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Leading Adaptive Change: A Framework to Transform Healthcare

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“I assumed if I was bold enough and pushed hard enough, others would follow,” related Dr. Val Ulstad as she recounts past efforts to drive healthcare improvements. “But, the pushing only strengthened the resistance.”

It turns out that leading change in health care is especially challenging for reasons Dr. Ulstad will discuss including conflict and resistance, culture clashes, denial, blame, and in-fighting. As a physician leader, Dr. Ulstad discovered that physician push back wasn’t a sign of disdain or rebellion, but rather a characteristic of modern medicine and often a call for help. Clinicians fear changes that might put at risk what they believe to be best practice medicine. Those worries often lead to a lack of participation in quality improvement initiatives because they don’t know how to engage in a meaningful way.

While some may perceive those non-participating members as lazy or unwilling, those behaviors may in fact be evidence of chaos, stress, burdened work loads and rapid, repeated, and high-volume change. When understood and embraced, these negative qualities can be leveraged into positive outcomes.

Join Dr. Val Ulstad, MD, MPA, MPH, FACC as she introduces the concepts, frameworks, and practices of adaptive leadership wherein she will share principles that will help healthcare professionals to work through complex health care initiatives where there is uncertainty, perceived scarcity of time and attention, and fast-paced change. These frameworks reveal what people exercising leadership can do once they have a deeper understanding of fear and the resistance to change. By applying this way of looking at human behavior, Dr. Ulstad shares with healthcare professionals how to be more effective and purposeful in their leadership work. Participants will learn how to:

Recognize the difference between technical and adaptive work.
Thoughtfully analyze stakeholder behavior in order to plan and make progress.
Effectively address resistance in others.

Participants will begin to see more clearly and act more intentionally to address the adaptive problems in healthcare.

