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					                Solution Sessions
Compressed Strategy Session That Deliver Big Results
                                Starring

                     Duke Rohe, drohe@pdq.net



                               Applications:

1. Shipping Blood Product via Pneumatic Tube System
2. Evaluating Material Transport Alternatives between Buildings
3. Creation of the GI Overflow Clinic to Service Patients on Off-Clinic Days
4. Revamping the Hospital Service for International Patients
5. Organizing the Thoracic Research Staff Output
6. Ideal Patient Experience Established For University Care Plus
7. Streamlining Discharge Services of Transportation, Lab and Pharmacy
8. Wheelchair Shrinkage Reduction
9. Referral Physician Database Integrity
10. Compressing The Outpatient Visit Day
11. Standardizing Charge Reconciliation




              Right Way                         Wrong Way
                                         Table of Contents
                                                    Or

                                        What’s on What Page




What Is it?       3
Solution Session Map 4
What Makes A Solution Session        5
Team Leader Role          6
„Don‟t Dares‟ of a Solution Session 8
Mr. Big Questions 9
Invitation to a Solution Session     10
Team Members: PreWork is 80% of the Success 11
What‟s It Like In A Solution Session 12
Anatomy of a Sensing Session         15
Sensing Session Questions 17
Fact Finding Questions          18
Ways Managers Can Help          20
Session Plan    22
Sample Kickoff script         23
Sample Session Agenda         26
Way Managers Can Help Their Representatives 20
Post-it Brainstorming 27
Solution Session use of Osborn Parnes Creative Problem Solving   28
Sample Certificate Of Appreciation 29
Effective Sub Team Meetings 30
To Kill An Implementation     33
Check-off List 35
Art Gallery      38




                                                                      2
                                  What Is It?

“WorkOut” is a time-compressed strategy session that brings all the parties
involved in a problem together to explore, design and craft a solution in one
setting. In theory, the doors are locked until a committable solution and plan of
implementation are derived. It works off the premise that more time doesn‟t
make a better decision and a golf game isn‟t much better with fifteen clubs than
with five. This type thinking was a culture buster for GE. It was top down driven
where Jack Welch, Mr. Big, came in and said “You guys all need to workout a
common solution and I‟m be monitoring your success”. Imagine a fast-forward
decision-making process with diverse disciplines all developing a best-fit solution
for the good of the system.

The session‟s agenda followed a creative problem solving technique used in
high-paced “Thinking Expeditions”. Combining this strategy and technique
creates model that can drive collective decision-making in most settings.

Eight disciplines at M. D. Anderson Cancer Center were attempting to put the
policy and procedures in place to send specimens and blood products safely
through the tube system. All had their own opinion of what they wanted to be
included in the tube use policy, but none had the ability to come up with a
collective solution. After three months of committee gridlock, they called on the
Office of Performance Improvement to get objective facilitation support. Having
just completed “WorkOut” training from GE and having creative problem solving
experience, both were combined into a high-impact session that resolved in 5
hours what couldn‟t be accomplished in 3 months. From this experience, a
methodology coined by nursing as a “Solution Session” was created and run in
ten different applications. All ten have turned out successful deliverables. Not a
bad average.




                                                                                  3
Solution Session Map
What is a Solution Session? An event oriented time compressed strategy
session. All impacted who can make a decision are invited. All possible fact-
finding is performed up front. The system of solutions is generated in a 2 to 4
hour session. Action teams develop the solutions and implement them. It‟s
value per hour-consumed ratio hard to match.

When is a Solution Session Used?
  1. Devising cross function solutions are needed.
  2. Where there is no process owner to an enterprise process.
  3. Times where consensus via collective decision-making is imperative.

Who’s invited?
 Content experts who can make binding decisions for their role, function or
  department.
 Those willing to commit to implementing decisions derived in the solution
  Session.
 Those who are willing to fight for the team‟s solution.

What is the manager’s role?
 Either be at the Solution Session or assign someone who can make decisions
  on your behalf?
 Support your team representative by providing them the time, resources for
  fact-finding (answering targeted questions) preparation needed for the
  Session?
 Do your best to assist all research all fact-finding questions and removing
  information barriers to making an informed decision at the Session.

What is the member’s role (member often is the manager)?
   Be prepared to commit to 8 hours of work for every hour of the Session
      length.
   Willingness to shed personal solution for the team‟s solution.
   Conduct fact-finding for your role, function
   Make decisions for the department, function or role they represent
   Gain input from constituents they represent and as well be the champion
      of the implementation itself.

What is the schedule like?
   Fact finding conducted between xx and xx. All members fact-finding will
      be shared with other members.
   Solution Session proposed date xx
   Team session to develop solutions between xx and xx
   First follow-up meeting xx
   Team session to refine solutions between xx and xx
      Second follow-up meeting xx


                                                                                  4
      What Makes Solution Sessions Successful
Responsibility Flow
As long as each know their role and responsibilities, then the best minds can
make the most informed decisions for their customers, their peers and their
organization. Squarely laying the responsibility of their role on their shoulders.
The facilitator cannot do the team leader‟s part, the team leader cannot do the
leadership part, the team leader cannot do the participants‟ part. The Solution
Session brings together the greatest minds of the organization who have the
most at stake in success and asks them to make the best informed decision
toward solution. Then take action to make it happen. It‟s responsibility alignment
with attitude.

      Facilitator: Role is to see to it that the Team Leader performs their role.
      Informs and coaches the Team Leader of how to conduct a successful
      Solution Session: Inquires as to how each of the steps is coming along,
      making certain they have a direct current from the leadership to the
      outcome of the process, that they KNOW that all key participants
      understand their role, their importance and are doing their fact-finding up
      front. The facilitator transfers the outcome responsibility to the Team
      Leader: “This Solution Session process works. It will succeed or fail
      based on you doing your part. If the participants don’t do their part, then
      you will have to make up the difference.”

      Team Leader: Role is to assure participants and their managers
      understand their role in the fact-finding, session and follow-up meetings.
      Conduct sensing sessions for those who are unknowns in terms of
      significance, role and commitment to the success of the session.
      Comment to the participants: “This Solution Session process works. It
      will succeed or fail based on you doing your part.” The Team Leader
      transfers the outcome responsibility Mr. Big: “This Solution Session
      process works. The team will come up with a set of solutions that have a
      firm business case. The only missing ingredient to make the them a
      success in this organization is leadership.”

      Mr./Ms. Big: Role is to sponsor the team, provide limits of sponsorship
      then do any necessary pushing within those limits. Pushing is generally
      not needed, but the mere fact it‟s available at the team‟s request validates
      the outcome‟s importance. Mr./Ms Big kicks off and ends the Solution
      Session. They support the follow-up and final-up meetings. They do any
      organizational blocking and tackling to get the implementation in place.
      Their leadership is only missing ingredient needed to turn the team‟s
      solution into reality. Be willing to fight for the team‟s solution.

      Participant: Role is to do the fact-finding up front. Participate in the
      session. Represent department and peers of their role in the binding


                                                                                    5
decision making of the session. This expansion of accountability is
frightening to most participants and managers and yet honoring at the
same time. It is a temporary leadership role during the Solution Session‟s
duration through implementation. Getting this understanding across is
crucial at the invitation and sensing session. The participants funnel
communication to and from peers within their role and/or within their
department in the fact-finding and in the development and implementation
stages. Participants do whatever is needed to support your subteam and
the total team to create the best set of solutions and implementation.
Each participant feels that failure or success depends on them doing their
part.

