change
Slide 60
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Responding to Stakeholder Feelings
Positive
• Channel the energy
• Beware of groupthink
• Name the problem of
mixed emotions
• Create a safe
environment
Ambivalent
• Help people make
sense of the proposed
change
• Actively engage in
meaningful discussion
• Listen for information
that may be helpful
• Address concerns
Negative
• Use two way
communication
• Keep people informed
about when, where,
how
• Keep surprises to a
minimum with regular
communication
• Anticipate questions
and concerns
• Publicize successful
change and progress
• Offer hope and
direction
Tip: Invest Time and Energy at the front end of the change to
manage reactions
Cawsey, Deszca, Ingols (2012)
Slide 61
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Change not always bad or feared
Slide 62
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Phases of Competency and Change
Individual
Unconsciously
unskilled
Slide 63
Source: Abraham Maslow; 1940; “Four Stages for Learning Any New
Skill””; Gordon Training International by Noel Burch; 1970
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Phases of Competency and Change
Individual
Consciously
unskilled
Unconsciously
unskilled
Page 64
Source: Abraham Maslow; 1940; “Four Stages for Learning Any New
Skill””; Gordon Training International by Noel Burch; 1970
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Phases of Competency and Change
Individual
Consciously
skilled
Consciously
unskilled
Unconsciously
unskilled
Source: Abraham Maslow; 1940; “Four Stages for Learning Any New
Skill””; Gordon Training International by Noel Burch; 1970
Slide 65
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Phases of Competency and Change
Individual
Unconsciously
skilled
Consciously
skilled
Consciously
unskilled
Unconsciously
unskilled
Source: Abraham Maslow; 1940; “Four Stages for Learning Any New
Skill””; Gordon Training International by Noel Burch; 1970
Slide 66
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Phases of Competency and Change
Individual
Unconsciously
skilled
Consciously
skilled
Consciously
unskilled
Unconsciously
unskilled
Source: Abraham Maslow; 1940; “Four Stages for Learning Any New
Skill””; Gordon Training International by Noel Burch; 1970
Slide 67
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Phases of Change - Organization
PHASE 1
THE HONEYMOON
 Sense of excitement
 Right “to do” list
 Things will get better (hope)
 Quick fixes are implemented
 Skeptics
Slide 68
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Phases of Change - Organization
PHASE 2
REALITY SETS IN






We/they
Inconsistency
Bigger than I thought
This will impact me
Some are getting it
Some are not
Slide 69
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Phases of Change - Organization
PHASE 3
THE UNCOMFORTABLE GAP




Performance gap is evident
Tougher decisions must be made
Process improvement increases
Inconsistencies obvious
Slide 70
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Source: The Right Stuff Movie
Chuck Yeager
Slide 71
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Phases of Change - Organization
PHASE 4
CONSISTENCY
 High performing results
 Everyone understands the keys to success
 Disciplined people and disciplined
processes
 Proactive leadership
Slide 72
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Most Trusted, Least Engaged
Slide 73
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“Rate honesty and ethical standards of people
in these fields”
100
90
80
70
60
50
40
30
20
10
0
% Responses "High" and "Very High"
85
75
70
70
62
58
53
52
41
38
28
24
10
8
Gallup Poll: http://www.gallup.com/poll/159035/congress-retains-low-honesty-rating.aspx
Slide 74
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Least Happy
 Nursing rated #2 least happy profession
– Compensation,
– Growth opportunities
– Workplace culture
“Nurses have more issues with the culture of
their workplaces, the people they work with, and
the person they work for”
CareerBliss.com released list based on analysis of 100,400+ employees, 2011-2012
Slide 75
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Engagement is Critical  Staff who have the most patient contact are
often the least satisfied and engaged
 There is a strong correlation between patient
satisfaction and staff engagement. Hospitals
that can provide the best environment for
employees will be rewarded with better patient
care.
- Press Ganey, 2010
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Owner vs. Renter
Is this an OWNER?
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As Little Work as Possible?
Slide 81
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Missed the WHY?
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WHY this all Matters…
Slide 83
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Engaged Work Environments  Engaged – work with passion and feel a profound
connection to their company, drive innovation and move
the company forward
 Not-engaged – essentially “checked-out” or sleepwalking through their day, putting time in but not energy
or passion in their work
 Actively dis-engaged- not only unhappy at work but
actively acting out their unhappiness. Every day these
workers undermine what their engaged co-workers
accomplish.
-Gallup
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Everyone thinks of
changing the world, but no
one thinks of changing
himself
- Leo Tolstoy
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Employee Engagement and Safety Link
Conclusion:
Employees with low
engagement are more
likely to work around
safety protocols, but are
less likely to work around
safety protocols when
highly engaged
Work arounds
4
3.5
3
2.5
2
Low Engagement
High Engagement
Source: Leadership, Rework, and Workarounds; Grant T. Savage, Ph.D.; University of Alabama at Birmingham, February 2011
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Interdependent Relationships
Quality Example
Relationship Between Employee Turnover and Patient Care
* Average Length of Stay
Source: VHA
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Patients’ Perception of Care = Quality
Vascular Catheter-Associated Infection
Patients’ Perception of Care = Quality
Pressure Ulcer Stages III and IV
Healthcare became really Personal…
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Can you Connect?

