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Mitigating Staff Resistance to Change through Communication and Engagement
February 8, 2018
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Joan Chaya Director of Workforce Development and Management
Maria Gerena Workforce Development
Manager
Adyna Gamboa Workforce Training
Manager
Jasmine Cruz Sr. Human Resources
Specialist
Daniel Fontanez Project Specialist
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• Welcome and introductions
• Understanding the “People Side of Change”
‒ Why have a change management strategy?
• Development of the Workforce Communication and
Engagement Toolkit for Managers
• Putting together change management and project
management
• Tools for mitigating resistance to change
‒ ADKAR case study
• Activities:
• Understanding and applying a business change assessment
• Return on investment (ROI) when focusing on the human
factor of change
• Evaluations & closing
Agenda
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• Children’s Hospital at Montefiore • Montefiore Einstein Center for Cancer Care • Montefiore Einstein Center for Heart and Vascular Care • Montefiore Einstein Center for Transplantation
• Clinical • Translational • Health
Services
• ~2,200 Faculty • ~1,450 Residents & Fellows • ~740 Allied Health Students • ~2,100 Graduate &
Undergraduate Nursing • ~200 Home Health Aides • ~100 Social Workers
Research Teaching
• Home Health Programs
• Primary Care • House Call
Program • Telehealth • Short and long
term care
• 11 Hospitals • 3,236 Total Beds • 150 Skilled Nursing
Beds • 1 Freestanding ED • 1 Rehabilitation
Hospital
Home Care
Hospitals
• Clinical support
• Network applications
• Finance • Legal • Strategic Planning • Purchasing • Compliance • Marketing • Public Affairs • Human Resources
• Care Management (~ 360K Covered Lives)
• Disease Management • Care Coordination • Telemedicine • Pharmacy Education
Information Technology
Corporate Functions
CMO
• Health Education • Community Advocacy • Wellness • Disease Mgmt. • Nutrition • Obesity Prevention • Physical Activity • Reduce Teen Pregnancy • Lead Poisoning Prevention
Community Health
• ~30,000 Employees • ~3,500 Physicians • ~ 4,300 Medical & Allied Health
Staff • ~4,060 Integrated Provider
Association Providers • ~3,350 Employed
• ~5,650 RN/LPN • ~4,200 NYSNA • ~12,700 1199
• 850 RNs
Workforce
Community
Academic Medical
Notable Centers of Excellence
Primary & Specialty
Care
• Advanced Primary Care • Mental Health • Substance Abuse • Sub-specialty Care • Dental • School Based Health
Centers • Mobile Health
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Integrated Delivery System
Our Locations
3,236 Total Beds Across 11 Hospitals
– Including 132 beds at the Children‟s Hospital at
Montefiore (CHAM)
– 86 NICU/PICU beds
150 Skilled Nursing Beds
200 Sites Including
Hutchinson Campus – Hospital without Beds
1 Freestanding Emergency Department First in New York State
68 Primary Care Sites
– 21 Montefiore Medical Group Sites
– 23 School Health Clinics
16 Mental Health/Substance Abuse Treatment Clinics
73 Specialty Care Sites
– 3 Multi-Specialty Centers – 4 Pediatric Specialty Centers – 12 Women‟s Health Centers
10 Dental Centers
5 Imaging Centers
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Who We Are
Montefiore, renowned for its long-standing commitment
to community-based healthcare, is leading a group of
nearly 250 healthcare providers, community-based
organizations, local government officials and more,
from across Westchester, Rockland, Orange, Sullivan,
Dutchess, Ulster and Putnam counties, to form the
Montefiore Hudson Valley Collaborative.
The Montefiore Hudson Valley Collaborative
Working together, we will champion new models of providing Medicaid
beneficiaries with higher quality care, while reducing expenditures through
enhanced coordination, community-focused care and education.
Our Guiding Vision • A more integrated delivery system, better able to take on risk and deliver
value.
• A more sustainable delivery system, care delivered locally and in the right
care setting.
• A more patient-centered delivery system, with expanded access to
services tailored to the unique needs of our patients and communities.
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Understanding the
“People Side of
Change”
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Think about a change you
were asked to make?
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What was your immediate response when
you heard about the change?
“I’M READY!! BRING IT ON!”
“That sounds like a GREAT idea!!”
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Or was it like…
”I don’t have the bandwidth!”
”Another flavor of the month!”
“Are you kidding me?”
“Didn’t we try this before?”
“Not again!”
“We’re doing what? by when?”
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How can a person’s reaction to a
“change” impact the project success
or failure?
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It’s easy to say. . .
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• We change for a reason
• Organizational change requires individual
change
• Organizational outcomes are the collective result
of individual change
• Change management is an enabling framework
for managing the people side of change
Change Management is necessary
because. . .
