Influencing Change
through Collaboration
Jerry D. VanVactor, DHA, FAHRMM
U.S. Army Medical Service Corps
Military Representative to the AHRMM Board of Directors
First…evaluate your
perspective….
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First…evaluate your
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First…evaluate your
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Agenda
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Objectives
How difficult is change?
Critical Thinking
Resistance to change
Equilibrium
Linear Management Concept and Theory
Chaos Theory
Interconnectivity
Stakeholder Management
Collaborative Communications Model
Succession Planning and Management
OBJECTIVES
• Can leaders influence change in organizational
behavior through collaborative communications?
• Does permitting multifaceted ownership of
processes throughout an organization aid in creating
opportunities for change?
• How can change be inculcated into organizational
processes and behavior?
• Who can best use collaborative communications?
• How can change help improve processes throughout
an organization?
Managers among health care organizations must
monitor change in anticipation of points of
convergence among trends and to effectively
meet challenges presented (Liebler & McConnell, 2012)
“More than 80% of all change efforts fail”
-- David Smith, Taking Charge of Change
Some reasons include:
- Underestimation of size and scope of initiative
- Technical constraints
- Lack of good leadership (Slone, Dittman, & Mentzer, 2010)
- Leaders set the direction for change
- Challenge others to develop suggestions for how
to best set a course toward organizational vision,
mission, values
- Develop metrics for assessing success
- Initiatives must be nurtured, cultivated, and
sustained
9
Supply chain specific
constraints
- Fixing the wrong things
- Failing to draw a line in the sand
- Ability to say “no” or “not yet”
- Ability to say “yes” at the appropriate time
- Quantification of benefits with change
- Inability to mitigate significant risks
(SOURCE: Slone, Dittman, & Mentzer, 2010)
- Change cannot be happenstance or based on
a preferred option
- change should be evidence-based and data driven
- Change should be orchestrated among the
very people it will affect
- inclusion = ownership
- Develop a roadmap for change
“If you don’t know where you’re going, you’ll probably end up
somewhere else.”
-- (Peter & Hull, 2009, p. 145)
Cheshire Cat scenario…
“Would you tell me, please, which way I ought to go from
here?”
“That depends a good deal on where you want to get to,”
said the Cat.
“I don’t much care where —” said Alice.
“Then it doesn’t matter which way you go,” said the Cat.
“- so long as I get SOMEWHERE,” Alice
added as an explanation.
“Oh, you’re sure to do that,” said the Cat,
“if you only walk long enough.”
(SOURCE: Carroll, L. (1865). Alice's Adventures in Wonderland, Chapter 6)
(SOURCE: Walt Disney)
How often do we hear…
Employee says…
You ask…
I heard that…
question the motive
I think…
ask for support for the statement
We should probably…
what led the person to make this
assumption
I believe…
show me data to support your
claim
In other organizations…
ask to see products that reflect
that idea as being the best
practice
This is how we have always done it!
WHY? Who made it policy? What do the rules/policies say?
Changing Organizational Culture
- Change requires planning, time, and energy
- Clarify the mission, vision, values, and need for
change
- Review and discuss frequently with those most
affected by change
- Communicate, communicate, communicate…
- Demonstrate patients and persistence
- Live the values being advocated
- Empower others to embrace change – encourage
acceptance and success
(SOURCE: Swayne, Duncan, & Gintner, 2008)
Principles of Resistance
- There is no change without resistance
- Resistance doesn’t indicate that something is
wrong; it indicates that something is
happening
- Can be overt or covert
- Can be active or passive
- “Pay me now, or pay me later”
Do we truly want equilibrium?
- EVERY organization will experience degrees
of disorder and chaos
- Don’t allow yourself to fall victim to
“equalitarianism” (Peter & Hull, 2009)
- Equilibrium may be a sign of stagnation in an
organization’s processes
- Change, in this regard, CAN be a good thing
for an organization
Linear Management
Manager
Supervisor
Subordinate
Subordinate
Supervisor
Subordinate
Subordinate
Supervisor
Subordinate
Subordinate
1st Commandment of the Peter Principle:
“The hierarchy MUST be preserved”
(Peter & Hull, 2009)
Chaos Theory
- Not ‘too many things happening all at once
while seeming out of control and
incomprehensible’
- Chaos Theory defined = while operations will
continue to occur over a period of time,
outcomes will always involve degrees of
variance and interconnectivity among an
array of inputs
- How many times in health care has the same physician asked
for the same thing more than once?
- Do we ever change requirements in health care?
