leading through change - national rural health resource center change.pdf · leading through change...

Leading Through Change

Shannon Studden

Program Specialist II

July 18, 2018

1

Rural Health Innovations’ Purpose

Rural Health Innovations (RHI), LLC, is a subsidiary of

the National Rural Health Resource Center (The Center),

a non-profit organization. Together, RHI and The Center

are the nation’s leading technical assistance and

knowledge centers in rural health. In partnership with

The Center, RHI connects rural health organizations with

innovations that enhance the health of rural

communities.

2

Upcoming Initiatives

• Create a culture of learning

• Develop capacity of local EMS to deliver classes

• Develop capacity of hospital Laboratory

departments to provide hands-on components

of MLT/MT curriculum

• Expand relationships with health care facilities

• Create/expand local or regional health care

academy

• Create a Workforce Development Committee

3

More Upcoming Initiatives

• Identify services that will be discontinued

following grant period

• Promote collaboration between entities that are

competitors

• Hand off leadership of stakeholder group

• Develop a pilot program to provide

transportation to health care appointments

• Find solutions to barriers that arose during

grant period

4

You Know How!

• Created a Bachelor’s degree program

• Built relationships with academic institutions

• Built relationships with health care facilities

• Increased awareness of Allied Health disciplines

• Convinced educational partners to expand

programs to rural sites

• Collaborated with local community college to

expand high school health care career academies

• Convinced employers and job seekers to use

website for employment (ruralhires.org)

5

You Really Do Know How!

• Broadened scope of traditional health care

network participants

• Educated 229 people on EMS-related topics

• Increased number of EMT students passing

the state exam

• Implemented CHW training program

• Created Health Care Academy offering

CE/CME to rural health care organizations

• Implemented school-based health center

management

6

Questions We’ll Answer

• Why do people react differently to change?

• How can we help others navigate the change

process?

• How can we manage our own emotions during

the change process?

7

Rider vs Elephant

Rider: Rational

Elephant: Emotional

Jonathan Haidt, The Happiness HypothesisChip and Dan Heath, Switch

8

Recent Research on Emotion

Clinical Decision Making

Providers’ clinical decisions are influenced by their own emotions, particularly anxiety, stress, fear, and denial (Kozlowski et al.)

Behavioral Economics

When we’re feeling sad, we’ll pay higher prices than when we’re feeling disgusted (Lerner et al.)

Emotional Contagion

Nurses implementing a Shared Governance initiative “caught” emotions from their colleagues, influencing perceptions of the intended change (Bartunek et al.)

9

Change Curve

Kubler-Ross, E., 196910

The Journey Through Grief

The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation

Scheck McAlearney et al., 201511

Change Curve: Denial

“It’s probably been one of the most unsettling things I’ve seen for physicians throughout our entire system.”

Scheck McAlearney et al., 2015

Denial

12

Change Curve: Anger

“By the time you’ve actually done all that, your patient encounter is halfway over.”

Scheck McAlearney et al., 2015

Anger

13

Change Curve: Bargaining

“Why do we need a cover letter? Isn’t it enough if I add a progress note?”

Scheck McAlearney et al., 2015

Bargaining

14

Change Curve: Depression / Trap Door

“The first two weeks, I could have quit medicine.”

Trap

door of

despair

Scheck McAlearney et al., 2015

Depression

15

Change Curve: Acceptance

16

Acceptance

“I have all I need at my fingertips. I think it’s a great system.”

Scheck McAlearney et al., 2015

Why do people react differently to change?

17

Reasons for Different Responses to Change

18

Difference in Circumstances

• Input during the change process

• Understanding

• Nature of the change

• Impact of the change

19

Areas of Impact

20

Technical: Resources & Knowledge

Does the organization have the technical resources

I need? Do I know enough?

Political: Power & Influence

How much power will I have to affect my

environment?

Cultural: Values, Norms, Mindsets

What’s important to me? How are things normally

done around here?

Tichy, 1982

Differences in Personal Characteristics

• Experience with the topic

• Openness to experience

• Comfort with ambiguity

• Anxiety

21

How can we help others

navigate the change process?

22

Appeal to the Rider and Elephant

23

Riders without

elephants: Understanding

without motivation

Elephants without

riders: Passion without

direction

Denial

• Manage expectations (“the party’s over”)

• Make the case for quality

• Communicate the vision

Scheck McAlearney et al., 2015

24

Denial

Anger

• Acknowledge difficulties and affirm support

• Communicate the vision

• Form a coalition or find a champion

Scheck McAlearney et al., 2015

25

Anger

Bargaining

• Listen to and implement suggestions

• Acknowledge competing priorities

Scheck McAlearney et al., 2015

26

Bargaining

Depression

• Allow time to adapt

• Reiterate support

Scheck McAlearney et al., 2015

27

Depression

Acceptance

• Reaffirm positive statements

• Continue to ask for input

Scheck McAlearney et al., 2015

28

Acceptance

Addressing T, P, and C

29 Tichy, 1982

Addressing Personal Characteristics

Less experience

• Time to absorb and adapt

• Direct support

Less comfort with ambiguity, higher anxiety

• Defined plan

• Clear end vision

• Frequent check-ins

30

Don’t Forget

• You may be farther along than they are

• Fundamental attribution error

31

How can we manage our own emotions during

the change process?

32

Manage Your own Elephant

• Pause

• Acknowledge feelings

• Avoid judgement

33

Where are you Stuck?

34

Technical: Resources & knowledge

Political: Power & influence

Cultural: Values, norms, mindsets

When You’re REALLY Stuck

• What’s the story?

• What are some alternative stories?

• If a given alternative story is true, how might

you respond?

35

Helpful Resources

Books

• Susan David, Emotional Agility: Get Unstuck, Embrace Change, and Thrive in

Work and Life

• Chip & Dan Health, Switch

• Daniel Kahneman, Thinking, Fast and Slow

• John Kotter, Our Iceberg is Melting

Podcast

• Hidden Brain, March 12, 2018: Daniel Kahneman: On Misery, Memory, and Our

Understanding of the Mind

Blog Post

• Marshall Goldsmith: Learn to Respond, Not React!

National Rural Health Resource Center Website

• www.ruralcenter.org

36

References

Bartunek, J., Rousseau, D., Rudolph, J., & DePalma, J. (2006). On the receiving end: Sensemaking, emotion, and assessments of an organizational change initiated by others. Journal of Applied Behavioral Science, 42:2.

Bridges, W. (2003). Managing Transitions: Making the Most of Change. Philadelphia: DaCapo Press.

Kozlowksi, D., Hutchinson, M., Hurley, J., Rowley, J., & Sutherland, J. (2017). The role of emotion in clinical decision making: An integrative literature review. BMC Medical Education, 17:255.

Kubler-Ross, E. (1969). On Death and Dying. New York: MacMillan.

Lerner, J., Small, D., & Loewenstein, G. (2004). Heart strings and purse strings: Carryover effects of emotions on economic decisions. Psychological Science, 15:5.

Scheck McAlearney, A., Hefner, J., Sieck, C., & Huerta, T. (2015). The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50:2.

Tichy, N. (1982). Managing change strategically: The technical, political, and cultural keys. Organizational Dynamics, 11(2), 59-80.

37

Get to know us better:http://www.ruralcenter.org

Contact Information

Shannon Studden

Program Specialist II

218-216-7044

sstudden@ruralcenter.org

38