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Organizational change can be represented
as three states of change
Current State
Transition State
Future State
How things
are done today?
How things will
be done
tomorrow?
How to move
from current
to future?
Current State
Transition State
Future State
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In reality, each impacted employee has his or her
own current and future state
Current State
Transition State
Future State
Organization
Current State
Transition State
Future State
Individual
How I do my job today?
How I will do my job after the change is
implemented?
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Clarity
•Change management methodology and evidence based data for success
Commitment
•Senior leadership buy-in
Capability
•Change management competencies for managers at all levels
Sustainment
•Support systems and opportunities for change managers to network
To empower organizations with tools and competencies to
prepare their employees for change.
MHVC Change Management Strategy
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Workforce Communication
and Engagement Toolkit
for Managers
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Key Communicators and Change Agents
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“WIIFM”
“Keep it simple!”
“How do I select a communication champion?”
“How do I manage employee questions about DSRIP?”
“What are examples of best practices in communication?”
“Guidelines and Talking Points”
“What are ways to communicate how DSRIP is impacting my organization?”
“Customizable talking points for multiple audiences”
“No acronyms!”
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The Workforce Communication Toolkit is an online support tool to help you communicate with your staff about changes in the workplace related to the New York State Delivery System Reform Incentive Payment program (DSRIP). The contents of this toolkit are divided into the following categories:
Visit us at Montefiore Hudson Valley Collaborative to learn about events, workforce training, Cultural Competency and Health Literacy, Hudson Valley jobs, and MHVC news.
Guides
Includes step-by-step guidance on communicating DSRIP in group settings (e.g. Town Halls, Department meetings, DSRIP 101 module, etc.)
Templates
Downloadable templates for each DSRIP project. These templates are designed to provide a brief overview of each project in a “one page” format. You may customize these with more or less detail depending on your needs.
Best Practices
Examples of best practices in DSRIP communication from your colleagues within the MHVC network of partners and other resources.
Online Resources
A selection of online DSRIP resources, informational videos, social networking & communities, Frequently Asked Questions, DSRIP 101 Glossary and other resources.
Start here to access the toolkit introduction and table of contents
Workforce Communication and Engagement Toolkit
22 Prosci® Change Management Practitioners in the
MHVC network
Coordinated Behavioral Health Services
(CBHS)
Children‟s Medical Group
Hudson River Healthcare
Hudson Valley Community Services
Hudson Valley Mental Health
Jawonio
MHA Westchester
Montefiore Hudson Valley Collaborative
Montefiore Medical Center
Planned Parenthood Mid-Hudson
Rehabilitation Support Services
St. John‟s Riverside Hospital
St. Joseph‟s Hospital
White Plains Hospital
There are 21 change management practitioners certified in the Prosci® methodology and tools from following partner organizations:
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Putting together Change
Management and Project
Management
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Comparing Change Management and Project
Management
Current state
Transition state
Future state
Project Management
Change Management
Process: • Initiation
• Planning
• Executing
• Monitoring/ controlling
• Closing
Tools: • Statement of work
• Project charter
• Business case
• Work breakdown structure
• Budget estimations
• Resource allocation
• Schedule
• Tracking
Process:
Organizational:
• Preparing for change
• Managing change
• Reinforcing change™
Individual:
• ADKAR®
Tools: • Individual change model
• Readiness assessment
• Communication plans
• Sponsor roadmaps
• Coaching plans
• Training plans
• Resistance management
• Reinforcement
Focus: Technical side of moving from current state to future state
Focus: People side of moving from current state to future state PM
CM
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Connecting Change Management to
Business Results
Project Name Purpose Particulars People
What is the project?
Why we are changing?
What we are changing?
Who will be changing?
What does this look like for your project?
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• Increase Probability of Success
• Manage Employee Resistance to Change
• Capture the People Dependent ROI
• Build Change Competency into the Organization
Value of Effective Change Management
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What are key contributors
to successful change
initiatives?
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1. Active and visible executive sponsorship
2. Structured change management approach
3. Dedicated change management resources
4. Integration and engagement with project management
5. Employee engagement and participation
6. Frequent and open communication
7. Engagement with middle managers
Top Contributors to Success
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What are obstacles to
successful change initiatives?
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1. Lack of active and visible sponsorship
2. Lack of change management resourcing
4. Employee resistance
5. Lack of buy-in from project teams
3. Manager and supervisor resistance
Top Obstacles to Success
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What to Do Differently Next Time?