- Resilience is defined by an organizations
ability, not to live under chaos, but to thrive
within it
- Organizations today operate in decentralized
business units and teams
- Much closer to customers than corporate staffs
- Change should originate at operating staff level
- Allows more ownership in the process of change
Interconnectivity of an
operational environment
Political
Infrastructure
Management
Economic
Social
Node
Link
Information
(SOURCE: US DoD, JP 5-0)
Who are stakeholders?
- Anyone with an interest in a process or
outcome
- Anyone who may need to support change
- Anyone who casts a “vote” on your success –
directly/indirectly; overtly/covertly
- May be an individual, group, organization, or
otherwise
Closing Stakeholder Gaps
- Demonstrated commitment to change
- Involve all stakeholders in change teams and
planning processes
- Ask questions – seek input from others
and listen
- Use feedback to shape solutions and
build support
- Regular, ongoing, constant communication
Operational
Environment
Ends
(What is the
anticipated outcome?)
Ways
(How does an organization perform the mission?)
Means
(What does an organization do?)
Strategic
Thinking
Strategic
Planning
Collaborative Communications
(Who else needs to know?)
(SOURCE: Adapted from Swayne, Duncan, & Gintner, 2008)
Strategic
Momentum
Criteria for establishing a need for
change
- Based on a business need, priority or benefit
- Identify a clear objective
- Have a clear beginning and end
- Within your “circle of influence”
- Challenging, but achievable
- Requires support and involvement
- Not your entire job
The science of Process
Improvement and Change
Management…
1.
2.
3.
4.
5.
6.
7.
Identify the problem
Hypothesize
Develop questions for analysis
Analyze potential solutions and root causes
Develop evidence-based conclusions
Identify possible solutions
Implement focused changes
–
–
Pilot a solution
Full implementation
Critical thinking skills…
- Process by which the thinker improves the
quality of his/her thinking by skillfully taking
charge of the structures inherent in thinking and
imposing intellectual standards upon them
- Self-directed, self-disciplined, self-monitored,
and self-corrective thinking
- Seldom should you accept the very first right
answer
– there is often more than one right answer
Strategic
Management
Senior Levels of Management
Process
Development
&
Decision-Making
Corporate
Vision
Development
Mission
Input
Procedural
Guidance
Strategy
Development
Operational
Management
Collaborative Communication
Stakeholder
Demands
Feedback
Loop
Mission
Accomplishment
Output
Compliance
with
Strategic
Goals
Process
Improvement
Ideas
Demand
Satisfaction
Collaborative Communication
Decision-Making
&
Process
Implementation
Mission
Input
Junior Levels of Management
Tactical
Management
Succession Planning
- Changes in leadership at the top levels of any
organization will cause stress and uncertainty
- Succession planning is often NOT a core
competency for health care organizations
- Strongest influence on succession planning =
historical precedence
- NO prevailing theoretical model exists
concerning “correct” succession planning
Reasons for not naming a successor
Response Choice
Not a high priority
Current CEO is too new
N
276
187
(%)
46
31
No internal candidate to prepare
Other
Not part of the organizational culture
Not offered a package
154
120
127
87
25
20
21
16
Challenge of too many qualified candidates
Not viewed as useful
74
7
12
1
(N = 606 freestanding hospitals surveyed)
(SOURCE: Garman, A. N., & Tyler, J. L., 2004, Table 3, p. 13)
Succession Management
- Early identification of talent
- Developmental assignments
- Internal vs. external successors
- Measuring success
- Transition process
- Allowing leaders to lead
Summary
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Objectives
How difficult is change?
Critical Thinking
Resistance to change
Equilibrium
Linear Management Concept and Theory
Chaos Theory
Interconnectivity
Stakeholder Management
Collaborative Communications Model
Succession Planning and Management
References
Carroll, L. (1865). Alice's Adventures in Wonderland. New York, NY: Barnes &
Noble Classics (1994 ed.)
Garman, A. N., & Tyler, J. L. (2004). CEO succession planning in freestanding
U.S. hospitals: Final report. Chicago, IL: ACHE
Harrison, J. P. (2010). Essentials of strategic planning in healthcare. Chicago,
IL: Health Administration Press
Liebler, J. G., & McConnell, C. R. (2012). Management principles for health
professionals (6th ed.). Sudbury, MA: Jones & Bartlett Learning
Peter, L. J., & Hull, R. (2009). The Peter Principle: Why things always go
wrong. New York, NY: Harper Business Books
Slone, R. E., Dittman, J. P., & Mentzer, J. T. (2010). The new supply chain
agenda: The five steps that drive real value. Boston, MA: Harvard Business
Press
Swayne, L. E., Duncan, W. J., & Gintner, P. M. (2008). Strategic management
of health care organizations (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.
Jerry D. VanVactor, DHA, FAHRMM
jerry.d.vanvactor@gmail.com