Masterclass on Best Practices of Managing Change - Day 3 Case Hospital - learning and teams

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IMPROVED STRATEGIC MANAGEMENT
CAPACITY PROJECT
Management of Change:
Learning from International Best
Practices
9.10.2013 - Ankara

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The Long Conversation:
Building Key Org. Capabilities

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Hospital of Children in Minnesota, USA

•

Medical errors are estimated to kill 44,000 to 98,000
patients annually.

•

Each year, in USA’s hospitals, 6.7% of all admitted
patients experience a medical accident.

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•

Anne Wilson is the Chief Operating Officer at the Hospital

•

She was recently witness of a nearly fatal event related
to a morphine overdose at the Hospital. Immediately after
the incident, a team began to examine its causes.

•

Anne prepared her meeting with the child’s parents. This
was a challenging and stressful situation for her and the
parents.

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•

Anne came to Hospital with the expressed intent to make

safety her highest priority.
•

She began by assembling a core team of people to
help design and launch the Patient Safety Initiative.

•

She also started to gather data on the current state of
patient safety; she conducted 18 confidential

focus

groups

with doctors, nurses, pharmacist, etc.
Employees felt relieved to have a safe place to discuss
their experiences with medical errors.
•

“As we conducted the focus groups, my office became a
confessional”.

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•

Anne launched a strategic planning process to define the
organization’s goals and objectives for the next five years.

•

Anne coined the acronym SAFE to summarize the four components
of the Hospital’s strategic plan.
SAFE stood for
Safety, Access, Financial, and Experience.

•

The safety component established the objective of achieving zero
defects in the delivery of clinical care and medications to patients.

•

Access involved eliminating deferrals, improving cycle time, and
increasing the number of patients served each year.

•

The financial component established goals related to cash
flow, return on capital and productivity.

•

Experience focused on enhancing patient/family satisfaction.

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Improve performance against Agency Mission
Type of Public
Organization

Mission

Examples

Performance
Objectives/Metrics

Service Delivery

Provide specified
services to the public
as efficiently and
effectively as possible

Health care agencies, Efficient delivery,
infrastructure
security and integrity,
development
error minimization
programs, financial
services, information
distribution, social
service agencies

Analysis and
reporting

Provide policy makers Treasuries, budget
with specified
authorities,
information and
intelligence agencies
analysis

Accuracy, timeliness,
risk management

What is my organization’s mission?
How is it expected to create public value?

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Lack of a performance culture

Before Change:
•

•
•

OSHA measured success in terms of the
number of inspections and fines
(sanctions) imposed.
Punitive attitude toward business.
Employees lose sight of the overall
mission.

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Lack of a performance culture

After Reform:
•
•
•

•

Commitment to Mission.
“Reducing
the
number
of
injuries, illness, and eaths in the
workplace.”
Goals and metrics related to “the
elimination of all preventable workplace
ills in ten years.”
Literally impossible to achieve --) goal
was to stimulate innovative thinking.

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Anne wanted to transform the organizational
culture to provide an environment conducive to
discussing medical accidents in a constructive
manner

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She took several important steps.
She created forums
where staff members
could come together to
discuss safety issues

and learn more
about current research
in the field.

Second, she instituted a

blameless
reporting system
for recording medical
errors.

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Anne

established

several

structures

and

processes to oversee and implement the patient
safety initiative
•

Patient Safety Steering Committee

•

Focused Event Analysis Process

•

Medication Administration Process

•

Safety Actions Teams

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Patient Safety Steering Committee:
• Oversee the safety initiative.
• Included many physicians as well as nursing union
leaders, a Board member.
• Committee took collective responsibility for
setting goals for the safety initiative and for revising
hospital policies and procedures.
• For example, the committee created the

Event Analysis Process.

Focused

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Change Program must be…
Element

Description

Organizational
structure

Teams and Social Open Networks
combined to provide both depth of
dimensional (function, processes) detail,
and breadth of multi-dimensional
perspective. Effective governance

by the cross-unit management
team with participation of key users.

