First Annual UCI Nursing Symposium

Bringing a team together… to make a change

Julio Harriague Senior Transformation Leader UCI Health

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Content

1. Building the Team

2. Being a leader/facilitator

3. Introduction to Change Management

4. Understand how to facilitate effective meetings

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Project Charter

A contract between the project team and the Executive

Sponsor, Champion, Process Owner, Black/Green Belt, and

Financial Representative detailing the specifics of the project

Describes the project using the following elements:

• Problem statement (i.e. definition of project)

• Project baseline

• Project goal and expected benefits

• Project scope and boundaries

• Team membership

• Project milestones

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Forming a Proper Problem Statement

EXAMPLE:

The Pharmacy at UC San Diego experienced an average patient medication

pick-up wait time of 30 minutes from 9/2012 – 11/2012. This resulted in an

average of 5 complaints per day, decreasing patient satisfaction and creating

a negative experience for anyone walking through the building.

Rules for creating a Problem Statement…

1. Description of concern/problem 2. When did problem occur?

3. Measure indicating magnitude or extent of problem 4. Description of impact or consequences presented by problem

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Forming a Proper Goal Statement

EXAMPLE: Reduce the Pharmacy’s average patient medication pick-up wait time from 30 minutes to < 5 minutes by July 1, 2013.

Rules for creating a Goal Statement…

1. Start with verb

2. What?

3. How much? (from ___ to ___)

4. By when?

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Team Members

Objective:

Assure that the team members are aligned around both

the project objective and how they will work together

1. Define roles and responsibilities

2. Understand team composition and structure

3. Understand the role of a leader

4. Understand how to facilitate effective meetings

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“A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable.”

J.R. Katzenbach & D.K. Smith, The Wisdom of Teams

Definition of a Team

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Team Member Roles • Executive Sponsor

• Process Improvement/Project Mgr. Director

• Financial Analyst

• Champion

• Process Improvement (PI)

• Project Managers (PM)

• Process Owner

• Core Team Members

• Ad Hoc Team Members

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Roles & Responsibilities

Sponsor

•Selects projects

•Selects champion and process owner

•Sets timeline and rapid pace

•Removes barriers as raised by champion or process owner

Champion

do not delegate

• Ensures change is sustainable after project closure • Has courage to

ask the hard questions

• Results oriented

• Reports to Leaders

Process Owner

•Runs project day to day

•Ensures team project timeline

•Meets with Champion

•Accountable for monitoring the project Y as part of the control plan

Subject Matter Experts (SME)

•Subject matter expert

•Brings info to and from co-workers

•Ambassador

•Runs tests and collects data

PI/PM

•Change agent

•Supports assessment and testing

• Spend 20% of their time leading project

• Identifies & analyzes data

• Develops control plans

Champion

•Has a big title

•Authorizes and funds work

•Sets tempo

•Asks the hard questions

•Results oriented

•Escalates issues to Sponsor

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• True teams are very different from other kinds of work groups

• Team effectiveness is measured by useful output, not good feelings

• Effective teams are skilled at dealing with internal problems such as conflict

• Diversity and complementary style and expertise make teams stronger

• Effective team leaders practice facilitation leadership rather than controlling leadership

• Teams benefit from the output of all members

• Mutual respect and mutual accountability are the cornerstones of team effectiveness

- George Soete, Reorganizing for a Changing Information World

Key Points About Teams

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Ten Ways to Ensure Team Excellence

1) Interdependence

2) Stretching tasks and assignments

3) Alignment of goals & purpose

4) Engagement of all team members

5) Trust and respect

6) Shared leadership and followership

7) Problem solving skills

8) Confrontation/conflict handling

9) Leader works hard, gives credit to the team

10) Celebration – milestones and completion

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Ten Ways To Kill A Team

1) No planned agenda or team activities

2) No clear purpose or understanding of end goal

3) Leader knows all

4) Not encouraging and praising the team

5) Leader takes all the credit

6) Cancelling meetings

7) Not following through on action items (leader and team)

8) No accountability

9) Negatively portraying process owners

10) Weak leadership (planning, organizing, addressing barriers, resolving conflict)

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Team Member Factors •Size of team