Manager of Participant: Role is to support the participant in fact finding,
carving out the necessary time for them to prepare the subteam and total
team solutions and implementation. Frequent inquiry as to any support
needed will add confidence in the participant‟s importance in their role and
input to the total team.

Subteams: Role is to take the ideas about solutions and develop them
into actionable set of strategies. This might include culling out the
undoable ideas, staging short and long term possibilities, creating
procedures, policies, gain input and acceptance…whatever is needed to
develop their set of solutions. There is a lead person deputized for each
subteam at the Solution Session. The effectiveness of these meeting
must be high and it is the Team Leader‟s responsibility to insure that this
occurs. The Team Leader conveys to each subteam: “The total team fails
of they don’t do your crucial part.”

Team: Role is to collectively pull subteam solutions together in a
collective system of solutions and implementation support. Reinforced by
the Team Leader to all the participants: The only way this team can fail is
if you don’t do your part.

The organization: Role is to endure and adapt to the proposed solutions
by their finest. With targeted resolve fro the team, success is in the
making.




                                                                           6
        Solution Session Team Leader Role
                                the hub of success

Roles and Responsibilities

   1.  Owner of the process – from design through implementation.
   2.  Act as Robocop for team assignments and commitments.
   3.  Maintain a bulldog mentality toward implementation success.
   4.  Good at pushing tasks on to those who are best at completing them.
   5.  Sustainer of the gain.
   6.  Work in tandem with the facilitator throughout the process. Free flow of
       thought and communication between the two.
   7. Be an awesome (not overbearing) contributing participant during the
       session.
   8. Expect to spend a 4 to 10 hours for every hour spent inside the workout
       session(s).
   9. Broadcast outgoing information to the team, be a funnel for incoming
       information.
   10. Do the legwork for those who don‟t pull their load.
   11. Keep your promises to the team and those impacted by the change.
   12. Be a cheerleader for the team.
   13. Celebrate ideas and successes often
   14. Be willing to change yourself
   15. Be an active part of the team
   16. Have a „system‟ mindset




                                                                                  7
‘Don’t Dares’ of a Solution Session
                                 Team Leader

  1. Don‟ t dare start a session without the resolve to make it successful.
  2. Don‟t dare invite someone to a session without telling them what is
     expected of them, how important the resolution is, and how to prepare to
     make it productive.
  3. Don‟t dare ask people to come to a session without providing some pre-
     think questions.
  4. Don‟t dare waste the team‟s time on what is not supportive of its purpose.
  5. Don‟t dare allow sub team meetings to be well facilitated or less than
     effective.
  6. Don‟t dare conduct a session without handing out assignments that further
     the team along toward its next meeting.
  7. Don‟t dare allow time passage to dampen team momentum.

                                  Participant

  8. Don‟t dare come to a session ill-prepared; without first doing fact-finding
      from your perspective.
  9. Don‟t dare come to a session unless you are willing to whole-heartedly
      participate in its conclusion.
  10. Don‟t dare come to a session without a willingness to shed your solution
      for the team‟s solution.




                                                                                   8
Mr. Big Questions
Clarifying Leadership Commitment for a “Solution Session”

In a Solution Session (a compressed, lock the door til‟ you come out with a
committable action plan) strategy session, Mr. Big is like the Jack Welch of GE;
the one who leads the charge. Early in the design stages Solution Session, you
had better know all about your power base. Where they are coming from, what
they are looking for, how far are they willing to commit in the participation,
implementation, and sustaining of change. It is much better to learn their
unmentioned expectations and limits up front than it is find out along the way.

A “Sensing Session” with leadership is necessary to
 drive out incorrect assumptions that may be held by leadership and the Team
   Leader concerning the change that is being requested.
 establish up front, the communication and support needed between the Team
   Leader and Mr. Big.
 discover the boundaries of Mr. Big‟s commitment.
 pass along the success factors needed and how leadership can help or hurt
   the outcome of the initiative.
 give leadership confidence in the Team Leader‟s confidence of being
   successful given certain levels of support.

Here are possible questions the Team Leader might use to gain mutual
understanding about leadership support, needs and direction.
      1. In leadership‟s own words, what would they like to come out of this
          change initiative? Get 3 to 4 major goals.
      2. Are there pre-set assumptions they hold about „the‟ solution? Are they
          open for different alternatives? Would they yield to what the team
          derives?
      3. What are the desired time frames for short, medium and long-term
          completion?
      4. Will they be willing to run interference with those who resist the final
          change? Describe mild, medium, and mega-resistance that might
          happen. Note: if they hedge or stay vague, this is a loud message.
      5. What amount of time, in hours, are they willing to spend supporting the
          project? (provide an weekly estimate for coming to kick off meetings,
          encourage the ranks, celebrate, attend progress meetings, …)
      6. What resources can be spent on this initiative? What would be the
          limits? $$, time, change…)


                                                                                   9
Invitation to a Solution Session
Wimps need not apply
                              GI Overflow Clinic
You pit a good worker against a bad system; the bad system will wing every time.
                                Rummler Brache

Purpose of the session: To design a strategy and process to manage the
variable patient care needs of the GI Overflow clinic in a reasonable and
responsible manner.

What is a Workout session: It is a time-compressed strategy session that
brings all the parties involved in a problem together to explore, design and craft a
solution in one setting. In theory, the doors are locked until a solution and plan of
implementation are derived. It works off the premise that more time doesn‟t
make a better decision and a golf game isn‟t much better with fifteen clubs than
with five. This is intended to be a “fast-forward” decision making process with all
disciplines developing a best-fit solution.

Who is invited: All groups who have a vested interest in the GI Overflow Clinic
will be asked to send a representative - physicians, clinic RNs, clinic PSCs, PAs,
Research Nurses, and Business Center staff.

Rules of engagement:
   1.    You will represent your discipline. That means you come with the
         authority to decide what will or will not be done by your discipline.
         Finding the boundaries and non-negotiables beforehand are essential.
         You will be provided with information to help you prepare for the
         session. To make the session as productive as possible, it may be
         necessary for you to meet with your peers before and after the workout
         session to get their feedback.
   2.    All data gathering, knowledge collection, benchmarking, determination
         of authority, rule challenging, and pre-thinking are done upfront.
         Remember that everyone at the session is depending on you to have
         sufficient knowledge to derive a committable solution in this one
         setting, so come prepared. A customized set of questions to guide
         preparation will be provided ahead of time.
   3.    You commit to taking the solution, redesigning your practices and
         policies for a pilot mode and then being the champion for your
         discipline to implement the solution Center-wide.
   4.    You commit to developing and setting the procedures in place to
         sustain the gain.


Nothing is done. Everything in the world remains to be done or done over
   … Lincoln Steffens




                                                                                  10
Team Members: PreWork is 80% of the Success
Handout for prospective members.

Solution Session is a way of pooling diverse parties of knowledge to collectively
make a more informed decision. Since the trademark of a Solution Session is to
come up with a system solution in a single setting, everyone participating must
arrive prepared with the knowledge, pre-thought and system mindedness to
make it happen. Mr. Big and the other members of the session team are not
going to like it if you arrive without the research needed to responsibly answer
questions, make decisions and fully participate in the solution-finding. What you
prepare for beforehand determines your value to the ultimate solution.

 Prepare the way: Think through what might be needed from your discipline‟s
perspective.

