Leadership in a Dynamic Environment: Creating an Organizational Cultural Advantage

March, 2015

By: Philip Hurst Ph.D. & Quincey Jones MBA

Objectives To explore the type of challenges your organization

is facing and will be facing in the near future. Examine lesson learned from the type of initiatives

that have worked in the past to solve challenges. To learn about the critical factors necessary to

create an organizational culture that supports key initiatives.

Learn how leaders can be more effective in implementing and sustaining initiatives.

As T.S. Eliot once said:"If you aren't in over your head, how do you

know how tall you are?"

It’s one thing to push past comfort zones and test your capabilities,but it’s quite another thing to survive doing so. Here’s the thing –good leaders take risks, but great leaders are prepared for the risks they take.Mike Myatt- Forbes contributor

How To Be In Over Your Head Without Drowning

Technical vs. Adaptive Challenges Ronald

Heifetz, Senior Lecturer in Public Leadership and Co-Founder of the Center for Public Leadership at the John F. Kennedy School of Government, Harvard University, and his work on leadership and organizational change

Two different types of challenge that organizations face- ‘technical’ and ‘adaptive’ challenges.

Technical challenges are ones that can be solved by improving an organization’s current practices. Solutions already exist in the world and experts can be used to align the organization’s strategy with established ‘best practices.’ Problems of this type are easily identified and lend themselves to an incremental approach that modifies business-as-usual, without deviating far from it (e.g., Electronic Health Records.).

By contrast, adaptive challenges are those that do not have clear set procedures, few ,if any, recognized experts, and no evident responses available to meet the challenge or solve the problem. They are more difficult to identify and easy to deny (e.g., IHC).

Review the following list and circle the technical and adaptive challenges your organization will face in the near future.

Environmental Change Factors within Healthcare

Heath insurance exchanges T

ICD-10 T Organizational

bandwidth A/T Money grant funding A/T Sustaining the mission A Price transparency T

Need more physicians T

Access to care T/A Philanthropy A Employee relations A Executive turnover A IHC A Others

__________________

Organizational Change Initiatives Exercise

In today’s world organizations are constantly implementing important change initiatives. Individually, write down three or four initiatives that your clinic/company has implemented over the last three years e.g., creating new services,:

______________________________ ______________________________ ______________________________ ______________________________

Organizational Change Initiatives Exercise

Discuss the initiatives above at your table. Did you have any initiatives in common?

Individually, put a star by the most successful (i.e., employee engagement, longevity, morale, and impact on results).

Initiative Exercise

What did you do more of, less of, or different to help create success for these initiatives?

___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

Leadership- Identifying Core AttributesMichhael J. Holosko 2009

Using a simple content analyses of both empirical and conceptual articles, the top five cited aggregated attributes, referred to a score leadership attributes, ranked in descending order were

1. Vision Having one: To have a description of a desired condition at some pointing the

future Implementing one: To plan and put in place strategic steps to enact the vision

2. Influencing others to act: To inspire and enable others to take initiative, have a belief in a cause and to

perform duties and responsibilities

3. Teamwork/collaboration: To work collectively and in partnership with others toward achieving a goal

4. Problem-solving capacity: To both anticipate problems and also act decisively on them when they occur

5. Creating positive change: Moving people in organizations to a better place than where they once were

Environmental Change for Integrated Heath Care: Key Long Term Impact Goals

Behavioral Health Specialists are located within active clinics in the main Federally Qualified Health Centers (or Look Alikes?)

Brief evidence-based behavioral health services are delivered routinely Administrator and primary care provider buy-in for integrated care occurs Workflow plan is established and disseminated Primary care providers use warm-hands offs as part of their regular practice

habits Behavioral health screenings are conducted routinely Behavioral health is part of the agencies organizational structure and

mission Behavioral health data is entered into the Electronic Health Record in a way

that is easy to access and can be complied into regular reports Behavioral health plans are incorporated into the overall treatment plans Behavioral health services are billed for and reimbursed by Medicaid as

allowable

How to stay focused through turbulent change? “Smac Recipe” (Specific, Methodical and Consistent)

• Operating DNA code for turning strategic concepts into reality

• Consists of 8-10 durable operating practices

• Which create a replicable and consistent success formula

• That is easy to grasp, articulate, follow and understand

• Helps employees know what to do and what not to do

• Lays out a simple and concrete framework for making decisions and taking actions

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COMPANY LEADERS

EMPLOYEES SAFETY CULTURE

SmaC Recipe Is Not A The Same As

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RESEARCH ON SUSTAINING HIGH PERFORMANCE

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SmaC Recipe - Fanatic Discipline Cycle

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What is Clinic Culture?

Culture is “the way we do things around here.”

