Rural Physician Leadership Curriculum

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Rural Physician Leadership Curriculum

• West Virginia University
• Rural Family Medicine Residency Program

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Rural Physician Leadership Curriculum

• Module 6
• Leading Change

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Description
Rural Physician Leadership Curriculum

• Funded by HRSA Grant D22HP00306
• Objective 1
• Develop a competency based longitudinal
  curriculum in Rural Physician Leadership

Konrad C. Nau, MD
Principle Investigator Chair, Dept of Family
Medicine-Eastern Division WVU Rural Family
Medicine Residency Program
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Learning Objectives Module 6
Rural Physician Leadership Curriculum

• Understand the importance of change
• Review the usual outcomes of change
• Develop a pathway for leading change
• Identify traits of successful change agents.

WVU Rural Family Medicine Residency Program
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Change

• an event that occurs when something passes from
  one state or phase to another

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Change

• undergo a change become different in essence
• losing one's original nature

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Change
WVU Rural Family Medicine Residency Program
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Sources of Change

• Patients
• Payors
• Technology
• Regulations
• Competition
• Other businesses

WVU Rural Family Medicine Residency Program
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Change

• These sources of change will always be exist in
  rural medicine
• Nothing endures but change.
• Heraclitus
• Become a student of change. It is the only thing
  that will remain constant
• Anthony J. D'Angelo, The College Blue Book

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Change and Time

• The rate of change is not going to slow down
  anytime soon. If anything, competition in most
  industries will probably speed up even more in
  the next few decades.
• John Kotter
• Harvard Business School

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Change and Time
BBC Friday, 1 September, 2000, 1812 GMT 1912 UK
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Change and Time
Elizabeth Salter, of WWF, the global environment
campaign, told BBC News Online "It seems to be
the female bears on Svalbard that are acquiring
male genitalia, a penis-like stump. "With other
species affected by endocrine disrupters, it's
more often the males that have genital
abnormalities. "And what's happening to the
bears is happening to gulls in the Arctic, too,
because of PCBs, DDT and dioxins."
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Change and Time
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Rate of Change

• It takes 5 years to change someones mind
• Or to allow yours to change
• Tom Gilmore
• Center for Applied Research
• The Wharton School

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In the Middle of Change

• Everything looks like failure in the middle. In
  nearly every change project, doubt is cast on the
  original vision because problems are mounting and
  the end is nowhere in sight.

Edward OConner, PhD Taking Charge of Change ,
2005 Tampa, Florida ACPE, Interact Physician
in Management Seminar.
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Remember the place in between

• Its not so much that were afraid of change or
  so in love with the old ways, but its that place
  in between that we fear..

Edward OConner, PhD Taking Charge of Change ,
2005 Tampa, Florida ACPE, Interact Physician
in Management Seminar.
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Successful Change

• Can be much more difficult than it seems
• Not as easy as writing a prescription
• Up to 80 of major change initiatives fail to
  realize intended objectives
• On time
• Within Budget

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Successful Change
John P. Kotter

• Likelihood
• Of Change
• Implementation
• Success

Total Number of Changes
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The Cost of Unsuccessful Change

• Personal
• Stress
• Worry
• Panic
• Blame
• Job satisfaction
• Health

• Organizational
• Time
• Money
• Trust
• Turnover
• Productivity
• Survival

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Let me get this right..

• Change is everywhere
• Change is coming faster
• Change is hard to do successfully
• Change if not done right is a mess
• Change is not as easy as lasix for pulmonary edema

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That is why

• Physician leaders need to understand a successful
  process for change
• Physician leaders must learn how to effect change
  in organizations as small as their clinic/offices
  and as large as their hospital/health care system

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• Take a look at Change
• From a different point of view

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The Change Model

• I) Plan the Change
• Understand
• Enlist
• Envision

• II) Implement the Change
• Motivate
• Communicate
• Act
• Consolidate

Edward OConner, PhD
Taking Charge of Change , 2005 Tampa, Florida
ACPE, Interact Physician in Management Seminar.
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Stages of Change Leadership

• Skipping stages creates the illusion of speed,
  but rarely produces success
• Expect a significant length of time to produce
  true lasting change
• FBS vs HbA1C

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The Change Model Plan

• 1. Understand
• Gather information
• Understand the environment
• Understand the need for change

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The Change Model Plan

• 1. Understand
• Perform a Force Field analysis

Forces Restraining Us from Achieving Goal
Forces Driving Change
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The Change Model Plan

• 1. Understand Ask effective questions
• What are we best at ?
• What contributes most to our success ?
• How would you describe the ultimate goal of this
  organization ?
• If we could achieve this, what would it do for
  you ?