1. What is the data that might be needed to make an objective decision?
   Number of staff involved, cost of negative event, occurrences or volume over
   time
2. What is the leeway you have in making concessions in current
   policy/practices for the good of the solution? Challenge traditional thinking
   here. What is the cost of doing it a different way? What about the cost of
   poor quality? What are the options that can be taken and what are their
   ramifications? You are preparing for solutions here, not protecting interests.
3. What are the resources you might need when you get into the “War Room” of
   the Solution Session? A single event solution may require just-in-time
   answers in the home department. You should have folks back in the home
   department ready to scramble to bring in what wasn‟t planned on.
4. Put on your systems hat. It is not you versus another department. It is
   everyone versus the problem. Come expecting to change how you do things
   to make it better for the whole. You may have to subordinate your operation
   to optimize the system output. This kind of thinking will help your research as
   well.
5. Benchmark what other folks are successfully doing on this problem. How did
   they get there? What is the difference between your way and theirs? What is
   the scaffolding of their infrastructure or culture and how might we emulate it?
6. What can you get rid of? What can others get rid of? Anything in the way of
   friction free work is in the way.

The pressure is on. All others coming to the table have gone through this
preliminary effort to make that.

Come ready to do some horse-trading.
What is not available in objective data, pre-work is done through horse-trading.
In the Solution Session, you have the best minds working in a collective field so
the corporate gut solution is going to be quite informed. The degree of success
is dependent on everyone‟s flex.


                                                                                11
                                          What’s It Like In
                                          A Solution Session
                                              Preparation For The Solution Session
                                              The overwhelming success is dependent
                                              on all its members coming equipped to
                                              create solutions and make decisions for
                                              needed change to achieve the session‟s
                                              purpose. Hopefully, before you arrive at
                                              the session all possible fact-finding
                                              regarding the topic has been evaluated.
You have done due diligence is discovering best practices (benchmarked) either
within the institution or in other institutions. You have canvassed fact-finding
input from your counterparts in your department or your role in the organization.
You have explored the negotiable and non-negotiable with your leadership
concerning possible decision-making in the session. Finally any fact-finding
questions you have of any of the other of the session members has been sent to
the team leader. Coming equipped with all this knowledge is your part in a
successful session.

What Can You Expect In The Session
The session length is 4 hours depending on the magnitude of the change it is
tackling. Participants claim it is one of the fastest four hours they have ever
spent. It feels like an explosion of ideas that form into settle into a set of
solutions that have the entire team fighting for their development and
implementation. The session will seem too fast for some, especially nurses, for
they like to complete one task before moving onto the next. The lack of time is
the stimulant to push past personal agendas to derive a set of team solutions.
The output will seem half-baked, but the solution will be fully developed in the
series of post meetings.

Here’s how it goes:
This is one of the most energy packed strategy session you have ever attended.
The participants will be broken into teams of eight. It will almost seem like a
competition of who can come up the most ideas. Each team member will be
equipped with a post-it pad and a marker. The team‟s goal is to come up with as
many ideas (real and far fetched) as possible. It may sound odd, but in this
session Quality is equal to Quantity. This is a creative problem solving process,
so the more ideas created, the more to choose from.

All ideas are captured via post-it notes. Rule: One idea per post-it; each post-it
has at least two words; subject and verb hopefully. As soon as you write it down
you call it out for your team members to hear then post it on the flip chart.




                                                                                   12
   Mess or Objective -Finding: 30 minutes. This is broken into two parts.
    Twenty minutes is spent generating as many ideas about messes relating to
    the given topic. Ten minutes is spent converging clustering the post-its into
    natural categories. Each category is then given a theme header. Throughout
    the session, the facilitator aggressively pushes each team to generate more
    and more ideas, help them get unstuck from evaluating ideas, and think
    outside the box.

       Problem –Finding: 45 minutes. This is the most important part of the
    session and the hardest to get used to. A good problem statement is half
    solved. It is the also the hardest to get used to. The suggestion is to try your
    hand at converting problem issues into problem statements. The problem
    statement usually with the word “How to…” Example: Problems such as
    User error, Wrong types of specimens sent, General Education (i.e. of the
    system, needed phone numbers), Back-up policy if system is down (currently
    non-existent), Turnover of employees would be converted to How to reduce
    user error, How to minimize wrong types of specimens sent, How to make
    everyone aware what is needed to be know, How to have a bullet proof
    backup system, How to deal with high turnover of staff understanding the
    system. Thirty five minutes is given to generating problem statements for the
    for the categories of Messes. To extract more problems, the facilitator calls
    out, “These are the only problems in our way of absolute success!” Ten
    minutes is given to converge these into common themes with headers.

      Solution-Finding: 45 minutes. This is the fun part. Each of the teams
       consolidates all the problem statements into a single wall of problems.
       Solution Finding is done with all thirty brains (if there are 30 members)
       focusing on each problem. Each problem statement is read out to the
       entire group, determined if it‟s worth a solution, and then solutions are
       offered. 35 minutes given to generating solutions 10 minutes to cluster
       them into natural them (often the same as the problem themes). Notice
       these are solutions in seed form, and will be further developed on the
       follow-up and final-up meetings.

      Action/Acceptance Finding: 30 minutes. The solutions themes are taken
    on by teams made up of members in the session. Usually 4 to 6 members. A
    team leader is assigned for each session. Members readily sign up for teams
    they have a passion for. You look odd if you are not signing up.

      Presentation: 15 minutes. Mr. Big usually returns to here the summary of
    solutions that each of the teams. Certificates for participation are often
    handed out afterwards.

      Food Finding: Generally, a catered meal is waiting at the end of the
    session for all that good brainwork.



                                                                                   13
It‟s best to set the follow-up and final-up schedule at the Solution Session. If
possible schedule the meetings is two weeks and four weeks post session. If
that‟s not possible, then attempt to get as close to it as possible. Half the
session‟s success relies on keeping the team‟s energy level remaining high
around bringing their part of the solution back to the big group.




                                                                                   14
Anatomy of a Sensing Session:
Overview: You want everyone coming to the Solution Session fully aware and
equipped to make informed decisions. The Sensing Session is a way to assure
the Team Leader that those coming know what they are committing to,
understand their role in fact-finding, and give them a sense of how the session
and follow-up meeting will be conducted

Goal:
  1. Bring on board those in question of importance, comprehension, and
      commitment of the Solution Session.
  2. Drive out up-font apprehension on the participant‟s and team leader‟ part
  3. Add legitimacy to the Session success.

Participants: This can be a collective meeting of attendees or a one-on-one
with the team leader.

Anatomy:
1. Preliminary: Best if the Solution Session invitation, purpose, description and
   fact-finding question have been distributed ahead of time.
2. Aspects elaborated in the session
       a. If it is a group session, establish facilitator ground rules to assure an
           efficient meeting: Ask permission to interrupt to assure equal airtime
           for all attending or keep discussion on topic.
       b. Origin of the project need for the Solution Session. Good if the value
           of instituting the change could be quantified.
       c. Specify the Session purse and scope (what‟s included and what not)
       d. Who sponsored (Mr. or Ms. Big) the change
       e. Explanation of why they were selected to attend
       f. Elaboration of others who will be attending (those impacted)
       g. Explanation of what‟s in it for them to participate.
       h. Give brief description of what and how a Solution Session is run
                 i. Mr. Big (sponsor)
                ii. Invitation and Fact-Finding question crafted
               iii. Sensing Session conducted
               iv. Solution Session event
                         Mess Finding
                         Problem Finding
                         Solution Finding
                         Action Finding
                v. Ideas created are both short term (within one year) and long
                    term
               vi. Follow-up and Final-up meeting along with in-between meeting
                    to form up the actual solutions
              vii. When final recommendations are formulated and submitted, the
                    only ingredient missing for success is leadership.