•Interest in and expertise about process

•Variety of perspectives

•Stake in the final outcome

•Team Chemistry

•Level of team experience

•Credibility and ability to represent peers

•Open minded

Team Challenges •Build trust

•Inspire a sense of “team-ness” and create a team identity

•Facilitate/support team decisions

•Expand team capabilities

•Capitalize on team difference

•Build interpersonal/team communication effectiveness

Selecting the Right Team Members

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Stakeholder Analysis

Objective:

Identify which groups/individuals will be most supportive and influential for your project

Advantage:

Determine who should be involved from the beginning of your project to generate stakeholder buy-in (i.e. individuals/groups who may not be supportive/cautiously supportive and can influence the potential outcome of your project should be involved from the start)

Disadvantage:

Can be controversial and politically sensitive

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Stakeholder Analysis - Template

Inpatient Length of Stay Reduction

Patients

Executive Leadership

Team

Nursing

Physicians

Case Mgmt. Identify MD champion and involve from start of project to generate buy-in

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Stages of Team Development

Initial activities or significant change in membership/charter

Lack of clarity about purpose

Members do not know each other

Members rely on external roles and status

Superficial discussions

Disagreement, express frustrations, challenge ideas

Learn to use conflict constructively – or will have passive resistance

Create new guidelines

Re-establish relationships

Re-interpret goals

“Competitive cohesion” develops (“We’re the best”)

THE PAYOFF!

Agreement on goals, roles, norms

Creative confrontation and innovative approaches Based on Tuckman, BW, “Development

Sequence in Small Groups”, Psychological

Bulletin, 1965, 63 (6)384-399.

Forming

Storming

Norming

Performing

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Change Adoption Curve

Finding innovators and early adopters is the first task; Bridging the chasm is the second task

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Abraham Maslow’s Hierarchy of Needs

“People are motivated to fill their unsatisfied needs”

Opportunity on Project

Use Skills

Important, Needed

Team, Friends

Security, Organization

Regular Hours/Plan

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“We are what we repeatedly do. Excellence then, is not an act, but a habit.” - Aristotle Greek philosopher & scientist 384-322 BC

Being a Leader/Facilitator

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Leader/Facilitator Role

What a Facilitator is

Guide

Influencer

Compassionate

Listener

Knows and Follows the PI methodology

What a Facilitator is not

Doer

Directive

Judgmental

Talker

Unaware of the PI methodology

A Facilitator is someone who helps a group of people understand their common objectives and assists them to plan to achieve them

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Understand the Role of a Leader/Facilitator

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Effective leadership requires five skills that are essential to success. The skills are:

1. Leading and Coaching

2. Delegating

3. Communicating

4. Decision making

5. Controlling time

Leadership Skills

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1 - Leading and Coaching

• Be clear on the team’s mission (review charter)

• Identify success criteria (participation, results)

• Be action centered (team tools, action items)

• Establish ground rules (attendance, action items, confidentiality)

• Share information (sponsor updates, your work, regular communication)

• Cultivate team unity (focus on the process)

• Involve people and get input for decisions (build trust)

• Resolve conflict

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Effective team leadership requires that the Leader not try to do everything – but instead to learn to empower and share responsibility with the team

2 - Delegating

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Effective team leadership requires skill in talking with people respectfully and in a way that can achieve results

3 - Communicating

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Team Leadership Communication Styles:

Lecturing: • One-way • Limited questions and answers USE: Disseminating information • Use as little as possible with your teams

Lecturer

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Team Leadership Communication Styles:

Training:

• Two-way

• Questions and answers

USE: Demonstration, mini

lecture, and discussion.

