Blind Spots for Transformational Change by jennyyingdi


									                                                                                         Volume 10, Issue 3 - February 7, 2011

                                                          Blind Spots for Transformational Change
                                                              By Barbara Balik, Steven Powell, Dorothy (Dolly) Bellhouse

FYA - For Your Advantage, is a free                  eadership is essential for successfully improving processes, managing change and
twice-monthly electronic newsletter.                 promoting a learning culture for continuous improvement to transform how we deliver
With every issue, FYA provides                       care to patients. Mid-level managers and the frontline seek commitment, support and
insights into the topics that concern          actions from senior leaders. Sometimes, however, leaders have blind spots about behaviors
healthcare leaders today and the               that can be barriers to improvement and transformative change.
challenges they will face in the near               We have been pooling our experience and research on leadership blind spots. We
future. The newsletter is provided             presented our initial work in a poster session at the Institute for Healthcare Improvement's
free to healthcare CEOs. The                   Annual Forum in December. This column summarizes potential blind spots of which we all,
editorial content is not copyrighted           as leaders, should be aware. We have also included countermeasures to practice to maximize
– except for those columns                     executives' leadership, engagement and visibility to support and sustain transformational
copyrighted by the author. CEOs                change.
may use the non-copyrighted                        Blind spot: Communication is critical.
material in any way they wish. The
newsletter can be printed without                   While communication is key, leadership actions are even more critical. Communication
prior permission.                              is necessary, but insufficient to lead and sustain change. Your team and associates throughout
                                               your organization pay as much attention (possibly more) to what you do (and do not do) as
FYA - For Your Advantage is                    they do to what you say. If you ask the organization to change, yet you don't, that will slow, stall
produced      by    TrendLeader                or stop your organization's change and improvement efforts. If you say you want the
                                               organization to learn from failure, but you find failure unacceptable, learning stalls. In fact, the
Connections. TLC offers a variety of                                                      1,2
                                               organization will mirror your behaviors.
healthcare products and services
that help executives to differentiate               Countermeasures for this blind spot include:
between “fads” and “trends” and to                    Lead by actions and words. Act your way into a new way of thinking rather than thinking
make connections with “Trend                          your way into a new way of acting. And, foster this habit in your team. Ultimately, your
Leaders” within the healthcare                        leadership will be your legacy. Build a culture that is leader-led, but not specific leader
industry.                                             dependent.
                                                      Provide clear, simple organizational direction.
          Table of Contents                           Memorialize stories of both frontline and managerial learning and change.
                                                    Blind spot: We need to focus on the big problems. Corollaries to this blind spot
                                               include: "Data will motivate change" and "My dashboard is my best friend."
  Blind Spots for Transformational
  Change ........................ Page 1 - 2        Most big problems are an aggregation of lots of small problems. For example, we often
                                               think there's a medication error problem. In reality, there are lots of different medication
                                               problems. Quarterly data can be directional, but it cannot provide enough information for
  Control Costs or Else! ........ Page 3       sustainable improvement efforts. In fact, gathering lots of data to understand the magnitude
                                               of related problems may have an inverse effect on staff's perception and satisfaction with
                                               management's support and focus on improvement efforts.
  Health Law Ruled                                 Countermeasures for this blind spot include:
  Unconstitutional ................. Page 4
                                                      Narrow the gap between problem identification and problem resolution - hours and
                                                      days instead of weeks and months.
                                                      Adopt a "small is big" philosophy. Tackle small problems when they occur.
                                                      Protect time on your calendar regularly for improvement learning at the frontline. Small,
                FYA Staff                             regular doses are better than infrequent larger blocks.
Publisher           Jerry F. Pogue
Editor             S. Harvey Price                  Blind spot: Being certain.
Web Master            Joel Schlarb                 Setting a clear direction for your organization is critical. However, we know things are
Circulation Manager Sheila Keizer              unpredictable. Think of planning a long road trip. You have everything mapped out with
                                               predictions of where you'll be when, but roadblocks and detours are inevitable. The level of
    TrendLeader Connections                    complexity of leading a healthcare organization is increasing in these uncertain times. Thinking
      26 Shawnee Way, Suite C                  you know can be a barrier to being able to see things as they truly are. Thinking you know can
        Bozeman, MT 59715
           (406) 586-6400                                                                                                          (Continued...)