                                                                                 15
i. Explanation of their commitment (they represent their department and
   their role across the organization within the scope)
j. Review the fact-finding questions as a means of opening dialogue.
   Highlight that the success of the session hinges on goof fact-finding.
         i. Explain what form the fact-finding is to be returned and by when
        ii. Reinforce that it is their obligation to create fact-finding question
            for others in the session if it can impact the success of the
            session.
k. Pause and ask the group, “What do you think about conducting the
   session in this fashion? ”
l. Provide the schedule to date or at least when they can expect
m. If group session, conduct a Hot wash-up.
         i. Write down Like: what did you like about this session.
        ii. Next, write down Better: what would have made this session run
            better
       iii. Go around room and have each share their likes, them repeat
            for betters.
       iv. Conclude the meeting




                                                                              16
   Sensing Session Questions
   Great answers start with great questions

                                     People Questions


   1. Can the emotion of the problem be used as leverage?
   2. What reservations do they have or obstacles to overcome in order to be a
       full-blooded participant?
   3. Are there tethers to upstream departments that keep them from acting
       decisively and do the up-streamers need to be brought into the Workout
       session?
   4. What effect does the problem have on their operation in manpower or
       service?
   5. Are they improvement-oriented or rule-oriented?
   6. Do the flex or freeze in the face needed change?
   7. Do they use data or expert opinion in decisions making?
   8. Are they influenced by departmental peer opinion?
   9. Are they influenced by Mr. Big‟s opinion?
   10. How permeable are they to internal and external customer needs?
   11. Where does fixing the problem fit with respect to their other commitments?
       Can Mr. Big help here?
   12. Are they a reluctant or hair-on-fire participant?


                               Process Questions
   The brain is a wonderful organ. It starts working in the morning and does not
                                    stop until you get to the office… Robert Frost
General
  1. What are your outputs‟ critical measures of service performance?
  2. What is the average patient wait in your area?
  3. If you work with patient material, how long does it stay in your area?
  4. What are the „moments of truth‟ that are key for a pleasant patient visit?
  5. What are the things in the way of providing top service? Do you have
     influence or are they out of your control?
  6. Are there downstream handoffs, what are their needs/requirements to
     deliver top service? (at the end of your process is a customer – what are
     their accuracy, timing needs?)
  7. Do you know the bottlenecks of your process? How do you keep it from
     getting constricted?
  8. Is the incoming workload match appropriate schedule and mix of staff?




                                                                               17
Fact Finding Questions
People tend to commit to a decision if they have exhausted all the facts.

                                         GI OverFlow Clinic
In Clinic Lobby
1. Is the patient kept aware of how long they might end up waiting? Are there periodic check-
    ins (guidelines) just to let them know they have not been forgotten? How often? Are the
    expectations set up front if a longer than desired wait is known?
2. Is there understanding on how to deal/diffuse with patients who have are demonstratively?

Appointment related
3. Is overbooking allowed? Are there certain physicians who do this more than others? Are
   they aware of it and the impact it has on their patients? Can PAs have an impact on
   minimizing this occurrence?
4. Do you know your no-show rate? Do you know what impact tele-mindering will have? Do
   you know how you stack up to the other clinics? Are there best practices sought among
   clinics?
5. How do you handle late arrivals? Are they placed in next available, non-scheduled slot? Or
   is it first come first serve? Is the practice consistent among all clinics? Should it be?
6. What is the average elapsed days for first available appointment slots for a) ASAP
   appointments and b) routine appointments

Facility
7. Are there cosmetic changes that would professionalism /personalize/servicize the visit with
    little cost?

Educational material
8. Could Education videos be used to add value during a patient wait (while saving time of
    caregiver)?
9. Are the Education materials clear, complete, concise, in laymen‟s language, consistent
    among areas, professional, delivered just-in-time, confirmed as understood?
10. Is the signage clear, professional, friendly? Does the customer know where and when to go
    to their next station?

Internal Communication
11. Does the internal communication pipeline clear, pertinent, uncluttered? Are there collective
    meetings (all staff) at a frequency? Are old expired communication deleted?

Physician awareness
12. Are there informal, fun, effective ways of making physicians aware of impact on patient
    wait/inconvenience? Place a value on patient wait/hour and issue IOUs for the month?
13. Is there a means for a Doctor give up/communicate his unused slots to other Doctors 3
    weeks out? Can there be an incentive for doing such?
14. Is there backup when a physician is out and a patient wasn‟t informed?

Staff education
15. Is there a fast track learning process for newcomers (including the things to watch out for,
    physician preferences, unwritten codes of conduct…)

Service awareness
16. Who are all your internal customers? Do you know their timing needs, accuracy needs?
17. What portion of the time are all the necessary ingredients available for an appointment?
    Chart, Results, staff for time of appointment?
18. Call for help: Is there a list of who to contact for help by type if need?




                                                                                                   18
19. Is there a measure of service „drops‟ (i.e. where the patient drove in from Laredo and we
    failed to notify them their doctor is out of town)?
20. What are the rules and freedoms in recovering from a service „drop‟ (parking voucher, meals
    on us…)?

Billing
21. Is it timely, clear and accurate? How do you know?
22. Is it easy getting to communicate with a counselor and how fast do they respond? Would it
     be helpful to get the patient to rate our financial service at the end of the call?

Communication/Phone/Voicemail
23. How easy is it for the patient to get the answer they need? How do you measure it? Call drop
    rate, hold time? Is there a decision tree to get the right inquiry to the right person? Is the
    voicemail greeting consistently informative among staff and among clinics? Do you have a
    greeting quotient or a report card?
24. If you have voicemail that patient access – is there a minimum requirement for greeting info?
    What about voicemail coverage when someone is on leave? Are all voicemail returned within
    the next business day?
25. Does the Communication suffer from page ping-pong or do return pages come with the name
    of the initiator? Is it communicated via overhead intercom or directly to the receiving doctor?
26. Are patients scheduled at their convenience or the hospitals? When multiple ancillary
    services are required are they scheduled tightly together yet with sufficient lead tome for the
    result to be ready for the clinic?

Organizational learning
27. Is there a method for passing along lessons learned, problem prevention, which could be
    standardized or made available for organizational (all clinic) learning?
28. Is there any means of line-balancing (staff sharing) such that some clinics aren‟t swamped
    while others are idle? Could there be a reward for a clinic migrating available staff to a
    „swamped‟ clinic?

 Process Questions
29. What are your outputs‟ critical measures of service performance?
30. What is the average patient wait in your area?
31. If you work with patient material, how long does it stay in your area?
32. What are the „moments of truth‟ that are key for a pleasant patient visit?
33. What are the things in the way of providing top service? Do you have influence or are they
    out of your control?
34. Are there downstream handoffs, what are their needs/requirements to deliver top service (at
    the end of your process is a customer – what are their accuracy, timing needs?)?
35. Do you know the bottlenecks of your process? How do you keep it from getting constricted?
36. Is the incoming workload match appropriate schedule and mix of staff?




                                                                                                 19
Top 10 Ways Managers Can Help Their Solution Session
Representative
Support is more than lip service

    1. Allow them time to do adequate ‘Fact-finding’. They could easily 8 to
       12 hours just preparing for the Solution Session event. When asked,
       „What will keep you from coming equipped to the meeting?‟ TIME is the
       overriding response. The Team Leader will be distributing Fact-finding
       questions.

    2. Coverage of the team member’s workload while they do their fact-
       finding and subsequent meetings. If they get time off and their
       workload demands don‟t change, it will have the same effect as not giving
       the time. Get someone to help „shoulder‟ the work while they are working
       on the team.