• Introduce new tools and

concepts

Trainer

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Team Leadership Communication Styles:

Facilitation: • The main knowledge exchange is between team members USE: Have team members exchange information and knowledge • build team knowledge • build team understanding • encourage teamwork

Facilitator

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Team Leadership Communication Styles:

Leading team: • Contributing member of the team • Leading team USE: Contributing your own expertise while at the same time leading the team • Leader as SME • Sharing with the team • Providing direction and support

Team Leader

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• Effective team leadership requires that the leader learn and apply

the elements of effective decision making

• Decision making is an important activity for teams. Project leaders

and teams need to make decisions but a method or strategy for

doing so is often neglected

• Recognize that it is time to make a decision, identified who should

make the decision, work the decision making process, summarize

the decision made and implement the decision

4 - Decision Making

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Decision Making - Continuum

Method Value Example

Consensus • Outcome – when a lot is at

stake

• Requires buy-in and support

• Takes more time

• Align team around

charter & project

objectives

Voting • Everyone participates

• Each position is known

• Majority - win / lose

• Rank problem causes

using a Fishbone diagram

with team

One Person • Fast

• High on assertiveness

• Low on cooperation

• Reserve a room

• Escalate a team issue

with project Champion

Different processes work in different settings.

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Decision Making - Consensus

I may not totally agree • But I’ve heard and have been heard

But I will live with it • At highest quality level, focusing on the positive

And will support it • Even after walking out the door

Consensus = Agreeing to proceed with no hidden reservations

It does NOT mean that everyone agrees.

It does mean that everyone agrees to implement and actively support

the decision because they believe their reservations and concerns were

heard and considered and that this decision is the best one under the circumstances.

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Decision Making - Fist of Five Consensus Building Tool

Fist to Five 5 fingers = Best 4 fingers = Good 3 fingers = Okay 2 fingers = Needs more discussion 1 finger = Not good FIST = Totally against or broken

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Effective team leadership requires that you forecast the time needed to accomplish tasks and deliverables

5 - Controlling Time

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What is a good leader?

http://www.youtube.com/watch?v=UQfrcOX5tW4

Role of a Leader

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Habits of Effective Leadership

1. Be Proactive: Take responsibility for your attitude and actions

2. Begin with the End in Mind: Begin each day or task with a clear understanding of your desired direction and destination

3. Put First Things First: Organize and manage your time according to priorities

4. Think Win-Win: Effectiveness is largely achieved through the cooperative efforts of two or more people

5. Seek First to Understand, Then to Be Understood: Most people do not listen with the intent to understand; they listen with the intent to reply

6. Synergize: Create cooperation or teamwork

7. Sharpen the Saw: Self-renewal. Have a balanced program in all areas of your life

- Steven R. Covey, The 7 Habits of Highly Effective People

Are the changes we have underway in our organization leaving our

people behind?

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On Reorganization …

“We trained hard, we performed well, but it seemed that every

time we were beginning to form up into teams and become

reasonably proficient, we would be reorganized. I was to learn

later in life that we tend to meet any new situation by

reorganization … and a wonderful method it can be for creating

the illusion of progress while producing confusion, inefficiency,

and demoralization.” Petronius Arbiter, 210 B.C.

Introduction to Change Management

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• Lack of Change Management

• Lack of Line Management accountability for project results

• Lack of Line Management involvement in process improvement teams

• Lack of formal sign off by Process Owner(s), Champion, Executive Sponsor

• Solution may be dependent on an internal department/function not managed by champion

• Solution may require a separate process (e.g. IT) – with its own proposal pipeline, timeline, and Project Manager

• Solution may not have a clear process owner

• May require technical skill/line authority that the PI/PM does not have

• Business priorities may change during implementation

• Key owners may change jobs

• Limited resources

• Lack of executive visibility of the impact of not implementing

What Leads to Improvement Breakdowns?

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Purpose: To minimize resistance and optimize compliance to the

process changes

Effectively communicate “what and why” changed

Understand and mitigate the sources of resistance in advance of rollout

Enhance driving forces and eliminate or reduce restraining forces

Change Management

Copyright © 2016 Prosci Inc. All rights reserved.

M T W R F

An email on Monday

for training on Tuesday

for “go live” on Wednesday

is NOT the way to prepare

and equip individuals to

successfully change

Copyright © 2016 Prosci Inc. All rights reserved.

Change Is a Process

Where you

are today

Where you

want to be

Future

state

Current

state

Transition

state

Future

state

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Copyright © 2016 Prosci Inc. All rights reserved.

Current

state

Transition

state

Future

state

Employees are comfortable with and prefer the

current state.

The Three States of Change

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Current State

• The current state defines who we are

• The current state is where we have been successful

• The current state is comfortable

The power of the current state

Copyright © 2016 Prosci Inc. All rights reserved.

