Download - Leadership Pearls for the Physician Champion
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Leadership “Pearls” for the Physician Champion
Jon Zlabek, MD, FACPGundersen Lutheran Medical Center
La Crosse, WI
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Learning Objectives
• Learn the components of strong vision casting
• Improve your understanding of organizational change
• Understand the importance of strategic team structures
• Learn the importance of your leadership development
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Gundersen LutheranService Area
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• Clinic founded in 1891; Hospital in 1902
• 7,009 Employees ◊ 693 providers employed/434 medical staff
• 325 Bed Tertiary Medical Center
• Service area covers 19 counties in Wisconsin, Minnesota, and Iowa with 45 clinic locations
• Western Campus of the University of Wisconsin Medical and Nursing Schools
• Five Residency Programs• Minimally invasive surgery fellowship
Gundersen Lutheran Health System
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Warning!Warning!Your Organization is
Unique!
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Our Go-Live
• Went live on November 1, 2008: EpicCare Inpatient Spring 2008
◊ Including provider documentation
ASAP Pharmacy ADT, Registration, HIM and Billing
• Went live with CPOE February 4, 2009• Have a home-grown ambulatory system
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Your Role: The Leadership Pyramid
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
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The Power of Effective Vision Casting
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The Power of Vision
• Ways to “lead”: Authoritarian decree Micromanagement Through Vision
Leading Change – John P. Kotter
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The Power of Vision
• Vision is a clear mental picture of what could be, fueled by the conviction that it should be
• Vision is a view of the preferred future
Visioneering – Andy Stanley
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The Power of Vision
• It always stands in contrast to the world as it is
• Vision demands change
Visioneering – Andy Stanley
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The Power of Vision
• Vision creates change by directing, aligning, and inspiring action
• It gives focus
• It guides and simplifies decision making
Leading Change – John P. Kotter
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The Power of Vision
• Vision motivates to action, even if the initial steps are painful and require sacrifice
• A good vision has the “Eye of the Tiger” Ambitious, but attainable goals
Leading Change – John P. Kotter
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The Power of Vision
• A clear, focused vision allows us to experience ahead of time the emotions associated with our anticipated future
• These emotions reinforce our commitment to the vision
Visioneering – Andy Stanley
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Communicating the Change Vision
How to cast a compelling vision:
1. Define the problem – What problem is my vision designed to solve?
2. Offer a solution – Your vision is the solution to the problem.
3. Tell them why to act.
4. Tell them why to act NOW. Visioneering – Andy Stanley
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Communicating the Change Vision
• Simple and clear• Stories and examples• Multiple forums• Give-and-take communication• Explain perceived inconsistencies• Repetition – let them chew on it
Leading Change – John P. Kotter
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Communicating the Change Vision
• If you and those around you cannot describe the vision driving the change in less than 5 minutes AND elicit understanding and passion in the person you are talking with, you have a vision problem The elevator talk
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Communicating the Change Vision
• Vision leaks!
• You must recast vision once a month or when there is a bump in the road, whichever comes first
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Who Can I Blame?
• “ . . . if the followers don’t get it, it’s because the leader hasn’t delivered it. And if the followers don’t own it, it’s because we’ve not made it accessible enough to own it . . .”
• “. . . as much as we want to blame the followers, the buck stops right here . . .”
Making Vision Stick - Andy Stanley
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Recommended Reading
VisioneeringPastor Andy Stanley
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Selected Principles of Organizational Change
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“If you don’t like change, you’re going to like irrelevance even less.”
General Eric ShinsekiU.S. Army Chief of Staff
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The Basics of Change
• Change is unavoidable • The pace of change will only get
faster• Resistance to change is universal
• A quick poll . . .
Developing the Leader Within You – John C. Maxwell
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The Basics of Change
You need to know:
• The technical requirements of change
• The attitude and motivational demands that bring it about Don’t blow off the psychology of change!