    3. Pave the way for them. Each team member will be representing their
       clinic/department and the peers of their job description. This is a lot of
       responsibility, so the more input they gather they more confident they will
       feel at the session. Offer to help your team coordinate to others. Their
       success in fact-finding is your success.

    4. Do some Solution Session thinking yourself then share your
       thoughts with your team representative. Their Fact-finding includes
       uncovering great ideas that could be performed. It may trigger more
       thinking on their part.

    5. Follow-up weekly to see how they are coming, what they have
       accomplished, do they need some extra support from you? Your interest
       in their success will bring success.

    6. Keep up with the Fact-finding questions given your team member.
       Also the Team Leader questions/prompts trying to address will be
       emailed. If the team member comes to the meeting ill-equipped, they let
       their whole team down.

    7. Encourage your representative to check with the development of
       ideas already in process in your area. Out of these might be ideas or
       problems that may be helpful in the Solution session.

    8. Praise and encourage them. Let them know how important their
       participation is. They will help mold the best practice for all the area they
       represent. A tall order, but the collective minds and resolve of all the team
       members will make this happen.




                                                                                  20
9. Connect with Team Leader if you are running into difficulty
   supporting your team member. They have a directly line to Ms Big to
   make this Solution Session successful.

10. Prepare for involvement in integrating the outcomes of the Solution
    Session into the procedures and culture. If departmental change is a
    battle, organizational change is a war!




                                                                         21
              Solution Session Plan
                                                                                                       color (copy/paste) the percent complete
1. Prework                                                                                                 10 20 30 40 50 60 70 80 90            100
a Secure a Team Leader champion to commit to complete process
b Valid vision/strategy completed/tested Case for change completed
c Secure a supportive, legitimate Mr. Big to champion the Session and implementation
d Develop the rules for session engagement
e Develop list of prework questions by function if possible
e Send out a Call for Commitment to targeted team candidates (all who influence/effected by output)
   Criteria: Work as a team, Respect/Speak for peers, More support than drag to solution
f Call one-on-one if response is slow


2. Sensing Session                                                                                         10 20 30 40 50 60 70 80 90            100
a Schedule session with key function candidates
b Meet with Mr. Big - to understand session role and followthrough enforcement
c Get candidates to develop lists of questions they want answered from other areas
d Create communication plan needed to inform, create moementum, open interdepartent networking
e Encourage/attend departmental data gathering/sensing sessions with functions staff
f Fact Finding -- make sure all areas arrive at session with available facts


3. Session Planning                                                                                        10 20 30 40 50 60 70 80 90            100
a Scope size of session based on team ability, session complexity,
b Develop the Agenda timing of Mr. Big, CPSI Training, Probing Statements, Action Plan creation and Presentation
c Poster the Ground rules, Fact Finding turned in, Purpose, Agenda
d Prethink the session set up needs: tables, material, fun things, scribing support, post-its
e Create walkaway workbooks: tabbed with prework, tools, agenda, training slides, session output, commitments,


4. Session Running                                                                                         10 20 30 40 50 60 70 80 90            100
a Facilitator equipped with CPSI knowledge, Team Leader role defined participant/leader
b Mr Big establishes importance, commitment, support and challenge to have commitable action plan presented in designated times
c Run the folks thru Objective/Fact/Problem/Solution/ActionPlan Finding for both divergent/convergent thinking
d If running multiple teams - schedule collective sessions to report output findings
e If team is cohesive -- move to entire group participating in Solution and ActioPlan Finding
f If teams can not, then run finding sessions separate. Combine their output at the end.
g Schedule Mr Big to return as the action plan is being developed
h Team presents their committable action plan to Mr. Big
i Gather all pieces of data and send session summary of finding to team members


5. Implementation Followthrough                                                                            10 20 30 40 50 60 70 80 90            100
a Team Leader schedule necessary followup session to report on their commitments
b Develop a strategy for implementation success: Start with we are successful, how did we get there? Then turn into action steps
c Followup on each member commitments, team leader runs interference where needed, Use Mr. Big leverage to push support thru
d Keep communication of progress to members to inform/ keep momentum high
e Along side each implementation step, pave way for management/culture acceptance
f Set D-Day for implementation -- allow for lead ime for training, equipment acquisition
g Create an action item punch list and update weekly for team
h Update culture as as the implementation progresses. Be honest with results.
i Bulldog each impediment in the way of success until it happens. People rarely fail, they just quit
j As key success factor data comes in, report it to the masses
k Personal and organizational confirmation/celebration in use
                                                                                                                                   22
Kickoff Script for the Ideal Patient Experience Team
Leaders who speak from the heart and prepare their ranks will win the war

Ms. Big role
 Welcome to the Patient Experience Team, we appreciate your participation.
 You are our elite group, Special Forces for customer service.
 We are here to do what hasn‟t been done before: collectively design how we
  want customer service to be experienced. What it looks, like, feels like, works
  like.
 You are empowered to make changes. We have some moneys for change; I
  will be there for you to support/enforce/reinforce what you come up with.
  Areas we cannot change are: uninfluence-able physicians practices. Our
  greatest leverage will be appealing to their sense of patient good and that
  their counterparts are doing it. (Others??)
 I am expecting that on Jan 14 in a 4 hour “Solution Session”, you will create
  the seeds of best practices that will be followed throughout UCP. I will be
  there to launch you off and I will be there to hear the results. If there are
  problems along the way, I‟m on call.
 Out of this session will come a set of committable action plans, and I will be
  there to support or push you along.

Team Leaders’ role
 A “Solution Session” is what GE calls a Work-Out. It‟s a compressed strategy
   session where you essentially lock the doors until you come up with a
   committable action plan. It is their way of busting up the culture and making
   solid change to keep the corporation healthy. We will have 4 hours to Identify
   our „Messes, Discover the pertinent problems, create ideas and solutions,
   then turn them into Action steps that stick.
 We are full-fledge participants
 We are co-leaders in the session development and project managers of the
   implementation
 Melinda will more than likely be the process owner that holds us to our
   commitments.
 During the Solution Session we will be the team leaders – “pushers” of new
   thinking
 Prior to the session will assist in instilling importance and understanding of
   what is needed.
 We will check up on progress, visit 1-on-1 if needed.

Facilitator’s Role
 Consider me the „climbing‟ guide for a “Solution Session”. One who has
   scaled a similar mountain and understands the way. Of course, your
   mountain has its own challenges.




                                                                               23
   My role is to transfer knowledge on how to stimulate new thinking, accelerate
    collective change, leave behind a means to repeat and apply this in other
    areas.
   I will be a coach and background support to Lorie and Melinda as we turn
    ideas into reality.