*Combined results from 2009, 2011 and 2013
• Communicate with more people at all levels
• Include face to face
• Increase relevancy
More Communication
• Using succinct, consistent and an accurate set of core messages
• Include a robust implementation plan
Better Communication Strategy
• Connect with the project sooner
• Begin in-person meetings earlier
Communicate Earlier
• Evoke more support and ownership from senior leaders
More Attention to Senior Leadership
• Assign expert resources to producing and implementing communications
More Dedicated People Working on Communications
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Tools for Mitigating
Resistance to Change
Awareness A
Desire D
Knowledge K
Ability A
Reinforcement R
The Five Building Blocks for Successful Change
The Five Building Blocks for Successful Change Change Begins with Understanding Why
What is the nature of the change?
Why is the change needed?
What is the risk of not changing?
Awareness
The Five Building Blocks for Successful Change Change Involves Personal Decisions
A decision to engage and participate
A personal choice What’s in it for me (WIIFM)?
Desire
The Five Building Blocks for Successful Change Change Requires Knowing How
Understanding how to change
Learning new skills
Training on new processes and tools
Knowledge
The Five Building Blocks for Successful Change Change Requires Action in the Right Direction
Achievement of the desired change in performance or behavior
The demonstrated capability to implement the change
Ability
The Five Building Blocks for Successful Change
Recognition and rewards that sustain the change
Actions that increase the likelihood that a change will be continued
Change Must Be Reinforced to Be Sustained
Reinforcement
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The Five Building Blocks for Successful Change
• What’s in it for me (WIIFM)?
• A personal choice
• A decision to engage and participate
Desire
• What is the nature of the change?
• Why is the change needed?
• What is the risk of not changing?
• Understanding how to change
• Training on new processes and tools
• Learning new skills
Knowledge Awareness
• Actions that increase the likelihood that a change will be continued
• Recognition and rewards that sustain the change
• Achievement of the desired change in performance or behavior
• The demonstrated capability to implement the change
Ability
Reinforcement
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Without Awareness and Desire you will see:
• Employees asking the same questions over and over
• Lower productivity & higher turnover
• Hoarding of resources and information
• Delays in implementation
• Employees revert back to old ways of doing work
• Ultimate utilization is less than anticipated
• The organization creates a history of poorly managed change
• Lower utilization or incorrect usage of new systems
• Employees worry whether they can be successful in the future
• Greater impact on customers and partners
• Sustained reduction in productivity
Without Knowledge and Ability you will see:
Without Reinforcement you will see:
The Consequences of Not Managing Change
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• ADKAR describes the building blocks and sequence
for successful change
• When changes are failing, ADKAR can be used to
identify which element is the root cause for the
change not being successful
Diagnosing Gaps with ADKAR
Individual Change Management Outcomes
A Awareness “I understand why…”
R Reinforcement “I will continue to…”
A Ability “I am able to…”
K Knowledge “I know how to…”
D Desire “I have decided to…”
When you create: You hear:
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• Five levers for
organizational change
management
• Communication
• Sponsorship
• Coaching
• Training
• Resistance
management
• Using the right tools, you
can move the organization
through ADKAR
• You can’t train desire
• You can’t communicate
ability
Organizational Change Management
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Relationship of Change Management Activities to ADKAR ADKAR Elements Who?
The most influential players
How? The most effective activities
Awareness of the need for change
Sponsors Sponsorship, Coaching, Communication
Desire to support and participate in the change
Knowledge of how to change
Ability to implement required skills and behaviors
Reinforcement to sustain the change
Sponsors, Sponsor coalition, Direct supervisors
Sponsorship, Coaching, Resistance management
Project team, Training team, Human Resources
Training, Coaching
Direct supervisors, Project team, Human Resources, Training team
Training, Coaching
Sponsors, Direct supervisors
Sponsorship, Coaching
A
D
K
A
R
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6/3/16
Assessing the results of change management activities
Change management levers
ADKAR phases of change
Assessing results (examples)
Awareness Communication Employee feedback
Desire
Knowledge
Ability
Reinforcement
Sponsorship Supervisor feedback
Training Training feedback
Coaching Performance feedback
Resistance management Audits and compliance
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Mapping Change Management Activities to MHVC Workforce Tools
• Workforce Communication and Engagement Toolkit for Managers
• Workforce meetings with partners
Change management levers MHVC Workforce Tools and Resources
Communication
Sponsorship • Leadership Steering Committee • Workforce Transformation Subcommittee • Project workgroups
Coaching • Change management cohort • Workforce meetings with partners
Training
Resistance Management
• Learner Central • Change Management Practitioner Certification
• Change management cohort • Supporting partners with internal initiatives • Workforce meetings with partners
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ADKAR Green Hotel Case Study
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Hotel Towel ADKAR
0
1
2
3
4
5
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A D K A R
Series 1
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Activity – Business Change Assessment
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The Change: Integrating Primary
Care into BH Settings
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ADKAR: How do you rank?