Developing the Leader Within You – John C. Maxwell
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2% Innovators
10% Early
Adopters
60% Middle Adopters 20%
Late Adopters 8%
Laggards
Developing the Leader Within You – John C. Maxwell
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Marc Wright www.simply-communicate.com
The Kubler-Ross Model
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Why People Resist Change
• They didn’t initiate it and aren’t involved with the process Changing vs “being” changed
• Habits and routines are threatened
• Fear of the unknown
Developing the Leader Within You – John C. Maxwell
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Why People Resist Change
• Satisfaction with the status quo
• The purpose of the change is unclear
• Change creates fear of failure
• Lack of respect for the leader They view the change according to the
way they view the “change agent”
Developing the Leader Within You – John C. Maxwell
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When Do People Change?
• Leaders create an atmosphere that causes at least one of these to occur: People hurt enough that they have to
change People learn enough that they want to
change People receive enough that they are
able to change
Developing the Leader Within You – John C. Maxwell
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Creating a Change Climate
• Understand the history of your organization
• Develop trust with those you are leading
• Place influencers in leadership positions and get them on board early in the process
Developing the Leader Within You – John C. Maxwell
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Creating a Change Climate
• Show people how the change will benefit them
• Give people ownership of the change Ask those affected to be involved Decisions should be made at the
“lowest” level possible – those in the trenches
Developing the Leader Within You – John C. Maxwell
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When Change Doesn’t Work
• It’s a bad idea• It’s not accepted by the influencers• It’s not presented well• It’s self-serving to the leaders• Too much change is happening too
quickly
Developing the Leader Within You – John C. Maxwell
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Errors of Change
• Making an error of change can have serious consequences: Creation of unnecessary resistance Employee frustration Poor implementations
◊ Too long and too expensive
Failing to deliver and sustain expected results
Leading Change – John P. Kotter
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Error: Allowing Too Much Complacency
• Failure to create sufficient urgency is fatal for a change process
• Leaders underestimate how hard it is to drive people out of their comfort zones
Leading Change – John P. Kotter
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Error: Allowing Too Much Complacency
• Reasons for high complacency: Past success Lack of a visible “crisis”
◊ “Things aren’t that bad” Low performance standards
Leading Change – John P. Kotter
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• Leaders tend to: Skip creation of urgency due to lack of
patience Underestimate the power of the status
quo Confuse creating urgency with creating
anxiety and make things worse
Leading Change – John P. Kotter
Error: Allowing Too Much Complacency
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Establish a Sense of Urgency
• “Problem-Cast” – tell them why the current situation is bad Use hard data about your current clinical
shortcomings – publicize the problems ARRA HIT dollars and timelines are important,
but don’t make it the central reason
• “Vision-Cast” - bombard them with the great future, but tell them they can’t capitalize on it with the status quo
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Error: Failing to Create a Sufficiently Powerful Guiding Coalition
• Individuals and weak committees don’t have enough power to overcome the massive sources of inertia
• They may get it off the ground, but it quickly fizzles away
Leading Change – John P. Kotter
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Error: Failing to Create a Sufficiently Powerful Guiding Coalition
• A weak committee will fail: Not enough credibility Wrong composition
◊ Too many managers, not enough leaders
• People “smell” lack of long term success and then disengage
Leading Change – John P. Kotter
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Error: Failing to Create a Sufficiently Powerful Guiding Coalition
• No one individual can: Develop the right vision Communicate it broadly and effectively Remove the key roadblocks Generate short-term wins Lead and manage all the sub-projects Anchor changes in the culture
Leading Change – John P. Kotter
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Create the Guiding Coalition
• The coalition needs to be powerful: Reputations and relationships Expertise Titles
◊ Assuming those with the title are strong leaders
Proven leadership capacity
Leading Change – John P. Kotter