Current

state

Transition

state

Future

state

The transition state creates stress and anxiety.

The Three States of Change

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Transition State

• Messy

• Disorganized

• Less productive

• Emotionally charged

The transition state is

Copyright © 2016 Prosci Inc. All rights reserved.

Current

state

Transition

state

Future

state

The future state is unknown or not well understood.

The Three States of Change

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Future State

• The future state is not fully defined

• The future state is worrisome

• The future state may not match my personal and professional goals

The uncertainty of the future state

Copyright © 2016 Prosci Inc. All rights reserved.

Successful change requires both the technical and people sides

Current Transition Future

Technical side

People side

Design

Develop

Deliver

Embrace

Adopt

Use

Results

Outcomes

Success = +

Installation*

Realization*

* Daryl Conner

Lean Six Sigma/Project

Management

ADKAR

Copyright © 2016 Prosci Inc. All rights reserved. 50

The achievements

of an organization

are the results of

the combined

effort of each

individual.

Vince Lombardi

Copyright © 2016 Prosci Inc. All rights reserved.

Current Transition Future

T C

C C C C C

C C C C C

C C C C

C C C C C

C C C C C

T T T

T T T T

T T

T T

T T T T

F F

F F F

F

F

T

T

T

F

F

F

F

F

Ultimately requires individuals to move

from their own current to their own future

An organizational move from the current to the future

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Copyright © 2016 Prosci Inc. All rights reserved.

If we do not support and equip

individual transitions,

then our future state looks nothing like the future state we expected

F F

F F F

F

F

F

F

F

F

F

F

F F F

F F F F

F F

F F F

F F F F

F

F

F

F

F

F

F

F

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“Some people change when they see the light, others when they feel the heat.” - Unknown

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Resistance

Resistance is a natural human reaction to change.

Resistance to change is normal.

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Understanding Change

Hand-writing exercise

The Five Building Blocks for Successful Change

Knowledge

Ability

Desire

Awareness

Reinforcement®

What is the nature of the change?

What’s in it for me (WIIFM)?

Understanding how to change (training)

Demonstrated capability to implement the change

Actions that increase the likelihood of continued change

Copyright © 2016 Prosci Inc. All rights reserved.

Real Life Example of ADKAR

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Same change, different Desires

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Not everyone changes at the same pace

Copyright © 2016 Prosci Inc. All rights reserved.

Exercise A

• Take out a blank sheet of paper

• Build a paper airplane

• That’s it!

Copyright © 2016 Prosci Inc. All rights reserved.

Exercise B

• There has been an organizational change

• Work with your team to build your ship!

• Standards are now in place, utilize the

instructions

• Build your ship!

• That’s it!

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• Create a relaxed environment

• Build a climate of trust

• Hold effective meetings

• Resolve conflicts successfully

• Communicate

• Prepare a project plan

• Get the work done

• Have fun!

Understand How to Facilitate Effective Meetings

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Sponsors kick off event and hear report out People who do the work develop the recommendations Decision-makers are present and ensure immediate closure Process addresses passionate issues/problems Topics tackled first are quick fixes Issues are clear, specific, well-defined Complaints are accompanied by suggested solutions Past is honored, not blamed Every issue has a Sponsor

Essential Elements

Complaining

No Blaming

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Team Member Roles

• Guides the group through various activities to achieve objectives

• Ensures all group members participate • Focuses group attention on what needs to be done • Promotes discussion to help the group overcome

differences and reach consensus

Leader

• Maintains focus on agreed-upon processes being used • Suggests techniques to help the group achieve goals • Helps the group apply tools correctly. For example,

when the group is brainstorming, make sure there is no evaluation

Process Checker

• Records ideas verbatim • When flip chart is used, writes large enough

so all can read • Makes sure all flip charts are labeled and

clear

Scribe

Time Keeper

• Leads initial discussion to allocate time to the agenda items

• Monitors agreed-upon timeframes and gives updates on use of time

Clear Role Definitions Help Team Process!