Your role:
 Prior to the session
 Your commitment is intelligence-gathering in the form of fact-finding. You are
  deputized for paving the way for change to your counterparts. What are the
  things you need to know before you can make a decision on behalf of ALL
  your peers. Remember Ms. Big is there to support you along the way.
 We need as much as your Fact-Finding as you can prepare. This is as much
  about making a more informed decision than anything else. Here are a
  „starter' list of question you may want to explore before coming to the session.
  Your use to the teams depends on your ability to ask good question and find
  good answers. We need your Fact-finding by January 7th – we will share it
  with the other team members.
 Discover what will make you „safe‟ in making a collective decision and do
  what it takes to get there.
 Your role is to collect ahead of the meeting ALL information necessary to help
  make a collective decision. You will be the “Why?” for testing the existing
  way and “Why Not?” for the skeptics of a new way.
 Research what are best practices among your peers, what about at other
  institutions, how did they get there, what were their pitfalls.
 Develop a feedback, feed-forward network. You are speaking for your
  associates so establish clear communication paths.
 Start now. Waiting to the last minute is an insult to the rest of those on this
  team. Their success is contingent on your conditioning prior to the meeting.
  Expect to spend 1 hour for every hour in the session.
 Touch base with Melinda or Lorie if you need help, more info…

What to Expect
 During the session
 Expect „different‟. We will use climbing analogies. To rush you along, to push
  you further, to give you insight.
 We need you to stretch. To look beyond the way it is. You are the culture-
  busters here.
 Think creatively, put on a pure service mindset, unencumbered by what is in
  the way.
 Expect a fast-paced flurry of thought collection. Pretend the outcome of this
  session will keep you from ending up like ENRON.
 All fact finding, purpose, vision, ground rules will be posterized around the
  room




                                                                                24
   You‟ll be split into two rope teams during Mess-Finding, and Problem finding:
    Lori and Melinda team leaders and participators. The group will be brought
    back together to compare findings and as a large team (if there is FULL
    participation) do Solution and Action/Acceptance Finding.
   You will alternate between divergent thinking (spinning out all possibilities)
    and convergent thinking (recrafting and selecting the best).
   At the end you will prepare a presentation of the solutions to Ms Big.
   Most people say they were rushed. It‟s supposed to be that way.
   Your solutions will be the seeds of subsequent meetings that refine the
    solution and list the transition considerations.
   It will be the fastest hi-energy 4 hour bonding session you will ever
    experience.
   After the session
   You will meet with knowledgeable folk to finalize the solution,
    action/implementation/transition plan.
   It may take several meetings to refine. Expect to spend 1 hour for every hour
    in the session.
   You will pave the way for its success, gaining input, alliances, “Survivor”
    strategies.
   Prepare for the feedback session to the team. Concise, complete, quick.
   Call in Lorie or Melinda if needed. They may join in your meetings because of
    how crucial your meeting is to the team.
   Don‟t short-change the team on „Think” time. Unless you have evaluated
    your solution and implementation from all angles, you jeopardize all.

Closing
 You are the minds that can make it happen – you will be the promoters of the
   change. You will be the ones who will make it stick.
This is the first of many changes that we will engage in. It is either change or be
changed. Better to be on the leading edge of change than the receiving edge of
change.




                                                                                 25
DISCHARGES “R” US
DISCHARGES     US
Agenda
(The faster we come up with an acceptable, commit-able solution, the sooner we get out of
here)

8:00a You are Here
        Food-finding

8:15    Howdy
         Mr. Big stresses a case for action
         Agenda
         Purpose- What are we trying to achieve
         Ground Rules/Responsibilities
         What To Expect
         Instruction Finding
         Bathroom Finding

8:35    Mess Finding
         Instruction:
            Convergent/Divergent thinking
            Harvesting the best, reshaping
         Session
         Present back to group
         Choose the high peaks we must scale

9:00    Problem Finding
         Possible problems
         Prioritize: Hot, medium, mild
         Teams Report Out
         Regroup and refine problem statements

9:50    You deserve a break today

10:00 Solution Finding
 Flurry of ideas that will solve the problems
 Sell and select the best
 Measurement == How do we know we got there
 Present to big group
 Be creatively crazy now.

11:00   Action/Acceptance Finding
         Borrow your solutions
         Prioritize: gotta haves, oughta haves, other
         Assign: Activity Commitment, Who/Completion date
         Prep for Mr. Big

11:45   Present to Mr. Big, Celebration, Schedule to First Follow-up

12:05 PARTY

Two weeks after this meeting, we will reconvene to show and tell our commitments and
finalize implementation pieces.



                                                                                       26
Post-it Brainstorming
Idea generation is a race against time, not painful evaluation
Overview: The Osborn-Parnes creative problem solving technique has an
efficient way to generate large numbers of possible ideas; then as a group, come
up with a collective agreement on which are the most important.

Goals:
   1. Rapidly generate many ideas around a topic (Divergent thinking)
   2. Cluster ideas into „themes‟ that to be acted on (Convergent thinking)

Materials:
3x5 Post-it pad for each participant, pens, flip chart per group

Participants:
Best if placed in groups of 4 to 8

Procedure:
   1. Number people off in groups of 6 (ideal). Can be altered to groups of 4 to
       8
   2. Have them stand around the flip chart, pen in hand
   3. Instruct them how to fill out an idea on a post-it
          a. As you think of an idea, write it down on a post-it. Try to write it
              with a subject and a verb
          b. As you post the note on the flip chart, call it out for the group to
              hear
          c. Generate as many ideas as rapidly as possible. Real ones, fun
              ones. In this exercise, quantity is equal to quality.
          d. Write one idea per post-it.
   4. Frame the specific topic (IMPORTANT) they are to be working on. The
       clearer the better. Example “Generate as many criteria as possible about
       what makes an outstanding team member.
   5. Announce to them a short amount of time (2 to 5 minutes) to generate
       ideas on a specific topic (Divergent thinking).
   6. Holler Go! to start them
   7. Give a count down each minute to move them along
   8. Tell folks if they are explaining their idea, they are not generating. Goal is
       numbers, not rationale.
   9. As a facilitator, steep up the energy by calling out ideas that might
       stimulate thinking. The facilitator‟s energy is contagious.
   10. Push them to get more ideas. The more ideas on the flip chart the more
       to work with.
   11. At the end of the idea generation period, stop them. Next, instruct them
       collectively to look at their post-its and begin moving/clustering them into
       common or natural themes. (2 to 4 minutes)
   12. Once clustering “head” each cluster with a word or two that characterizes
       the entire cluster.


                                                                                  27
Solution Session use of
Osborn-Parnes Creative Problem Solving
The secret sauce to a Solution Session

Overview: To creative solve a problem, use the previously described post-it
brainstorming process for each of the “Finding” sessions below.

If the topic is specific and facilitated aggressively, the group can come up with a
collective solution and action plan, within 1 to 2 hours. Large cross-functional or
institution-wide set of solutions can be completed in 4 hours.

Participants: Those with knowledge and stake in the outcome of the solutions

1. Mess/Objective-Finding (Looking at the “mess” or objectives interrelated
   issues, challenges, problems, and opportunities to find an area on which to
   focus). List significant challenges/opportunities, then isolate the main ones

2. Problem-Finding (Discovering a suitably “fuzzy” problem, full of opportunity
   or need for unusual and novel solutions and approaches). List of problem
   statements, then identify the best wording of the central problem. Start
   statement with “how to…to help folks form how-to statements:
REFRAMING THOUGHT CARD
                                 Problem-Finding
     Thought Starters:

     How to Correct…                     How to Produce…
     How to Improve…                     How to Shift…
     How to Change…                      How to Develop…
     How to Overcome…                    How to Stop…
     How to Reduce…                      How to Exceed…
     In What Way Might We…               How to Do Away With…

                                1999 - The School for Innovators


3. Solution-Finding (Converging on a subset of ideas, synthesizing and refining
   them into potentially useful solutions, and exploring barriers and approaches
   to acceptance). Possible solutions derived from the idea finding, then the
   selection of the best one(s)

4. Action-Finding (Generating and refining potential action steps to move the
   solutions through acceptance and into implementation). The action steps
   needed for successful installation. Most times staff take the solution post-its
   and add names, resources and target dates to them.