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Highly Recommended Reading
Leading ChangeJohn P. Kotter
Developing the Leader Within YouJohn C. Maxwell
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The Importance of Strategic Team Structures
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Physician Leadership Team
• A group of 5 specialty-diverse physician leaders who were my “Guiding Coalition”
• My “go-to” group for decisions that were too big for me to make alone; my trusted advisors
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Physician Leadership Team
• I spent lots of time and asked a lot of advice from others before choosing and making the “pitch” to them
• Our group: Emergency Department Physician– 0.3 FTE General Medicine Section Chair – 0.1 FTE Hospitalist/Assoc. Director of Residency – 0.1 FTE OB/GYN Physician– 0.1 FTE Myself (Internal Med/Vascular Med) 0.5 FTE
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Physician Leadership Team
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
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Physician Leadership Team
• I poured lots of leadership development time and energy into them: Read several leadership books together Discussed difficult leadership decisions Discussed potential “fires” and how to
handle them Openly discussed our leadership
strengths and weaknesses
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Recommended Reading
Developing the Leaders Around YouJohn C. Maxwell
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Advisory Team
• Multidisciplinary group representing Physicians and Associate Providers in every inpatient specialty
• At least one per specialty• Total of 35 people
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Advisory Team
• My “go-to” group for decisions that were too big and far-reaching for the Physician Leadership Team: New Same Day Surgery flow Navigator build Smart Text content
• Most functioned as their department’s Super Users
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Advisory Team
• They must be committed to the project’s success in relation to their department and the organization
• They need to have your “back” and the project’s “back” when challenged
• They will take a lot of hits for you, so be very appreciative!
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Advisory Team
• We “funneled” all communication to and from their department through them Able to answer most questions in a way
their department could best understand
MD Champion sanity: 35 people asking me questions instead of several hundred
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The slides that follow are some of what I presented to the Advisory Team at our first meeting . . .
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Advisory Team Roles
• You must give us your input!• This is one of the high-risk areas of the
project.• Represent your department . . . they are
depending on you!
Communicate with the Implementation Team
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Advisory Team Roles
• You need to tell those around you how the project is going: Must keep abreast with what is happening Plan an update at every department meeting Ask us clarifying questions as they occur
Communicate with Those You Represent
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Lead By Example
• Maintain a positive attitude, even when things get rough . . . your colleagues are watching you closely
• You will be asked to be in the first wave of training and be “Super Users” so you can dispel myths and fears of your colleagues
Advisory Team Roles
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Epic Super UserEpic Super User
Picture YourselfPicture Yourself
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Executive Leadership
• It is critical to have Executive Leadership 110% behind the project Thankfully, ours was and still is
• In your interactions with them, remember a few important things . . .
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Executive Leadership
• “Don’t surprise us” Let them know of controversial decisions
well in advance to avoid the hallway ambush
• Present likely scenarios in advance so they can process their responses What if “Dr. Jones” refuses to do XYZ?
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Executive Leadership
• Full disclosure Don’t even consider anything less than
total honesty and transparency Trust is a vital commodity Your CEO should not lose sleep over
your management of this project
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Executive Leadership
• Escalate issues appropriately Find your organization’s balance
between “hands off” and “micromanagement”
• Allow them to help you Present issues in such as way to allow
them to help you make the project succeed
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The slides that follow are some of what I presented to Executive Leadership when requesting Physician and Associate Staff time to be Super Users . . .