Culture is the code, the core logic, the software of the mind that organizes the behavior of the people

The culture reflects the lessons learned that were important enough to pass on to the next generation

Culture is what we do when we think no one is looking

Gradient of cultural resistance to change initiatives

Prepared- embraces and encourages change

Unprepared- slow to change with some push back

Contra-prepared- highly resistant

Prepared Cultures focus groups say

High energy and very team oriented culture with lots of room for advancement

If you don’t value our mission you will not make it through orientation Heard it before but it is real here, we do value people Throughout the organization it is a respectful work place Guys are willing to help and ever one is willing to watch each other’s

back Comradery is strong in the field Very clear from top down understand what to do We look out for the new guys Coaching, mentoring is high in the field. There is a clear ‘care’ in the craft. Don’t be shy to speak up

Unprepared Cultures focus groups say

Be open and want to learn Good attitude. Have a positive work attitude, in other words do not let

the political jargon above you get in the way A lot of frustration in getting the job organized a lot of barriers to

getting the job done. There is a lack of organization and communication All in all a okay place to work Just stay focused on doing your part and pull your weight It is a stable company and we get good pay but it could be managed a

lot better There is an open door policy except a few Follow company protocol and remember fitting in is the key so play nice

with others Taboo, don’t be a cowboy, slow down make sure your supervisor has

given you the green light

Contra-prepared Culturesfocus groups say

Be open to a lot of criticism Keep your mouth shut- do your job and keep your nose clean Don’t mess up – first time you have a bulls eyes No team spirit- bosses only care about their bonuses- Even if out of your control they hold you accountable--- follow the book, if

you don’t you are in trouble, e.g. days off without pay Do what you are supposed to do and be where you should be Be prepared to earn your money, there isn’t anything else Don’t ask questions Don’t do it if you don’t know what you are doing Relationships are very bad. WE get it from the supervisors and the

supervisors get beat down not broken down by the managers Lot of years and we get a little leaner every year

The Denison Culture Model

Culture is about Relationships

What we want: Company that:

Grows our potential by developing our skills and competencies.

(Capability Development)Supporting evidence:_____________________________

Encourages sharing of successes and failures… without ‘just focusing’ on fault finding.

(Organizational Learning)

Supporting evidence: ___________________________

Is receptive to new ideas or suggestions regardless of where they come from.

(Creating change)Supporting evidence:_____________________________

Culture is about Relationships

What we want: Management that:

Defines ‘why’ we are in business, what is our purpose, and what we ultimately hope to achieve. (Vision)Supporting evidence:_____________________________

Provides us principles to guide our organizations conduct and help employees and leaders make consistent decisions and behave in a consistent manner

(Core Values)

Supporting evidence: ___________________________ Provides us with our long term strategies – high priorities

established to ‘operationalize’ the vision.(Strategic direction)Supporting evidence:_____________________________

Culture is about RelationshipsWhat we want:

A supervisor that: Can clarify those areas where employees can make decisions, have

input, or those areas beyond an employee’s scope and responsibilities.(Empowerment)Supporting evidence:__________________________

Will engage in dialogue and get multiple perspectives so they can resolve the inevitable challenges and problems that arise as we work together. (Agreement)Supporting evidence:___________________________

Help employees understand how the work they do impacts others-how other’s work impacts them.(Coordination & Integration)Supporting evidence:__________________

Communicates our objectives with focus on both task (what) and process (how) that we need to meet in the next 3 months to a 1 year. (Goals)

Supporting evidence:__________________________

Culture is about Relationships

What we want: Peers that:

Are reliable in getting their job done and help to build effective work teams.(Teamwork)Supporting evidence:_____________________________

Strive to help our customers (internal and external).(Customer focus)Supporting evidence:

____________________________

Global Purchasing: Executive Team

Global Purchasing: Middle Managers

Global Purchasing: Buyers

Return on Shareholder’s EquityLow Performing Culture High Performing Culture

Average ROE = 6% Average ROE = 21%

• Study of 161 publicly traded companies from a broad range of industries• Contrasts the performance of the 10% of the organizations with the best culture scores with the 10% of the organization with the worst culture scores• Average ROE for the organizations with the lowest culture scores is 6%, average ROE for organizations with high culture scores is 21%• Highly similiar results for return on total investment

• Study of Automotive Service Centers in the USA• Total of 338 dealerships and over 12,000 employees• Compares organizational culture and customer satisfaction

Satisfying Your Customers

Below 50% Highly Satisfied Above 80% Highly Satisfied

N = 554 N = 1232

Culture and Innovation

Market Value Attributed to Future Growth

26%

Market Value Attributed to Future Growth

65%

Questions every leader should answer about IHC

1.Who is our senior leader of integrative health care? An advocate or mid level manager will not command sufficient organizational

gravitas to pull off the task and convey the importance to the whole organization.

The person needs to be active, engaged, and highly respected leader

2. What should our IHC goals be? Set challenging targets in much the same way you set other operational targets.

3. What is the relationship between IHC and other performance metrics in the organization?

By examining the relationships between IHC and other outcomes a CEO can assess the contribution that IHC makes to the organization’s fulfillment of its mission

Critical questions 4. What culture must prevail in our organization to allow IHC to come

forward? Is our staff committed to and engaged in establishing IHC processes and

protocols in our facility? 5. How will we grow IHC leaders? 6. Spread the word on JND’s. The acronym JND stands for Just Noticeable

Differences. How will you capture the successive small changes along the way that indicate that you are moving in the right direction?

You may contact Hurst Behavioral Group at 770-880-5156or email Dr. Hurst at pwhurst@hurstbgi.com

March, 2015

By: Philip Hurst Ph.D. & Quincey Jones MBA