                                                                                   28
             DISCHARGE PATIENT FLOW SOLUTION SESSION

                    CERTIFICATE OF APPRECIATION
Presented to

                                    Clara Barton
                   on the seventh day of May, A. D. two thousand and two.

On the occasion of completing the first Discharge Patient Flow Solution Session, I wish to
extend to you my gratitude and appreciation for improving the flow of patients who are
discharged from the institution and reducing the time that these patients must wait to
leave the institution. It is through this level of commitment, hard work and cooperation
that we are able to discover new ways of caring for patients by expediting the discharge
process and ultimately earning their trust. It is because of people like you that we are
make life better for our patients.



VP Nursing Practice & Chief Nursing Officer     VP Hospital & Clinic Operations




                                                                                             29
                                        Effective Sub Team
                                        Meeting Tips
                                         As a team leader, you are responsible for
                                         taking the seeds of ideas for solution, culling
                                         out the keepers and the sleeper, bringing
                                         the minds and the hearts of the team
                                         members together to develop the viable
                                         solutions and insure effective team
                                         meetings provide the deliverables for the
                                         Total Solution Sessions. Your team is an
essential part of the total set of solutions needed to achieve the Solution
Session‟s purpose. Your success affects the total teams success. Here are
some pointers for getting there.

1. Schedule a meeting with your team after the session as soon as
possible. There is a momentum from the session that will aid their engagement.

2. Get the session output as quick as possible. If it is not out to you in 3
business days, get demanding with your team leader. She is there to support
your success.

3. The team leader should envision what a successful process or set of
solutions might look like. Review all the „How-to‟ problem statements, their
solution ideas, the Solution Session Purpose statement and then envision what
the new process, assumptions, culture, resources must be.

4. Review the session post-it output. View all the problem statements in your
team area, view the ideas for solution, add to it, give it context to it. Hint: do this
along with another team member to add quantity and quality of this the output

5. Send out the session output ahead of time to the team members with a
note for them to review and think of ways to accomplish each. That is there
preparation requirement for an effective meeting. Have them think of solutions
for the short-term (within 3 months). And long-term (6 months and greater).

6. Look for pre-thinking possibilities before the meeting. Sometimes there
are ideas for solutions such as policies, forms, etc., that are obvious needs.
Assign these out to prospective members before the meeting so they can arrive
with samples and prepared minds to open up discussion.

7. Time-box your meeting to cover all the ideas, add context to them, define
the perquisites needed to form them into actionable items. Deputize all the team
members at the beginning of the meeting to keep the team on focused, inside the




                                                                                      30
time limit, and looking for action items to that can be distributed to even the
workload. Appoint a Robocop to keep team focused if needed.

8. Deputize outside help. Call on those who can be counted on to assist in an
aspect of the proposal completion. Clarity of the task is essential. Balance the
workload as best as possible among the team…knowledge areas may restrict
this, but try to even the burden.

9. Attempt to give each member a set of assignments so that team
production is high between meetings. Share the load of idea development. For
short-term ideas, generate what is needed to for implementation (create policy,
training curriculum, communication etc.). For long term, at minimum, have all the
implementation steps, information systems specification, etc. needed for the
long-term rollout.

10. The Team leader should ask more and advocate less. Team members
tend to withhold their thoughts unless you ask. Facilitation is really about great
questions. A team leader can give their input by making good inquiries. Think of
all the members as data sources. As a facilitator, if you don‟t harvest all of it, the
team loses.

11 . Be careful not to consume too much time on any one solution.
Discussion is good, but if it is not leading toward an actionable item, make the
best collective decision and move on. Beware of „pet‟ solutions over collective
solutions.

12. Your solution should answer why/who/what/when/how as needed along
with any critical factors/assumptions/prerequisites (i.e. Leadership directive, etc.)
needed for success. Try to think about the business case for each change.

13. Review action items at the end of the session and assure clarity around
what is expected. Send out a set of minutes to the members and team leaders of
the action items, their owners and their completion date.

14. Transfer any ideas for solutions along with their problem statements to the
most appropriate team. During the Solution Session, ideas are consolidated
quickly and may be better suited for another team. Send a request to the other
team and gain agreement before passing it off.

15. After all solutions have been drafted, review the problem statements and
ask: Did our solutions cover all these problem statements sufficiently and are
there more problems statements needed to be developed for success?

16. Develop a list of cross-talk items that needs to be answered by other sub-
teams. Often there are input points needed from other sub-teams to secure a
complete process. As these occur, list them then send them to the appropriate


                                                                                    31
sub-team leader. Put on any timing considerations so their team can have the
input ready by the time it is needed.

17. There are generally two sub-team meetings between the Solution Session
and the first follow-up meeting to be fully prepared. Follow up with the team
members by phone or email to see if they need support and understand the
importance of completing their action item.




                                                                               32
TO KILL AN IMPLEMENTATION
                                                                             Duke Rohe
Tips:
Fighting is fun if you know you are going to win!…Duke

Overview: Most change efforts don‟t die on the drawing boards, but in the face
of an ill-prepared implementation strategy. The ten „killers‟ of implementation
below are not hard to overcome, just easy to overlook.

Goals:
  1. Make the transition through change as smooth as possible.
  2. Become a think-through piece in developing a change strategy
  3. Prepare the implementation team to outlast the resistance to
      implementation.

Participants: Management and team preparing and conducting an
implementation plan.

Procedure: Have the team read the ten „killers‟, then envision their
implementation as a battle against the old way of doing things. As the team
develops its implementation strategy, dialogue how each of these might apply
and is addressed. They must overcome these ten oversights which have killed
many a great solutions before their time.

   1. Be unclear why they are enduring this change. The best way to rip the
      heart out of a change effort is to not be clear on the reason why this
      change must take place. If the troops cannot personally understand its
      benefit to them and the ones they serve, they will defend the old way and
      not fight for the new.
   2. Go into battle with a victim mentality. If management and the
      implementation team can‟t see success, those carrying it out won‟t. There
      needs to be a bulldog mentality that we will do everything it takes to make
      this effort successful. Treat it like a war, not just a battle. It‟s not a matter
      of if we will win, but when we will win. A good saying from TV preacher
      Joyce Meyers, “You can be pitiful or you can be powerful, but you can‟t be
      both!”
   3. Assume everything will fall into place. Assumptions can either save
      you and they can slay you. The worst thing to happen is to assume there
      will be no resistance to change, people will understand what to do and
      everything will unknown will take care of itself. If you don‟t know, then
      YOU DON‟T KNOW. Pretend there is an underground war against the
      change that you are introducing (psst…there is) and you need to know
      where all pockets of resistance are before charging into uncharted
      territory.
   4. Under-resource the effort. Change takes extra thought, effort,
      manpower, stress, and supplies. If ample resources are not evident to the