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Things Unique to Physicians #1
• Unlike other hospital employees, due to rotation schedules, some physicians may not set foot in the hospital for months Internal Medicine clinic-hospital docs Rheumatologists Dermatologists, etc
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Things Unique to Physicians #1
• The 2 week Go-Live “Blast” of support when Epic is onsite, or even the lower level support intensity the month after Go-Live won’t help some of them
• Therefore, they are at higher risk for troubles
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Things Unique to Physicians #2
• Most physicians and associate providers will use Epic only sporadically throughout the day, and in “bursts”, unlike nurses Morning rounds Afternoon rounds
• The rest of the day they live in the clinic or operating room
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Things Unique to Physicians #3
• Physicians will have questions not only when they are in the hospital, but also at their “home base” – usually in clinic This is a less chaotic environment to get
more Epic support A local knowledgeable person from their
department/section is important
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Things Unique to Physicians #4
• By far, physicians have been the group that struggles the most with change of this type
• A struggling physician group trickles down to negatively impact others around them (Nurses, HUCs, etc)
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Creative Use of Physician and Associate Staff Super Users
• So, support for physicians and associate providers needs to: Be available for a longer period of time Be timed correctly for when they are
using Epic (rounding) Be locally available for questions when
they are not in the hospital (in their clinic)
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Tips For the Physician Champion
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Interactions with the Implementation Team
• You are the bridge/translator between the Implementation Team and end users You understand the clinical side already You must also have an understanding of
the technical side
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Interactions with the Implementation Team
• Consider taking full Clinical Documentation and Orders training Understand the build process Feel their pain
• Be intimately involved with the build You will understand and see things the
builders won’t and vice-versa
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Interactions with the Implementation Team
• Keep track of how the teams are doing to appropriately “time” your requests
• Don’t overburden them
• Give them what they can handle, when they can handle it
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Interactions with the Implementation Team
• Review training materials in detail and attend several early sessions to ensure the wrinkles are ironed out Identify workflows that will be difficult
• Give the training team tips on how to handle difficult providers Setting ground rules for the classroom How to relate with “Dr. Jones”
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Interactions with the Implementation Team
• Be a “thanking” machine! They are working like crazy and can’t
hear it enough
• Publically praise them whenever you can
• If a particular team is struggling, pour more into them
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Interactions with the Implementation Team
• Protect your Implementation Team. Call out providers being unkind to them
• Maintain an eternally positive attitude – there will be plenty negative thoughts and fears floating around
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Implementation Team
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
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Interactions with the Implementation Team
• You have a captive audience of leaders who are likely embarking on the biggest challenge of their lives
• Use this opportunity to develop them as leaders: Leadership material recommendations Large group teaching One-on-one interactions
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Pure GoldLeadership Nuggets
Illustrating Principles of Organizational Leadership through the Epic Project
Jon Zlabek
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Interactions with the Implementation Team
• Large Group Leadership Topics: Understanding organizational change Basic and advanced conflict resolution “Your potential exceeds your
expectations” The approach to “critics” Relating with difficult providers
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Strong Relationships with End Users
• It’s culturally important to be a physician first Be in the trenches with them Know the local culture and workflows
• You must know the personalities and how they will react to changes Communicate uniquely with each person
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Strong Relationships with End Users
• Listen before you react Even if you have the answer right away,
they need to be heard
• Empathize with them
• Have a contagious positive attitude Your attitude leads the way
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Strong Relationships with End Users
Under-Promiseand
Over-Deliver
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Communication
Don’t rely on:
• Cascading (trickle-down) communication Example – talking only at Department
Chair Meetings
• Email While efficient, it isn’t enough
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Communication
• Get in front of them face-to-face in small groups at their department meetings We went to each department 5 times
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Communication
• Tell them the expected “Wins” early and often (every time you present)
• Our big expected wins: Best Patient Care
◊ Safety, satisfaction, and quality
High Employee Engagement◊ Efficiency, recruitment, and retention
Decreased Cost of Healthcare
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Communication
• Inform them early and often that this is an “all in” type of project – training and use. No one is exempt.
• Proactively address every excuse! Computer skills training Typing training Tons of computers for access “Page me” if you get stuck – don’t struggle
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Communication
• After Go-Live, get in front of the departments again: Thank everyone for their help Focus thanks on the Advisory Team
member in front of their peers Ask for optimization requests Report on the pre/post metrics to anchor
the change in the culture
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Anchoring Change in Culture
• “Culture changes only after you have successfully altered people’s actions, after the new behavior produces some group benefit for a period of time, and after people see the connection between the new actions and the performance improvement. Thus, most cultural change happens [at the end, not at the beginning].”
