Going Beyond Conventional Wisdom

Engaging Stakeholders

The Complexity of Healthcare

Healthcare ‘the most complex of any industry’ Peter Drucker.

The Risk of Silo Mentality

Healthcare complexity can lead to a strong silo mentality.

What is change management?

A structured approach that helps 6-sigma teams manage the ‘human aspects’ of change in order to:• Anticipate and manage issues effectively• Provide positive outcomes• Use some tools and techniques to Analyse present state Define future state Develop a transition plan

How do people feel when faced with change?

• Annoyed• Feel alone• The focus on what they are losing (see it as a

threat, not an opportunity)• There is a limit to the amount that one can handle• All people are at different levels of readiness• Revert to the old behaviour when the pressure is off• Doubt they have the resource, time, energy,

money or skills to handle the change

Change and Improvement Do Not Come Easy

Basic premise To improve we must continuously change

Physics tells us

For every action (change) there is an equal & opposite reaction

Human nature

People resist change (i.e. look for excuses, wait and see, etc.)

Why? Because change takes people outside their comfort zones

Therefore The more you change the greater the resistance

The greater the resistance

The more difficult it is to improve

Key StakeholdersPut yourself in the shoes of the stakeholder and answer the Question:

• What’s in it for me? “W.I.I.F.M.?”

• What’s against my interest? “W.A.M.I.?”

The two greatest questions when preparing for a change campaign

How do we recognise Value?

• The customer must be willing to pay for

the activity

• The activity must transform the product or service in some way

• The activity must be done correctly the

first time

What is Stakeholder Management

Stakeholder management is a set of techniques that harnesses the positive influences and minimises the effect of the negative influences

• Differentiate between motive and expectations• Understand the roles each stakeholder will play at

each stage of the project.• Revolving alliances• Picking the right fights• Communication, Communication, Communication!

Identifying stakeholdersPatients

Management and staff

Suppliers

Government

Local Community

Board of Directors

Funders

Media

RegulatoryBodies

Not all stakeholders have • the same expectations• the same motives• are equal

Stakeholder Priorities

Stakeholders:• CEO • HSE/DBF Ambulance Service• Stroke Consultants • Stroke SpRs• Stroke CNS• ED Consultants• ED SpRs• ED CNM3• ED Nurses• ED Admin Staff• Radiologists• CT Radiographers• SHO’s• Medical Records• Operations• Switchboard• IMS department• Laboratory

keep satisfied key players

minimum effort keep informedhi

ghlo

w

low (blocker)

high (supporter)

interest / position

pow

er /

role

1

4

2 3

5

6

78 9 10

1112

1314 16

1718

15

Stakeholders Influence

Who?

•will be adversely affected by potential environmental and social impacts in the project’s area of influence?

•are the most vulnerable among the potentially impacted, and are special engagement efforts necessary?

What?

•stage of project development will the stakeholders be most affected (e.g. design, implementation)

• are the various interests of project stakeholders and what influence might this have on the project?

Which?•stakeholders might help to enhance the project design or reduce project costs?•stakeholders can best assist with the early scoping of issues and impacts?

Who?

•strongly supports or opposes the changes that the project will bring and why?•is it critical to engage with first, and why?•is the optimal sequence of engagement?AND - Whose opposition could be detrimental to the success of the project?

EnablementTactics for your toolkit

• demonstrate competence• buffer from the team• advocate for those who can't• ensure traceability of agreements, requests, or

decisions• make sure there is a structure to engage• make visible lost time (or other impacts) due to

delayed responses• encourage delegation of authority if possible• look for informal settings to access busy

stakeholders

Stakeholder engagement allows Project teams to manage the politics that often come with large complex projects. It helps to win support for your project and eliminates a major source of project and work stress