                                                                                     33
   troops, they will feel at risk to failure. If leadership is supporting the
   change, then they need to supply what is needed to make it successful.
   Example: During the early stages of engagement, leadership may need to
   beef-up staffing until the new way burn-in.
5. Send the troops in ill-prepared. Poor training, incomplete resources,
   instructions not available at the time of need. Instructionalize the
   workplace where possible (use Visual Controls). At the point of action,
   place instructions of what to do, what is needed, who is to do it and what
   happens next. Expecting everyone to keep all this in their head and do it
   right every time is begging error.
6. Go into the engagement without communications. Communications
   are vital signs of the engagement. This includes feedback from the staff
   (what is not going as planned) and feed-forward (what needs to change
   because of what is not going according to plan. It sends encouragement
   from the leadership. A communications system needs to be well thought
   through in content and in frequency. There is an assurance of „caring‟
   relayed as you hustle to support information need.
7. Don’t anticipate chaos. If you don‟t promise chaos, the unexpected,
   boo-boos in the proposed process; you are doing your implementation and
   those deploying it a disservice. People will fight for cause, but they will
   quickly back down from a poor strategy.
8. Forget to hand-hold during the first days of engagement. Promise
   and provide support in the early stages of engagement. Validate their
   output. Listen to their concerns…then answer their need or if at minimum
   promise quick/partial fixes the next day. Until the troops get comfortable
   with the new way, then change „support‟ should be there until they are.
9. Fight the war it all at once. Wars are won one battle at a time. If
   possible, stage the implementation into coordinated a natural sequence
   that match the staffs‟ ability to absorb change. If possible, create a
   „beachhead‟ of success by piloting the change in a small area before total
   implementation. Quick-wins are better than overwhelms.
10.        Expect the new way to remain. Old patterns drift in, enthusiasm
   and the cause for change drift out. Take „change‟ temperature readings
   from the staff. Ask what‟s NOT working according to plan. Measure the
   implementation‟s change on the workforce output. Purposely dismantle
   the old way so they cannot return to it. Incentivize the people to do it right.
   How you follow-up determines whether the staff will believe you that
   change was necessary in the first place.




                                                                               34
      Check-off List for a Successful Solution Session
A wise man is just a fool with a good memory.

   1. Introduce the concept to the team leader. Gain commitment to go the
       distance on bringing out a solution.
   2. Help craft a „Case for Change‟ or „Shared Need‟
   3. Identify and secure an appropriate “Mr. Big”, overall leadership to
       encouraging and supportive yet demanding for results. The higher level,
       the better. Get their time availability at least 6 weeks out (ours was 8
       weeks out)
   4. Identify functions or disciplines or groups that impact the “process”.
   5. Identify key people in those areas you can invite to the session (stack the
       deck for success). Coverage should consider shift and discipline
   6. Test the Case for Change for validity with some of the potential team
       members (backdoor marketing).
   7. Take the process to change/improve develop a set of Fact-Finding
       questions (Attached) for each function to look investigate. The purpose is
       to help make well-informed decisions.
   8. For those areas where key people are unknown – request leadership to
       assign based on the Rules of Engagement (attached). Commitment
       means they represent the decision-making for the discipline.
   9. An email attachment from the Team Leader is sent to each team member
       containing: the purpose of the session, what is a Workout Session like, the
       Rules of Engagement, the front end Sensing session.
   10. Have the team leader run a Sensing session in her on area with her own
       fact-finding questions. This will aid in drawing the same out in others. Tip:
       try to surface major fears to the change and find what would
       minimize/eliminate them.
   11. Team leader to set up a “Sensing” session (attached) with the crucial
       players to clarify and foster their support.
        The purpose of the Workout session
        The reason they were invited to participate
        The rules of engagement
        Their pre session assignment with a due date
        Go over the Fact-Finding questions they ought to research for the
           session
        Ask, “Can I count on you?”
   12. Formulate what is needed prior to session (See mindmap)
        Tips: Set Fact Finding due date 1 ½ weeks prior to the WO Session.
           That way the binders can be given to the team members ahead of
           time. This legitimizes the session. Sample cover, tabs, Purpose,
           Ground Rules, Contact list, Agenda
        Create tools that will help during the session– (refer to Mess and
           Problem finding Reframe cards, So What sheet, 5 minute meeting)
        To set due-dates, approximate time to massage fact finding and load
           binders, sequence and work backwards from Day of WO Session.


                                                                                 35
       Determine schedule to get to the solution and action/acceptance within
        proposed time (ours was 4 hours)
     Determine the number of team members (suggest groups of no more
        than 8) with a facilitator for each. Even out the team makeup between
        extrovert/introverts.
     Prime facilitators for their role: using the sticky notes, moving off detail,
        pressing decisions in time.
13. Develop script for Mr. Big
     Meet to go over script,
     Keep his or her schedule free or soft in case can come in and break
        any stalemates,
     Set a time for him to return to hear the great solutions
14. If scribes are used to collect and print session output real-time
     Test all equipment ahead of time
     Prepare document template for bulleted output
     Develop plan B‟s in case there is an oops!
     Tip: allow time during the session to scribe collaboration, printing
        output
15. Reformat Fact Finding from all the participants homework (see attached)
     Follow-up 3 workdays prior to send out and apply 10% guilt for
        stragglers
     Send out the summary of Fact Findings at least 3 workdays prior to the
        session
16. Design note of appreciation – get signed by Mr. Big
17. Design an overflow gag gift (How about a badge of honor called the O-
    Team)
18. Arrange for food catering or snacks during short session
19. Posters made and hung around room: Fact Findings, Purpose, Ground
    Rules, and Responsibilities for session. Post-it flip chart paper for posting
    sticky-notes
20. Arrive an hour early. Tip: Make certain the room is not occupied the hour
    before. Test out equipment.
21. Bring clock and make available for all to see.
22. During Session – refer to mindmap
     Describe what‟s in their binder. Tip: Many said this binder sent out
        ahead of time would have prepped them before coming
     Tell them what to expect, what they are going to feel like in a
        compressed decision environment,
     Tip: remind them, time is working against you. Don‟t die in the detail.
     Limit teaching to 15%. Mostly on the Creative Problem Solving
        Techniques (attached)
            a. Convergent/Divergent thinking
            b. Mess finding, Problem finding, Solution finding,
               Action/Acceptance finding
            c. Sticky notes (blue slip style) and how to use them



                                                                                36
       Force teams to follow the process, keep them on time on task, stay out
        of the detail
     If there are enough facilitators, assign one for each team
     Tip: Save the sticky notes to compare with scribes work. Remember to
        header them or place a key word to help out the scribe in categorizing.
     The group presents solutions and commitments to Mr. Big
     Mr. Big inquires
            a. Do you feel these solutions can bring success?
            b. Can you go back to your department and pus the solutions with
                my help?
            c. Do you have any questions of me on how I will support?
     Set follow-up meeting to present their progress (suggest two weeks to
        keep the momentum high)
     At the end, Do a Hot wash up using the key words: well what went
        well, better: what could we do better, recommend: would you
        recommend this type of session on other projects.
23. After Session
     Scribes collapse their findings together
     Turn the Action Plan into electronic form
     Meet with two members and get their input/additions to the Action Plan
     Email out to the team one-day post session, including Mr. Big.
            a. Mess Finding
            b. Problem Finding
            c. Solution Finding –
            d. Action/Acceptance Plan
            e. Hot wash up notes
24. Prepare a set of Lessons Learned to 1) continually improve future
    Workout sessions 2) let the team members know what was planned to
    happen vs. what actually happened. Be open to their input and they will
    truthfully give you their opinion directly or indirectly. Email it out to the
    team
25. When distributing the Action Items, make sure Mr. Big‟s name is at the
    front of the list for all to see. Validate with Mr. Big that he received the list.
26. Call each Action item leader (action items scheduled to be complete 2
    weeks post session).
     Define the scope and what is included in their item.
     Assign a point person on each action item so there is not time loss
        waiting on someone else to take a lead.
     Hunt for any holes in action items missing or connections with existing
        processes.
     Offer support where you can add value.
     Check to see if there is a need to sell the idea to the users
     Invite Mr. Big for a roundup of the completed solutions. Notify all the
        team members he will be there.




                                                                                   37
It’s what you do now when you don’t think you have
time to do anything that takes you where you need to be
when it’s too late to do anything about it!
Robert Gary, Texas Utilities




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