Tag: change

Want To Hear From A Governance Expert? Pearls

Governance PearlsGlen Tecker, a governance consultant, spoke recently.  Here’s what stood out:

People want to understand why leadership acts:

What is perceived, is.

Perceptions rest on available information, accurate or not.

In the absence of information, we assume.

Behaviour, no matter how crazy, has a logical basis.

People have little idea about what they need, but strong opinions about what they want.  So ask: find out what people want.  Communicate how you used those wants to add value and inform decisions. Focus on outcome; describe success.  Often, people only find out what they believe is important by being asked.

People engage when things:

Matter to them

Make a difference for them

Are enjoyable for them.

You need all 3 to function:

  1.                 Authority
  2.                 Process
  3.                 Capacity

Without these, you will be dysfunctional.

Re: Big vs. Small organizational groups:

  1. Big Groups serve representative, political functions:  they govern a whole profession.
  2. Small Groups serve corporate deliverables: they govern an organization as an enterprise.

Big groups discuss and produce information that small groups use to decide.

Culture of trust needs:

  1. Clarity and consciousness about what will equal success.
  2. Open access to common information.
  3. Confidence in the competence of your partners.

‘Voice’ differs from ‘vote’.  The majority must know the concerns and objections of the minority voice.  All views need a voice but not always a vote.

Medicare vs. Patient Care

i_love_medicare_stickerConference participants wore ‘I Love Medicare’ pins in Calgary.

Nietzsche might ask

Do you love medicare because patients benefit, or do you love medicare because you benefit?

Do you love ‘free care’ more than patient care?

People can care more about the idea of universal health care than they do about the care patients receive.

They deny data showing

long waits

poor patient outcomes

lack of access

lack of coordination

high cost

inefficiency

lack of control

provider frustration

Their solutions focus on

more control

more funding

more rationing

more cuts to salaries > 100k

more patient education to divert access

They would rather fight for a failed system than fight for improved patient care.

dog-ma-tism

n. An arrogant, stubborn assertion of opinion or belief

dog-ma-tism n.

1. positiveness in assertion of opinion especially when unwarranted or arrogant

2. a viewpoint or system of ideas based on insufficiently examined premises

Medicare dogmatism will guarantee mediocrity at best.

We need a system that:

puts patients’ needs first

makes patient experience central to funding

gives patients great access

offers patient choice

guarantees quality care (Quality should be a given)

demonstrates business excellence

attracts the best leaders

rewards great outcomes; not mediocrity

aligns incentives for every provider

rewards grass-roots provider innovation

gives control to health-care experts

This can happen in a publicly funded system, but it will never happen if people resist change.

We need to stop thinking that health-care is so special, complicated and unchangeable.

Do we love medicare more than patient care? Can we have an adult conversation about change?  What do you think?

87 Ways to Block Patient Flow Improvements

Blond Boy CryingChange stretches us.

Even good change – getting married, having a baby, retiring – is tough.

In our department, we’ve had a ton of change to improve patient flow, and we’ve heard a ton of complaints.

Here’s a few:

  1. You’re moving too fast.
  2. You’re moving too slow.
  3. What’s taking you so long to get moving?
  4. I wasn’t at the meeting.
  5. I wasn’t invited to the meeting.
  6. You had the meeting without me!
  7. You have too many meetings.
  8. I’m tired of going to so many meetings.
  9. No one asked for my opinion.
  10. You already asked for my opinion.
  11. You should talk with those of us who do the real work.
  12. You shouldn’t listen to whiners from the front line.
  13. You should consult outside experts.
  14. We don’t need experts telling us how to do our job.
  15. You’re too idealistic.
  16. You’ve lost your ideals.
  17. You can’t see the big issues.
  18. You can’t see the details.
  19. Why improve what’s  already better than most?
  20. This place has gone to hell.
  21. But look what we stand to lose!
  22. You have too many details unanswered.
  23. Your proposal is too detailed.
  24. It’s too complicated.
  25. It’s too simple.
  26. It will never work here.
  27. It’s never worked anywhere else.
  28. It takes too much time.
  29. I have nothing to do now.
  30. I’m underutilized.
  31. It takes too much energy.
  32. What are you not telling us?
  33. Your emails are too long; you tell us too much.
  34. You don’t expect us to believe that’s why you’re doing this, do you?
  35. Your data is biased/skewed.
  36. You collect the wrong data.
  37. Your data is anecdotal.
  38. Let me tell you a story I heard…
  39. You should work more clinically; you spend all your time in the office.
  40. You work too much clinically; you should spend more time in the office.
  41. This seems to be all about special treatment for XX providers.
  42. What’s wrong with special treatment for YY providers?
  43. Why should we treat patients as family?
  44. Just because I get special treatment for my family doesn’t mean other patients should get it too.
  45. We might miss one sick patient.
  46. These patients aren’t sick; they should wait.
  47. These patients could all be seen in a walk-in clinic.
  48. These patients need a nurse, a full set of vitals, an ECG, and an acute bed STAT.
  49. One bad outcome is enough to stay the way we were.
  50. It costs too much.
  51. This would work if we spent more.
  52. You are asking us to do someone else’s work.
  53. Someone else is stealing my work; I’m going to submit a union grievance.
  54. There’s no infection control.
  55. We don’t need to see infectious patients so quickly; they can wait.
  56. It’s too stuffy.
  57. It’s too breezy.
  58. There’s too much paperwork.
  59. There’s no paper for notes.
  60. There’s no privacy.
  61. I need more people around to feel safe.
  62. There are too many people.
  63. We need more nurses/doctors/patients/support in the same space.
  64. I feel disconnected from other staff.
  65. I don’t like working shoulder to shoulder with other staff.
  66. It feels like you aren’t supporting the team.
  67. It seems like you only support the X team.
  68. You’re dividing the X team.
  69. I’ve done this for decades.  I don’t need to change a thing.
  70. Those new guys are out of date.
  71. It’s the wrong focus.
  72. You just want to be famous.
  73. Why don’t you spend time on what really matters?
  74. You are out of touch.
  75. You sound like a corporate pawn.
  76. All you care about is X metric.
  77. You just want to undermine Y group of workers.
  78. This sounds like what failed last time.
  79. Are you saying we aren’t working hard enough?
  80. You don’t know what you’re talking about.
  81. If you just changed X, you wouldn’t  need to do this.
  82. You know, this will never work.
  83. We need to give more power to the people actually doing the work.
  84. This is embarrassing.
  85. I used to be proud of working here.
  86. I wouldn’t send my family here; I’d send them to the terrible hospital down the road.
  87. Why can’t you admit this is a stupid idea?

Kotter discussed many of these in  “Buy In”.  He suggests that there are 4 main attacks:

  1. Fear Mongering
  2. Death by Delay
  3. Confusion
  4. Ridicule/Character Assassination

Kotter proposes the following response:

  1. Invite attacks
  2. Respond with clear, simple common sense
  3. Respect always; never fight
  4. Focus on the audience
  5. Prepare for attacks

Change cannot be blocked.  Leadership is change.  Time changes things even if leadership will not.  Patients have benefited from disruptive innovations in our ED, and our whole team proudly wears the scars we earned through it.

How have you responded to change?  Does this list sound familiar?  Click Leave a Reply or # of Replies below.