Project Stakeholder

Define – the problem

Measure – process map the problem area and set up data collection

Analyse – analyse data, identify root causes of problems, identify waste

Improve – draw up improvement and implementation plans

Control – monitor and control risks of solutions failing, handover

? define measure analyse improve control

The Lean Six Sigma Model

SIPOC

UNDERSTAND THE PROCESS AT A HIGH LEVEL

1. Identification of Stakeholder groups2. Identification of the Stakeholder interests in

the project 3. Categorisation with regard to criticality4. Analyzing critical stakeholders and

identification of actions/strategies5. Communication Plan

Stages in the analysis

Stakeholder Roles in Decision Making

22

Consult for

Authority

Involve for Commitment and

expertise

Consider for response or input

Inform for understanding

Enlist for communication and dissemination

Degree of Influence

•This pyramid of decision making authority assists with differentiation of stakeholders by level of influence over the success of the project.

•The degree of influence over a change initiative increases with the position on the pyramid.

Decision Time!

Key Project Stakeholders

• Approvers: Sponsor, Business Owner, Budget Holder

• Blockers: Other Functions who control aspects of the process, legal, regulatory

• Influencers: Key individuals who will be listened to by the Approvers and Blockers

We need to identify all the Key Stakeholders early on so that we can plan how to engage them

Kurt Lewin’s change model

Unfreezing

Refreezing

Moving

RACIOnce stakeholders have been identified the team must determine to what extent stakeholders must be involved in the project (participation, direction, input, inform). A RACI chart is used to capture that information.

• Responsible: execute, participate, do work.• Accountable/approval: provide direction, approval for

Responsible party.• Consultation with this party required, must have some

input.• Inform: Responsible party should inform this group of

actions.

Phase

CommentsNo Stakeholder

Def

ine

Mea

sur e

Anal

ys eIm

prov e

Con

trol

1 CEO I I I I I

2 Director of Nursing C I I I I

3 Directorate Nurse Manager C I I I I

4 CNM from the Pilot wards C A C A A Stakeholder meeting involvement

5 Staff Nurse C R I R R

6 Head of Portering I I I I I

7 Pharmacy Porter C R I A R Stakeholder meeting involvement

8 Head of Pharmacy C I C C C

9 Pharmacy Operations Manager I I C C C

10 Pharmacy Dispensary Manager C R C A A Stakeholder meeting involvement

11 Dispensary pharmacist I R C R RDefinitions:Responsible - work to achieve the taskAccountable - ultimately answerable for correct & through completion and delegates the work to those responsibleConsulted - opinions soughtInformed - kept up-to-date on progress

Kano Model

Excitement

SatisfiersBasic

Perform

ance

Fullyimplemented

Absent

Customer Satisfaction

-

+

Disgusted

Delighted

Basic Quality: These requirements are not usually mentioned by customers. These are mentioned only when they are absent from the product.

Performance Quality: provides an increase in satisfaction as performance improves

Excitement Quality or “wow requirements”: are often unspoken, possibly because we are seldom asked to express our dreams. Creation of some excitement features in a design differentiates the product from competition.

The Kano model

What do our patients want from a service? ‘Listen To’

Right Medication @ Right Time

Basic (‘unspoken’)Access

Contact in hoursStraight to Respiratory Ward, Management Plan

Performer

Delighter (‘unspoken’)Contact out of

hoursStraight to Respiratory Ward

Frustrating-‘Having to explain to junior doctors when breathless, ‘history taking’

Kano Model used to identify from patients what do they want from a service

1. Engage in issues that matter 2. Be ready to act 3. Engage the right stakeholders 4. Engage empowered representatives 5. Seek shared value 6. Agree rules of engagement 7. Manage exceptions8. Provide adequate resources9. Choose the right formats 10. Act fairly Listen to (critical) stakeholder views –• Build trust• Be open• Be accountable • Look beyond the engagement

When you have the basics

Remember Lean is simple and systemic

they must be part of an infrastructure designed to assist in the overall organisational strategy

project teams alone cannot change organisations