Presenter • Leads presentation of group’s work to other

groups

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Leader/Facilitator Role Adjourning: Terminating the Group’s Work

Performing: Functioning as an Effective Group Working positively toward shared goals Problem-solving and decision-making Open communication, trust, dealing with conflict

Norming: Managing Conflict, Establishing Ground Rules Resolving control concerns Establishing group agreement Storming: Dealing with Issues of Power and Control Conflict among group members Low level of work Confronting dependency on Leader/technical expert

Forming: Developing a Positive Work Environment Becoming oriented to the group Developing commitment Needing direction

Delegating Supporting, letting go

Supporting Offering own ideas and resources Being available for consultation Smoothing boundary between group and organization

Coaching Facilitating communication Surfacing issues, legitimizing Managing conflict Inviting input and feedback Expecting and accepting tension

Directing Climate setting, group-building Clarifying roles, expectations Providing structure

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Time Topic Discussion Leader Materials/Tools

9:00-9:15 Welcome, Introductions and Team Agreements

Champion, Green Belt Tool: Ice Breaker

9:15-9:25 oWhy do this project?-Link to Strategic Priorities oTeam Roles

Champion, Green Belt Tool: UCI FY 2016 Goals

9:25-10:00 Overview of DMAIC Methodology oSMART Goals oProcess Mapping basics oMeasures oBaseline Data oTesting Cycles oHow do we sustain the gains?

Green Belt, Process Owner

Green Belt Presentation

10:00-12:00 Working Session: Our Project Kick-Off oValidate our problem statement, goal and project scope oProcess Mapping our process oWhere are our opportunities? oCause and Effect Diagram oBrainstorm ideas for improvement oPrioritize ideas for improvement oHow will we collect our data? oPlan first PDSA’s oWhat is the schedule for our team meetings?

Green Belt, Process Owner, Team Members

Materials: oFlip Chart and markers oPost-Its Tools: oIn Scope/Out of Scope oProcess Mapping oCause and Effect Diagram oPrioritization Matrix oData Collection Plan oPDSA Action Plan

Meeting Agenda (Example)

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Rules concerning how a meeting will be run

Rules about how team members will interact

Rules on what behaviors are acceptable/unacceptable

Teams should reach consensus on the ground rules they are willing to honor

These ground rules will promote acceptable behaviors, while minimizing

confusion and misunderstandings

Ground rules should remain active and open over the course of a team’s life

Help teams self-manage and self-correct.

Using ground rules as team operating mechanisms:

Meeting - Ground Rules What are they?

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Attendance

Promptness

Assignments

Breaks

Full participation

Conversational courtesy

Decision-making

Other group norms

Establish Ground Rules For

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• Start and end on time

• Limit talking to one person at a time

• Turn off/vibrate cell phones, email, and pagers for the duration of the meeting

• Arrive at decisions by consensus

• Be open to new ideas and opinions

• Keep discussions honest and confidential

• Stay focused on the topics; check other hats at the door

• Have fun

Sample Ground Rules

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Establish a Parking Lot

Topics that will be addressed at the end of the session, or at future sessions

Items that should be handled in a separate forum

Use the Parking Lot to keep team focused and on track.

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PDCA vs. DMAIC vs. Change Management

PLAN

DO

CHECK

ACT

PDCA DMAIC ADKAR

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Elements of Successful Change Management

Strong

Project

Charter

A Clear and

Shared Vision

Capacity for

Change = Haphazard change,

false starts

Strong

Project

Charter

A Clear and

Shared Vision

Actionable

First Steps =

Anxiety, frustration,

learned

helplessness

Strong

Project

Charter

Capacity for

Change

Actionable

First Steps = Diminishing

momentum,

diffuse effort

A Clear and

Shared Vision

Capacity for

Change

Actionable

First Steps =

Low priority,

bottom of the in-

basket

Strong

Project

Charter

A Clear and

Shared Vision

Capacity for

Change

Actionable

First Steps = Successful

change

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Implementing Change

Lean Six Sigma

Methodology

Change

Management

Effective

Results

Lean Six Sigma Green Belts

Effective Results (R) are equal to the Quality (Q) of the solution times the Acceptance (A) of the idea and

Accountability (A) of the implementation

Q x A2 = R

On Time, within Budget, and the Business, Technical, & Human Objectives are met

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