All of us must first feel inspired, engaged, and
connected before able to give our best work.
Without a connection, we will still work, but
not as well as needed or desired.
Connection truly is a distinguishing factor.
Slide 92
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Would a Consumer Choose You?
 83 % of consumers are very/somewhat concerned
about hospital quality
 93.8 % reported being willing to go out of their way
(drive further, reschedule appointments) and 64.9%
said they would pay more to seek care at a more
highly-rated hospital
 57 % believe online hospital quality ratings are a
trustworthy source of information
 60.7 % feel the federal government should pay
highly-performing hospitals more
Source: HealthGrades, Inc. 2010 survey
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Behavior Standards are So Important
Patients want to be
cared for by a friendly,
caring, and
empathetic team
Slide 94
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Swim Instructor versus Life Guard
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Coaching versus Criticism
Slide 97
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Mandatory vs. Optional - A Culture of
“Optionality”
Slide 98
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How do YOU respond to Change?
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Change Resiliency  Positive
 Organized
 Flexible
 Focused
 Proactive
-A Change for the Better, Daryl R. Connor
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Those that Deal Well with Change Strong support system/seek support
 Sense of control over their lives
 Positive outlook
 High self-esteem
 See change as a challenge/opportunity
 Committed and involved
 Have an internal belief/value system to
experience change within an overall philosophy
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“Psychologically Hardy”  Recognize Choices – stressful life events as
interesting; separate out thoughts and emotions
 Engagement – work hard to influence part of the
stressor
 Growth – situation is an opportunity to develop
and grow
Slide 102
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Good Leadership is Critical…
Slide 103
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What draws people to Leaders?
 Trust
 Compassion
 Stability
 Hope
Slide 104
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Connecting Heart and Mind
Heart
Slide 105
Mind
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Communicating: The Suggested Sequence
Why
What
How
Slide 106
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Speak to the Head and Heart

Create a compelling story
- Use metaphors, analogies, imagery
- Use simple language