FYA - For Your Advantage                                         February 7, 2011                                                         Page 1
                     Blind Spots for Transformational Change (Continued...)
block your ability to exploit the power of uncertainty and be              your organization to a true learning organization, you need to
opportunistic. If you think you know, you tend to pay less attention.      commit to a longer time horizon. Your organization's culture was
    Countermeasures for this blind spot include :
                                                      5                    built over a period of years. Creating a sustainable culture change
                                                                           requires a multi-year focus. While you can make progress each
       Be curious. No one person, regardless of his or her                 year, to truly change how your organization works (its culture,
       experience or position, has all the answers. Foster the             norms, beliefs and habits) you need to invest your and your team's
       ability to challenge one another safely within your team.           energy and expertise over a longer time horizon.
       Don't assume that the data is telling the whole truth. Go to              Countermeasures for this blind spot include:
       the workplace to see how the work actually happens and
       what problems are encountered. Develop this habit in your                    Set expectations that this will be a multi-year endeavor.
       management team.                                                             Create milestones so you and your team can feel and see
       Cede decision rights to those closest to the problem. Make                   the progress.
       sure you and your team are developing the system, not                        "Feeling" change often happens before "big dots" move.
       necessarily the solutions. If you spend time learning                        Memorialize stories of what the improvements are and how
       throughout your organization, the 'answers' you seek will                    they feel on the frontline and within your management group.
       become self-realized.                                                     A note of reassurance: we have not found these blind spots
       A true learning organization learns from problems. Start            all in one organization. The intent of our research is to make
       with your management team seizing one problem a week                these blind spots visible, so that management is not only sensitive
       as an opportunity to learn and improve.                             to them, but can take action to counteract them. This is not an
   Blind spot: We just need the right people and its corollary             individual activity. Blind spots are hard to see, especially in your
"We just need to hold people accountable."                                 own work and behavior. You will need your management
                                                                           colleagues to help you see yours as you can help them see theirs!
      You need the right people with the right skills. Certainly having
qualified, skilled personnel and staff to deliver safe, effective and
efficient care are essential. Yet, the technical skills required to
deliver and support care are not the only skills required to improve
care processes or change culture. Therefore, leaders must build
capacity for continuous organizational improvement through
training, coaching and mentoring. The right people to act as change
agents may already exist in your organization, but they have not
been adequately engaged, empowered, trained or supported for
the change to be successful.
      Making the outcomes for all work clearly understood will help
people at all levels be accountable. You will be more able to
focus your energies on leading and supporting your organization's
transformation when staff acts accountably rather than having
someone "holding" them accountable. Would you classify your                                                  Left to Right:
institution as a 'learning organization' whereby the focus is on                 Steven Powell, Healthcare Team Training
learning from errors, as well as, successes?
                                                                                 Dorothy (Dolly) Bellhouse, Rule 4 Consulting
    Countermeasures for this blind spot include:
                                                                                 Barbara Balik, PhD, The Common Fire
       Hire for values and provide skills development.
       Build a true learning organization by building your direct              Womack, J., “Homicide By Example?” e-letter 07.13.10
                                                                               Kenagy, J. W., Designed to Adapt – Leading Healthcare in Challenging Times,
       reports' ability to coach and teach problem solving in the              Second River Publishing 2009
       course of work.                                                     3
                                                                               Tucker, A. & Singer, S., Going Through the Motions: An Empirical Test of
                                                                               Management Involvement in Process Improvement, HBS Working paper 2009
       Ask people to "show” you problems instead of telling you            4
                                                                               Langer E., Professor, Harvard University, video blog excerpt from “The
       about them. Ask people how they know about problems –                   Biggest Mistake a Leader Can Make, Insights from Imagining the Future of
       have they seen them?                                                    Leadership, A Harvard Business School Symposium, August, 31, 2010
                                                                               Balik, B, Gilbert, J., The Heart of Leadership: Inspiration and Practical
    Blind spot: Change is an event.                                            Guidance for Transforming Your healthcare Organization, AHA Press 2010
                                                                               Spear, S., Bowen, K., Decoding the DNA of the Toyota Production System,
     Sometimes leaders feel they can change this organization
                                   7                                           Harvard Business Review September-October 1999
this year (in fact, they have to!). Each new year seems to bring a         7
                                                                               Kotter, J., Rathgeber, H., Mueller, P, Johnson, S., Our Iceberg is Melting, St.
sense of urgency around key imperatives. However, to transform                 Martin’s Press, 2005