1 2 3 4 5
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Score your ADKAR
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What does your ADKAR profile
look like?
0
1
2
3
4
5
6
A D K A R
3
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What are Barrier Points? 54
The first score of 3 or less in the ADKAR model is
referred to as the barrier point to change. The barrier
point must be the first area addressed in order for
change to be successful.
• Determine where the
ADKAR focus is needed
• Create an Action Plan to
alleviate the barrier point
0
1
2
3
4
5
6
A D K A R
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Barrier Point Action Plan
Barrier Point Action Steps (examples)
Awareness Review communication plans at all levels within the organization, Make sure to reach target audiences, Engage direct supervisors (“middle managers”)
Desire
Knowledge
Ability
Reinforcement
“What’s In It For Me (WIIFM)”, Communicate the personal consequences of not changing
Identify gaps, Focus on education and training
Allow time to develop new skills and behaviors, Provide ongoing coaching and support, new measures and expectations for performance should be clearly defined and communicated to everyone
Ensure that support systems are in place to keep people from reverting back to old behaviors, Implement reward systems that reinforce the change
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Return on Investment (ROI) of
Change Management
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Certainty of expected ROI or
benefit from change
Amount of change to how people do their jobs – ‘people change’
Changes that have no ‘people change’ have high certainty in the
expected ROI
Changes that are highly dependent on ‘people change’ have low
certainty
High
Low High
Low
Why does actual ROI differ from expected ROI?
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Change Management and
Uncertainty
Certainty of expected ROI
Amount of change to how people do their jobs – ‘people change’
Effective change
management allows you to decrease the
uncertainty associated with changes that
impact how people do their jobs – improving
the ROI of your projects that impact people
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• For any given organizational change, there are three „human‟ factors that impact the amount of expected improvement from a solution:
‒ Factor 1 – Speed of adoption
‒ Factor 2 – Ultimate utilization
‒ Factor 3 – Proficiency
• These are realities of a project‟s implementation
‒ They define and constrain the value a project delivers
ROI of change management model
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The Human Factors that Determine
the Financial Return or ROI
How well are individuals performing compared to the level expected in the design
of the change?
How many employees (of the total population) are
demonstrating “buy-in” and are using the new solution?
How quickly are people up and running on the new systems,
processes and job roles?
Speed of Adoption Ultimate Utilization Proficiency
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Factor 1 – Speed of adoption
• Expected (baseline)
‒ Based on explicit or
implicit assumptions
‒ Project implementation
phase and plan
‒ Phased roll out?
• Actual
‒ How quickly people get on
board
‒ Passive resistance
‒ Active resistance
‒ Through effective
communication and project
launch
‒ Through sponsorship and
coaching
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Factor 2 – Ultimate utilization
• Expected (baseline)
‒ Perhaps implicitly
assumed 100%
‒ May have done scenario
analysis
‒ Participation
• Actual
‒ How many people “opt out”
of new way
‒ Can result in any
breakdown of ADKAR
‒ Reinforcement and
resistance management
play big roles
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Factor 3 – Proficiency
• Expected (baseline)
‒ Assumed ongoing
improvement from the
solution
‒ Comes as a result of new
processes, interactions
with technology,
behaviors, structures, etc.
• Actual
‒ Determined by
competence of each
individual who is doing
their job a new way
‒ Can be reduced as a
result of resistance
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Financial Correlation Conclusion • Understanding the expected financial return of a project, you
can begin to asses the project dependency on three human
factors to help determine the likelihood achieving that expected
financial return
‒ Speed of Adoption
‒ Ultimate Utilization
‒ Proficiency
• Each human factor will impact the financial return realized.
• With no change management, the likelihood of achieving
ultimate utilization, speed of adoption and proficiency
expectations tied to financial return goes down significantly.
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Data Supports the Connection
Prosci 2016 Benchmarking Data
Date from 2007, 2009, 2011, 2013, 2015
Percent of Study Participants Who Were On or Below Budget
48%
62%
70%
81%
(n=356) (n=1054) (n=1434) (n=267)
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Data Supports the Connection
Prosci 2016 Benchmarking Data
Date from 2007, 2009, 2011, 2013, 2015
Percent of Study Participants Who Were On or Ahead of Schedule
14%
32%
52%
71%
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Correlation Conclusion
• Research supports the connection:
‒ Better change management means better realization of benefits
‒ Of the 245 research participants who reported having excellent
change management effectiveness, 94% met or exceeded project
objectives
• Start collecting your own data on your own projects:
‒ Define success metrics (what are the benefits you are trying to
achieve?
‒ Measure for benefits realized
‒ Measure for change management effectiveness on each project
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Questions?
Thank You!