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The Change Model Plan

• 2. Enlist
• Select champions
• People with vision,motivation
• Address stakeholder resistance
• What is the organizations readiness to change
• Build a change team
• People with position, power, experience,
  management

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The Change Model Plan

• 3. Envision
• Develop a vision
• where you want to go
• Feasible, tangible, simple picture of the desired
  future
• Develop a strategy
• how youll get there
• Framework for operational decisions

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The Change Model

• I) Plan the Change
• Understand
• Enlist
• Envision

• II) Implement the Change
• Motivate
• Communicate
• Act
• Consolidate

Edward OConner, PhD
Taking Charge of Change , 2005 Tampa, Florida
ACPE, Interact Physician in Management Seminar.
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The Change Model Implement

• 4. Motivate
• Set ambitious stretch goals
• Identify a crisis
• Create a crisis

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The Change Model Implement

• 5. Communicate
• Keep it simple
• Tell the story with analogies, examples and
  metaphors
• Repeat the story
• Share information
• Use multiple media

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The Change Model Implement

• 6. Act
• Keep structure compatible with the vision
• Train employees
• Generate and publicize short-term successes
• Deal with those who undercut needed change

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The Change Model Implement

• 7. Consolidate
• Change policies and systems that dont support
  the change
• Hire and nurture employees who can implement the
  vision
• Use new projects and change agents to
  re-invigorate the change process

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In the final analysis, change sticks when it
becomes the way we do things around here.

• John Kotter
• Leading Change

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Resistance to Change

• Remember not all challengers are opposition
• How do I know what I think until I hear what I
  say
• Early vocal critics can become strong later stage
  allies.

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Resistance to Change

• Remember not all challengers are opposition
• How do I know what I think until I hear what I
  say
• Early vocal critics can become strong later stage
  allies.

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Encourage Visible Resistance

• Often difficult
• Can increase the likelihood of change management
  success
• Covert resistance (especially emotionally based)
  often lowers performance and dooms the change

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Creating Visible Resistance

• Hold meetings and informal discussions
• Ask open-ended questions and listen
• Conduct anonymous surveys
• Bring in an outside consultant

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Handling Visible Resistance

• Demonstrate openness
• Demonstrate understanding
• Implement or at least clarify their suggestions
• Avoid negative consequences in response to
  unwanted comments
• Provide visible rewards to encourage the process

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Handling Visible Resistance

• Relationship development is important in
  minimizing the effect of the resistance
• Clarifying how your change gets others what they
  want increases the likelihood of their eventual
  support

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Visible Reactions to Change

• People with different histories will see
  emotionally different possible outcomes when
  viewing identical facts

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Handling Visible Reaction

• The Denial Group
• this will never happen here
• why change, were doing just fine

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Handling Visible Reaction

• The Denial Group
• Strengthen your relationships
• Provide information from diverse sources
• Focus on first steps

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Avoid confrontation
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Handling Visible Reaction

• The Hopeless Group
• We should never have done this,
• - I told them so..

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Handling Visible Resistance

• The Hopeless Group
• Obtain needed information
• Acknowledge their reality
• Paint a picture of the future
• Demonstrate commitment

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Handling Visible Reaction

• Naïve Enthusiasm
• Things are great !!!!
• and
• This will easily make it even greater !!!!!!

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Handling Visible Reaction

• The Naïve Enthusiasm
• Get them started before they wear out
• Develop realism
• Begin the concept of measuring results
• Acknowledge success

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Develop Realism with Targets
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Handling Visible Reaction

• The Confident Group
• This stuff makes sense
• When do we get started
• We can even have some fun doing it

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Handling Visible Reaction

• The Confident Group

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Aoccdrnig to a rscheearch atCmabrigde

• It doesnt mttaer in waht oredr the ltteers in a
  wrod are, the olny iprmoetnt tihng is taht the
  frist and lsat ltteer be at the rghit pclae. The
  rset can still be a total mses and you can still
  raed it wouthit porbrlm.
• This is bcusese the huamn mnid deos not raed
  ervey lteter, but the word as a wlohe.