  FYA - For Your Advantage                                       February 7, 2011                                                                   Page 2
                                            Control Costs or Else!
                        By Rick Kneipper, Chief Strategy and Innovation Officer & Co-Founder of PHNS

       he latest in the continuing onslaught of financial        became one of the nation's biggest private-sector pilot
       challenges for hospitals came from the CEO of             projects for global payments.
       Blue Cross Blue Shield of Massachusetts (BCBS),               BCBS reported that 6,300 doctors paid under the
who recently warned Massachusetts hospitals and                  AQC plan in 2009 had improvements in the quality of
physicians that they must switch from traditional fee-for-       care faster than the 14,200 other doctors in the BCBS
service contracts to a global payment plan. In a letter to       HMO network.
400 leaders of hospitals and physician practices, the BCBS
                                                                      In 2006, Massachusetts passed a sweeping overhaul
CEO stated that hospitals and doctors will have to agree
                                                                 of the state's healthcare system, which influenced the
to accept a global payment plan or will face level or
                                                                 Obama administration's national healthcare reform plan.
reduced payments, according to a Boston Globe 1/23/
                                                                 However, the Massachusetts plan "has since faced
11 article by Robert Weisman.
                                                                 unexpected and unchecked growth in costs, both to the
    Instead of traditional fee-for-service contracts that        government and individuals, forcing the government to
pay for individual doctor's visits and procedures, the BCBS      cut benefits and raise taxes. Now analysts say that without
global payment plan will put hospitals and physicians on         significant policy changes, the program's long-term
an annual budget that will include incentives to control         viability is in doubt," according to an article by Peter
costs and improve care.                                          Suderman in the 1/11/10 edition of The Daily Caller. The
    According to the article, the letter from Andrew             article further states that "Since 2006, the cost of the
Dreyfus, the BCBS CEO, stated that "Fee-for-service              state's insurance program has increased by 42 percent,
payment rates cannot continue to rise if we are to meet          or almost $600 million. According to an analysis by the
the community's goal of affordable care. Ultimately, we          Rand Corporation, in the absence of policy change,
must continue to work to identify ways to reduce the level       healthcare spending in Massachusetts is projected to
of payments."                                                    nearly double to $123 billion in 2020, increasing eight
    The objective of the plan is to stop the out of control      percent faster than the state's gross domestic product
double-digit healthcare premium increases in                     (GDP)."
Massachusetts. The article stated the plan is focused                According to a 6/16/10 Fortune article by Shawn Tully,
on Massachusetts hospitals, which control 30-40 percent          "The median annual premium for family plans jumped 10
of healthcare costs in Massachusetts, according to Nancy         percent from 2007 to 2009 to $14,300 – again, that's a
Turnbull, associate dean and senior lecturer on health           substantial rise on top of an already enormous number.
policy at the Harvard School of Public Health. Cost control      For small businesses, the increase was 12 percent... From
also is a major initiative of the new governor of                2007 to 2009, the employee contribution for family policies
Massachusetts, Deval Patrick, who intends to introduce           rose a steep 17 percent, or $624 a year, to $4,200."
legislation to require hospitals and doctors to move                 Massachusetts led the way to national healthcare
toward fixed annual payments.                                    reform, which led to rapidly escalating costs and little
    The global payment plan is based on BCBS's                   quality improvement. We should watch
experience with an "alternative quality contract" (AQC),         carefully the new initiatives in
a global payment model that rewards providers based              Massachusetts to reform its healthcare
on cost control and medical care outcomes, instead of            system by new methods to improve
the number of visits and procedures. The AQC plan was            quality and reduce out-of-control costs.
previously instituted by Andrew Dreyfus when he was
BCBS EVP for healthcare services, and resulted in moving            I would like to hear your comments.
40 percent of BCBS' health maintenance organization                             Send them to:
(HMO) members to the AQC, which the article states           