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Focused Event Studies:
Conduct investigations following serious (and less
serious) medical accidents,

Learn a great deal about improving patient safety
by applying this structured
procedure frequently.

problem-solving

Conducting a confidential blameless analysis of
the incident.

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Medication Administration Process:
Effort to overhaul the hospital’s medication
administration system with the goal of
achieving zero defects.
Effort to demonstrate how the organization could
improve
patient
safety
by
redesigning
processes and systems.

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Safety Actions Teams:
Mary, a clinical nurse specialist, decided to create a safety
action team in the hematology/oncology unit.
This cross-functional team of eight employees began
to meet monthly to discuss medication safety issues.
After the meetings, the team members briefed their coworkers about the problems they discussed and the
improvements they hoped to implement.

Each person also gathered ideas and suggestions to
share with the rest of the team at the next meeting.

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Safety Actions Teams:

Two other units observed the Mary s efforts and
launched safety actions team in their areas.
Witnessing these successful efforts, the Core Committee
directed the manager of each clinical unit to establish a
safety action team.

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Building Organizational Capabilities

Changing the collective behaviour
of the group changes the culture…

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Collaborative network

Element

Intra-unit team

Social network

Org. Scope

Functional or business units

Multi-functional and multi-business

Size and
cohesiveness

Small, closed and tight

Large, open, and loose

Members

Employees affiliated to functional or
business unit

Users across the organization at all
levels.

Perspective

Depth of dimensional detail, regarding
function, product, geography or channel.

Breadth of multi-dimensional
interdependences

Paradigm
Variety

Low. Social and technological affinity
induces shared paradigms among
members.

High. Paradigms may clash, exposing
conflicts and dilemmas.

Coordination
Role

Key user coordinates intra-unit work and
learning, connecting it to the larger multidimensional perspective addressed by the
social network.

Key users participate in crossfunctional action-learning and
knowledge diffusion across the social
network, informing it with their narrow
intra-unit perspective.

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Final Thoughts

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Leading through an involved and
developmental style of leadership
that creates a supporting
atmosphere for learning &
exploration

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…working on the short and long
terms in parallel, you are going to
be stronger.

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Change Program must be based on…

A structured chronological framework

A Development and Learning process

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Element

Description

Strategy

Bidirectional alignment between organization and the adoption strategy.
Automation, coordination and information support opportunities are identified by
a discovery process that contains Osmosis, Growth and Adaptation. Strategy is
not only deliberate, but also emergent.

Leadership

Top managers create the appropriate environment for exploring opportunities
and learning; this environment is neither directive nor laissez faire but “involved
and developmental”. Cross-unit management team stimulates convergence of
the learning process.

People

Key users/agents are catalysts of learning acting as pivots between the deep
intra-area perspective in their units and functional domains and the broad interarea perspective of internal and external business processes and systems.
Supporting specialists work under a “prototype” mindset.

Organizational
structure

Teams and Social Open Networks combined to provide both depth of
dimensional (function, processes) detail, and breadth of multi-dimensional
perspective. Effective governance by the cross-unit management team with
participation of key users.

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Element

Description

Planning and
Control

Directed incrementalism: a management decision making approach that
balances direction (expressed as vision and objectives) with incremental
execution. Visions are translated into strategic options and put into practice
through action-learning. Fast learning cycles eliminate non promising options
and concentrate resources on most promising ones, progressively revealing
appropriate transition paths. This approach is key to handle the inherent
uncertainty and political context of the Long Conversation.

Motivation

People motivated by an environment of collaboration, discovery, conjoint design
and public recognition of contribution, combined with the satisfaction that results
from achieving business value from ES by co-creating a path of small,
progressive victories.

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Be a Leader, not a Bureaucrat

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Oswaldo Lorenzo
Professor of Management
Deusto Business School, Spain
Blog: www.longconversation.com
@Lorenzooswaldo

Masterclass on Best Practices of Managing Change - Day 3 Case Hospital - learning and teams

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