Leading Change – John P. Kotter
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How We “Connected” the Change to the Improvement
• Mortality• Length of Stay• ED Throughput• OR Start Time• Patient Satisfaction• Documentation Audits• Medication Events
• Lab and Radiology Utilization
• Professional Charges• Paper Savings• Transcription Savings• Implementation
Savings
Don’t forget the “Soft Wins”!
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The slides that follow are some of what I presented to departments before Go-Live . . .
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DeepDeepThoughtThoughtss
bybyJON ZLABEKJON ZLABEK
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Go-Live Expectations
• The Go-Live process will be a HUGE thing Get ready for a wild ride, baby
• All of the benefits from this project WILL NOT be seen in the first few weeks-months
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Go-Live Expectations
• There will be bugs to work out
• Believe it or not, we’re not going to catch everything in the thousands and thousands of decisions we have to make
Please be patient!
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We Are ALL Leaders . . .
Leading By Example
• Maintain a positive attitude, even when things get rough Go-Lives of this magnitude can get
“bumpy” . . . expect some difficulty Medical and non-medical staff are watching
you closely and taking cues from your reactions to change
Whether you like it or not, you are a role-model
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We Are ALL Leaders . . .
Communication is KEY!
• Please read and keep abreast with what is happening Department meeting updates Talking with your Advisory Team Rep Bridges (our weekly newspaper) Medical and Associate Staff E-Newsletter GLadiator Link (our intranet)
• Ask us clarifying questions as they occur
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A Normal Part of Big Change
• People tend to experience different emotions at this stage of change in a big project like this . . . Excitement Concern, worry, fear . . .
• These are normal!
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Keep Perspective . . .
• Thousands of organizations are using electronic health systems
• Hundreds of organizations are using Epic• They succeeded.
• Some of the reasons we’re in great shape . . .
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Keep Perspective . . .
• Epic’s inpatient system has been consistently rated #1 by customers Many other hospitals are working with
lesser-rated vendors
• The Epic Inpatient 2008 version has many new features to streamline care and make our lives better Other hospitals using Epic have paved the way
for improvement to our benefit
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Keep Perspective . . .
• We will be the first hospital to Go-Live with “partial dictation” Other hospital’s MD/PA/NPs need to type a lot,
or else dictate all the notes
• We have been using an electronic medical record for over 10 years in the clinic A lot of other places were still on paper when
their hospitals went live
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We Will Prevail
• There is absolutely no doubt in our minds that we will have overwhelming success during Go-Live
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We Will Prevail
• However, we need to stay on track and work together: You will need to be focused during
training There will be a learning curve There will be tweaks to make along the
way Patience please . . .
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Engaging Everyone
• Everyone who “touches” hospital and Emergency Department patients must participate for success
• Administration is 100% behind the policy of everyone being engaged
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Training
• Training details: Please arrive on time and be free of
patient care duties (ideally “pager off”) Training is not the time to question or
challenge workflows ◊ Write down your questions and ask me after
class
Please be respectful to your trainers!
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Physician Champion Tips At Go-Live
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Physician Champion Tips At Go-Live
• Lots and lots of caffeine• Lots and lots of sugar
You should easily burn off more than you can ever consume!
• Have a fresh pager battery at all times!