  FYA - For Your Advantage                             February 7, 2011                                             Page 3
                                     Health Law Ruled Unconstitutional

      federal judge in Pensacola, Florida, ruled last week               But the Florida lawsuit is the most high-profile and politically
     that the entire healthcare overhaul is unconstitutional.       charged lawsuit against reform. It was brought by 26 states
     This is the most profound blow yet to President                and the National Federation of Independent Business (NFIB).
Obama's signature domestic legislation.                             In addition, several members of Congress signed amicus briefs
    But Judge Roger Vinson stopped short of ordering the            in support or opposition.
federal government to stop enacting the law.                           The issue is widely expected to reach the U.S. Supreme
     Vinson ruled that the law's requirement that nearly all        Court, but probably not until sometime in 2012.
Americans purchase health insurance coverage is not within               The key legal question in the numerous lawsuits over the
the legal bounds of Congress's power under the Commerce             individual mandate has come down to whether the
Clause.                                                             Constitution's Commerce Clause gives Congress the power
     Because several district courts have ruled differently on      to regulate the decision to buy insurance.
the issue, the ruling is unlikely to have an immediate impact           The states and NFIB contended during oral arguments in
on implementing the law, but it is expected to increase the         December that congress has no constitutional right to force
partisan, political rhetoric for and against health reform. The     Americans to buy insurance coverage. They said that while
U.S. Department of Justice said it plans to appeal the decision     Congress is authorized to regulate activity, they can't regulate
and is considering whether it needs to ask for a stay.              inactivity – or not buying insurance.
    "We strongly disagree with the court's ruling today and              The federal government argued that Congress has a right
continue to believe – as other federal courts have found – that     to regulate the insurance market because it is unique – it's fair
the Affordable Care Act is constitutional," DOJ spokeswoman         to assume that every single person will need health care at
Tracy Schmaler said in a statement.                                 some point in his or her life. If they're not insured, their costs
    The Pensacola case is now likely headed for the 11th            will have to be picked up by other consumers, driving up rates
Circuit Court of Appeals, which is based in Atlanta and             for everyone and putting them in the insurance market whether
considered one of the most conservative circuit courts. Other       they plan to or not.
reform-related lawsuits are traveling through the Fourth and             During oral arguments in December, Vinson suggested
Sixth Circuits.                                                     that it would be a "giant leap" for the Supreme Court to say a
     So far, four district court judges have ruled on the merits    decision not to buy insurance is the same as activity. He
of the health reform law. Underscoring the political subtext of     questioned whether Congress could require people to buy other
the legal debate, the judges have ruled along partisan lines.       products if they have a positive impact.
    Two judges, both appointed by Republican presidents, have          Could they "mandate everybody has to buy a certain
struck down the law or its main provision. Two other judges         amount of broccoli?" Vinson questioned, comparing the positive
appointed by Democrats have upheld the legislation as               impact both could have on health.
constitutional.                                                         The federal government argued that health insurance and
   A dozen more legal challenges to reform have been                healthcare are unique markets and that Congress has the
knocked out of court on procedural grounds.                         power to regulate them.

    About                        PHNS provides IT services for hospitals, other healthcare providers and businesses. PHNS’
                                 IT services include application hosting, co-location and managed services; electronic offsite
                                 data back-up and data vaulting; business continuity solutions; disaster recovery services;
                                 and systems integration services. PHNS also provides comprehensive business process
    solutions for hospitals including admitting, HIM (including medical record management and storage, transcription,
    coding, release of information and electronic medical record services) and revenue cycle services. PHNS creates
    business-healthy hospitals by improving operations, enhancing technology and increasing cash on hand, which allows
    hospitals to focus on their core competency – patient care. PHNS has approximately 1,670 customers, including
    approximately 400 hospital IT and business process customers and approximately 1,270 IT customers. PHNS is
    headquartered in Dallas, Texas. See for additional information about PHNS.

  FYA - For Your Advantage                                February 7, 2011                                                      Page 4

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