Edward OConner, PhD Taking Charge of Change ,
2005 Tampa, Florida ACPE, Interact Physician
in Management Seminar.
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Handling Visible Reaction

• The Confident Group
• Remove barriers to success
• Maintain the gains
• Identify the next opportunities
• Apply their learnings to next transition

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Celebrate and Reward Success
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Change is a Decision

• Decision Effectiveness
• f (Timing, Sequence,Execution)

Edward OConner, PhD
Taking Charge of Change , 2005 Tampa, Florida
ACPE, Interact Physician in Management Seminar.
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Change is a Decision

• Timing how well tactics are matched to the
  appopriate stage
• Sequencing tactics are preceded by associated
  steps
• Execution critical tactics are well executed

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Summary of Successful Change Leadership

• Prepare for change
• Keep the change effort focused
• Demonstrate effective teamwork
• Model beneficial behaviors
• Establish operating guidelines

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Change Leadership Summary

• Prepare for change
• Multi-staged approach
• Dont skip steps

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Change Leadership Summary

• Keep the change effort focused
• Make the objective clear
• Limit the scope of change

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Change Leadership Summary

• Demonstrate effective teamwork
• Model beneficial behaviors
• Active listening
• Support and build consensus
• Respectful differing and confrontation

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Change Leadership Summary

• Establish operating guidelines
• Time management
• Roles and responsibilities
• Organized discussions

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Change Leadership Summary

• Remember that 80 of major change initiatives
  fail to reach their intended goals

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Change Leadership
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Change Leadership Summary

• The most challenging obstacles to success
• Human acceptance
• Adoption of a change

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Change Leadership Summary

• So.
• When you do
• succeed
• RECOGNIZE

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Change Leadership Summary

• So.
• When you do succeed
• REWARD

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Change Leadership Summary

• CELEBRATE
• Successful
• CHANGE

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Illustration Credits

• Reaction to Change Captain Bob Webb
• http//www.motivation-tools.com
• Metamorphosis - M Roussev
• members.tripod.com/ mroussev/Metamorphosis.htm
• Monarch Metamorphosis MSN Encarta
• http//encarta.msn
• Children crossed arms DennisJones Gallery
• www.dj-art.com/ Children/children_1.htm
• Greece Soccer Team CNN
• http//edition.cnn.com/SPECIALS/2004/euro2004/

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Illustration Credits

• Enthusiastic Dog
• www.dogtrainingraleighnc.net/ BuildingToyDrive.htm
  
• Enthusiasm Poster
• www.dribbleglass.com/ misinspired/enthusiasm.htm
• Anger Cartoon
• www.explodingdog.com/ mayfourteen/angerwo.html
• Favre Concussion NFL
• www.nfl.com/news/ story/7777467
• Hour Glass- Doan
• www.doan.com/summary_ services.html

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Illustration Credits

• Microscope
• www.washington.edu/ research/atuw/economic.html
• Polar Bear Change
• news.bbc.co.uk/.../ tech/newsid_906000/906832.stm
• Winds of Change
• hypnodreams.org/free_ hypnosis_download.htm
• Hopeless man
• www.firewise.org/.../ structure_triage_III.html
• Calendar
• www.therefill.com/ RefillLooseLeaf.html

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Illustration Credits

• Failure cartoon
• www.markstivers.com/ cartoons/main.html
• Failure poster
• byerly.org/ posters/failure.htm
• Time Mgmt Meeting
• www.rogerreece.com/ time-management-seminar.htm
• Doctors meeting cartoon
• www.cartoonstock.com/ directory/d/doctor_gifts.asp
  
• Chunk of Change Poster
• schools.sd68.bc.ca/.../ idioms2003/idiaomsa.htm

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Illustration Credits

• Zion Chain
• earth2marsh.com/images/ ontheroad/parks_page.htm
• Celebrating fans
• www.wvu.edu/football_ tickets/footballFAQ.html
• www.inkiboo.com/?go/ 2002_06_01_archive.asp
• Denial hand
• http//www.guiadoimigrante.com/service/default.asp
  ?not_id1557languageP
• Confident worker
• www.selectcrawfordcounty.com/ business.php