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Physician Champion Tips At Go-Live
• Be on the go and in the trenches
• Put out fires immediately
• Go to the command center only: For food To resolve burning issues To check on the Implementation Team
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Physician Champion Tips At Go-Live
• Carry candy – the cure for many a stressed-out end user
• Carry relevant tip sheets and other support material with you to hand out
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How I Addressed Resistance
• First of all, do your best to prevent resistance: Strong, clear vision communicated
repeatedly Administration that is solidly behind you “Nip it in the bud” when you first hear
about it – Have great spies
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How I Addressed Resistance
• Second, LISTEN PATIENTLY Let them fully vent NEVER strike back at this time Top quote from a surgeon:
◊ “His/her behavior stinks, but that’s how a surgeon asks for help”
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How I Addressed Resistance
• Third, remember your role (protect your sanity) “Going electronic was a board decision –
I’m just the implementer” “I didn’t invent Epic” “I am not the Epic police – I can’t punish
anyone for bad behavior”
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How I Addressed Resistance
• Third, remember your role (protect your sanity) “There is a defined escalation pathway
in place for your concerns. I’ll be happy to guide you if you wish”
Second best quote of the project: ◊ “Epic isn’t meant for the older docs who are
ready to retire, it’s for the next generation of physicians”
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How I Addressed Resistance
• Lastly, work your butt off to teach them and fix things Offer help immediately – this resolves
most lower level resistance right away “Under-Promise” and “Over-Deliver” Follow up with them to let them know
you are still working on a solution and/or what the resolution is
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The Importance of YOUR Leadership Development
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The Leadership Pyramid
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
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• Success in current and future environments depends on your competitive drive and lifelong learning
• You must intentionally and continually develop yourself as a leader Don’t even consider “winging it”
Leading Change – John P. Kotter
Leadership and Lifelong Learning
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Who’s Gonna Pay?
• If you are not willing to pay the price of developing yourself as a leader, your people will pay the price of your poor leadership
• Who is gonna pay the price?
The Way of the Shepherd – Leman & Pentak
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Who is ultimately responsible for
YOURYOUR leadership
development?
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Foundation of Leadership - Trust
1. Integrity Honesty Congruence – walk the talk Humility - quick to apologize & forgive
2. Intent Pure motives Mutually beneficial agenda Act in the best interest of others
The Speed of Trust – Stephen M.R. Covey
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Foundation of Leadership - Trust
3. Capabilities Know and use your talents and skills Keep up to date
4. Results Take responsibility for results, not just
for “trying” Communicate the results “Beginners are many; finishers are few”
The Speed of Trust – Stephen M.R. Covey
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Recommended Reading
The Speed of TrustStephen M.R. Covey
speedoftrust.com
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A Leadership Development Plan
• Form solid trusting relationships with those around you, then:
1. Lead something2. Read everything you can on leadership
– leaders are readers3. Attend leadership courses/conferences4. Learn from leaders better than you –
get a leadership mentor
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Highly Recommended Reading
The 21 Irrefutable Laws of LeadershipJohn C. Maxwell
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Epic – Home Life Balance
• Awesome wife and kids!
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Epic – Home Life Balance
Your career is a 30+ year marathon, not a sprint
Take a step back and look at the big picture . . . What matters most?
Leave work at work
Family comes first
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Epic – Home Life Balance
Movie recommendation about this issue:◊ “Click” with Adam Sandler – stresses the
importance of “Family Comes First”◊ The modern day movie version of the song
“Cats in the Cradle”
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Epic – Home Life Balance
• I did my very best to avoid taking work home, and when I was getting crushed, tried to do it early AM or late PM Worked very hard to compartmentalize
my two worlds Personal policy:
“Taking work home will be uncommon”
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Epic – Home Life Balance
• Took strategic blocks of time off: After big bursts of project intensity Times that the Implementation Team
needed me less Took more than a day off at a time Pager free – pushed every work thought
out of my mind
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Epic – Home Life Balance
• I actually grew in other critical areas of my life that helped keep me going:
Improved my spiritual life◊ One tends to experience the need for divine
intervention more in projects like this
Improved my physical conditioning with a few triathlons last year and now in training for a marathon
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My Top Leadership Lessons
• Your career is a 30+ year marathon, not a sprint; Leave work at work – family comes first
• Never rely on cascading communication
• “Under-Promise” and “Over-Deliver”
• Your guiding coalition and initial structure set-up are critical – take your time and get it right
• Your leadership development is the key to your success – be a “student” of leadership
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“It ain’t an easy job, but when you bring a couple thousand
Gundersen Lutheran employees through
implementation, and you ain’t lost a one of them . . .
Ain’t a feeling like it in the world.”