Careful use of data

Infuse energy and enthusiasm

Understand what people are feeling

Frequent, consistent, aligned
communication

Maintain high level of visibility
Slide 107
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Principles of Influence  Self-Awareness: the basic competency of
influence
 Collaboration: the duty of influence, at its core,
is about getting a group of people to accomplish
something that one person cannot do alone
 Connection: the strategy of influence
Slide 108
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You cannot take your Organization
Further than you have taken Yourself
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Characteristics of Effective Leaders..
 Cared about us
 Gave honest feedback
 Developed our skills
 Coached our performance
 Celebrated our success
…….Good Communicators
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Navigating Change -
Some is not a number,
soon is not a time,
and hope is not a plan
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Words Mean Things…
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The Leader’s Role in Navigating through
Transitions
Before
After
During
 Round on your Team and Ask- How are you doing?
- What are you thinking?
- How are you feeling?
- What’s working?
- What’s not working?
- How can I help?
 Rounding on patients
 Thank You’s and Recognition
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Create a Learning Organization Culture
• Create organizational agility and
resiliency
• Encourage pilot programs
• Build organizational alignment
around values and culture
• Encourage staff to be change
agents
Slide 114
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Assist the Skeptics and the Laggards  They dislike uncertainty
 Often the last to adopt
 Point of reference may only be the past
 Little tolerance for uncertainty
 Suspicious of innovation and change agents
Slide 115
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Employees Cope Better  Feel same level of commitment, control and
challenge as their leaders
 Understand that change is important
 Believe they can influence decisions and
outcomes
 Experience the journey not as a threat but an
adventure
 Leadership from top down must create conditions
to make that possible
- Bridges, Managing Transitions
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Reactions to Change are Personal
Consider 3 or 4 changes you have experienced1. What was the change and how was it introduced?
2. What was your initial reaction?
Enthusiasm?
“Wait and see” attitude?
Ambivalence?
Cynicism?
3. Did your attitudes change over time?
4. Was there a pattern to your response?
5. If you experienced ambivalence, how did you resolve it?
6. How have these experiences colored your expectations
and feelings toward change in the future?
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Manage your Energy-

Physical energy:
you are a resource

Emotional energy:
the quality of your
energy
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Manage your Energy 
Mental energy: it’s all in your head

Spiritual energy: connecting to
purpose
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Remember Nursing expertise and leadership in
healthcare today is more critical than
ever
 Stay flexible and positive through
lightning speed change
 Maximize your energy
 Make an action plan
Slide 120
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What has Changed in Healthcare?
 External Environment
 Technology
 Transparency
 Research
 Integration
Quint Studer – Culture of High Performance
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Slide 122
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What has remained Constant in
Healthcare?
 Passion
 Fortitude
 Willingness to learn
 Purpose, worthwhile work and making a
difference
Quint Studer – Culture of High Performance
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Become a Champion of Change..
and Inspire as you Lead
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Our Objectives 1. Examine the external changes in
healthcare
2. Understand one model of successful
change
3. Discuss the critical role every nurse
plays in the future of healthcare
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What are:
Two things you can
start tomorrow that
will make you more
effective to inspire
and lead through
change?
Slide 126
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We all Make a Difference…
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Purpose and Worthwhile Work...
Our patients depend on us and
we depend on you. Yours might
be the first face they see when
they come through our door.
Yours might be the voice they
hear right after a surprise
diagnosis. Yours might be the
eyes they look into as they are
pushed in a wheelchair to a
frightening procedure. Your
attitude reflects us and everything
we are proud of in this
organization. You have chosen to
help serve our patients and we
appreciate you. Thank you.
Slide 128
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Parting Thought -
“If you want to go fast, go alone. If
you want to go far,
go together”
- African Proverb
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Thank You!
Pam Beitlich
www.studergroup.com
(850) 934-1099
Slide 130
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References and Resources
Balogun, J. & Johnson, G. (2005). From intended strategies to unintended outcomes: The impact of
change recipient sensemaking. Organizational Studies, 26(11), 1596.
Bridges, W. (2003). Managing Transitions: Making the most of change. (2 nd Ed.).
Cawsey, T. Deszca, G., Ingols, C. (2011). Organizational Change: An action oriented toolkit.
Thousand Oaks, CA: Sage.
Kotter, J. P. (1996). Leading change. Boston: Harvard Business Press.
Kotter, J.P. (2002). The heart of change. Boston: Harvard Business Press.
Kotter International (2012). Retrieved from: http://www.kotterinternational.com/ourprinciples/changesteps/changesteps
Ritter, J. (2012). Resistance to change and change management. In N. Borkowski (Ed.),
Organizational behavior in health care (pp. 373-397). Boston: Jones & Bartlett.
Zenger | Folkman Company. All rights reserved. UWMC.PM-CCDG.EL4.0 Rev 05.02.06
Slide 131
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