Published in: Healthcare

Leading Adaptive Change: A Framework to Transform Healthcare

  1. 1. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential Val Ulstad MD, MPH, MPA Leading Adaptive Change
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential 2
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Why Adaptive Leadership? • Describes what people do • Describes what people exercising leadership can do if they see differently • A way of developing a shared language to describe group dynamics • Describes a way to be an active engaged organizational citizen • Really resonates with professionals in health care
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Adaptive Leadership Work of Ron Heifetz, M.D. People adapt more successfully to their environments by facing painful circumstances and developing new attitudes and behaviors.
  5. 5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Tensionofchange CONCEPT #1 Productive Range of Tension Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108.
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential
  7. 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Human Systems Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. I understand the reality of my condition. I am looking to you for guidance and honesty. I understand what I need to do. I don’t want to hear any more bad news. I can’t make sense of any of this. I am so terrified I don’t understand a word you are saying. I came for a pill or gadget to fix this.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Human Systems Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  10. 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential CONCEPT #2 Types of Situations Requiring Leadership Technical - Apply abilities that already exist in the system’s capabilities Adaptive - People deeply and broadly within the organization need to learn new capabilities
  11. 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential
  12. 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Address the Gap Between The Way Things are and Achieving the Triple AIM Improved Health of the Population Enhanced Patient Experience of Care (not forgetting the experience of the people who provide it) Reduce (or at least control) Total Cost of Care The Challenge
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Properties of an Adaptive Challenges Wicked Problems •Gap between way things are and desired state •Varied points of view •Requires difficult learning •Involves facing loss •New competencies must be developed •People with problems have problem solving responsibility •Takes longer than technical work •Requires trying things •Generates disequilibrium, distress and work avoidance
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The most common cause of leadership failure is treating an adaptive challenge with a technical fix.
  15. 15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Question #1 What is the work? Gap = difference between the way things are and the desired state Start somewhere meaningful and manageable
  16. 16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Adaptive Work Diminishes the gap between the way things are and the way things need to be to create a better future Adaptive leadership is the activity that mobilizes people to perform needed adaptive work
  17. 17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Adaptive Work You Question #2 Who Cares About the Work?
  18. 18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Organizations are illusions; they are just groups of relationships - Parker Palmer
  19. 19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential When you consider Lincoln, did he embody - Authority? Leadership? Both?
  20. 20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Authority Leadership • Leadership is an activity • Authority, power and influence are tools but do not guarantee leadership - necessary but insufficient
  21. 21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential CONCEPT #3 There is a difference between the role of authority and the exercise of leadership.
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Authority (whether formal or informal) is necessary but insufficient for the exercise of leadership. Ability to constructively influence is a critical resource for leadership even when/if you have a big title.
  23. 23. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Developing Influence • Assess their capability • Help them see what’s in it for them • Earn trust • Speak to their perception of cost • Acknowledge their perception of risk Adapted from C. Dwyer, The Shifting Sources of Power and Influence, Amer Coll of Phys Executives, 1992
  24. 24. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Your Success at Influencing Another •Their capability to do what you ask •Plus + • (Their Perception of Potential Benefit X Their Perception of the Probability of the Benefit Really Happening) •Minus - • (Their Perception of Cost -Their Perception of Risk) It’s all about perception.
  25. 25. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Developing Influence Perception Matters You will tend to over focus on ● Potential gain to other ● Extent to which you are trusted Other will tend to over focus on ● Potential personal risk ● Potential personal cost Adapted from The Shifting Sources of power and Influence – Dr. Charles E. Dwyer
  26. 26. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Emotional Bank Account Adapted from S. Covey Sr., Seven Habits of Highly Effective People, Simon and Schuster, 1999 Esteem Acceptance Respect
  27. 27. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Emotional Bank Account Balance Sheet Courtesy Kindness Honesty Keep commitments Discourtesy Disrespect Interrupting Overreacting Causing another to feel ignored Becoming arbitrary Betraying trust Threatening Adapted from S. Covey Sr., Seven Habits of Highly Effective People, Simon and Schuster, 1999 Esteem Acceptance Respect
  28. 28. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Build Up The Emotional Bank Account • Understand the individual ● seek to understand the way you want to be understood • Attend to the little things ● be kind and courteous • Keep commitments • Clarify expectations • Personal integrity ● Walk your talk ● Be loyal to those not present • Sincerely apologize when you make a “withdrawal” Adapted from S. Covey Sr., Seven Habits of Highly Effective People, Simon and Schuster, 1999
  29. 29. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential People will trust you when you fulfill their expectations (their wants and needs). Your balance increases in their emotional bank account People will distrust you when you fail to fulfill their expectations (their wants and needs). Your balance decreases in their emotional bank account Constraints of Authority
  30. 30. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Exercising leadership to do adaptive work means disappointing people’s expectations at a rate they can tolerate.
  31. 31. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Exercising leadership to do adaptive work means disappointing people’s expectations (that things will stay the same) at a rate they can tolerate. (and not ignore you or try to silence you or resist in infinitely creative ways)
  32. 32. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Resistance (passive or active) • A signal that you are losing influence and are exceeding the amount of loss and uncertainty they can tolerate. • Clarify your intentions • Refine your approach to the tensions between perspectives (conflicts) inherent in the issue • Try again to help the group make progress
  33. 33. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Technical challenge Time Making Progress on Work Adaptive Challenge Tensionofchange Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  34. 34. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Technical challenge Time Making Progress on Work Adaptive Challenge Tensionofchange Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  35. 35. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Tensionofchange The Work Distress Distress Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  36. 36. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Tensionofchange The Work What People Will Not Tell You, Their Behavior Will Reveal Blame others, distract attention, denial Blame others, distract attention, denial Distress Distress Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  37. 37. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential CONCEPT #4 Work Avoidance as a Signal of Being Outside the Productive Range of Tension 37
  38. 38. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Work Avoidance (Resistance) • Displacing responsibility • Attack authority • Kill the messenger • Scapegoat • Distracting attention • Pretend to be busy • Define problem to fit your competence • Make the problem too big • Restructure/reorganize • Meetings with only information exchange when engagement is needed • Pick a fight • Denial • Flavor of month?
  39. 39. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Work Avoidance (Resistance) • Displacing responsibility • “The rest of my team is incompetent” • “Our coach is not doing their part.” • “This is a passing fad – the leaders don’t really want this” • Distracting attention • “This cookbook medicine!” • “This all about money not care.” • “I am too busy – I have a day job” • “I can’t ask my colleagues to do that!” • Excuses for missed meetings • “I am losing income to do this work” • Denial • “This work will not change anything” • Not showing up 39
  40. 40. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential PRODUCTIVE RANGE HOLDING ENVIRONMENT Work avoidance Threshold of learning Limit of tolerance Technical challenge Time Adaptive Challenge Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. Work avoidance Tensionofchange Are You Reading the Signals People are Sending You? Work Avoidance Signals Being Out of Productive Zone
  41. 41. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Resistance/Work Avoidance When people resist the change you are helping them face and avoid the work – which of the following is true? a. It can mean they just don’t think the issue requires their involvement b. The rate of change is too much for them to tolerate c. It can mean they are overwhelmed and don’t know what to do next d. It means you need to try a new “test of change” e. All of the above 41
  42. 42. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Tensionofchange The Work Distress Distress Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  43. 43. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential What Does Work Avoidance/Resistance Tell You? Interpreting stakeholder behavior when they are engaged about the work Which ones are above the limit of tolerance? Heat too high Which ones are engaged in the work? Heat is in the zone to keep things cooking Which ones are below the level of learning? Heat too low
  44. 44. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Tensionofchange The Work What People Will Not Tell You, Their Behavior Will Reveal Blame others, distract attention, denial Blame others, distract attention, denial Distress Distress Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
  45. 45. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Adaptive Work You Question #3 How are the people who care about the work reacting to the work? What does the work avoidance suggest?
  46. 46. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Which statement best represents how you are feeling? Choose one 1. I feel like I’m taking a drink from a fire hose; I’m overwhelmed 2. Seems like good common sense to me; I’m with you, keep going 3. This really doesn’t apply to me ; I’m not in charge, so I’m not sure I need this 46
  47. 47. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Productive Range Threshold of learning Limit of tolerance Time Tensionofchange Where We are Right Now Based on R. Heifetz. and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA, 2002, pg 108. Taking a drink from a fire hose Overwhelmed Seems like good common sense to me I‘m with you, keep going This doesn’t really apply to me I’m not in charge, I don’t need this
  48. 48. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Question #4 What Do I Do Next? • Use yourself differently • Keep people who are making progress engaged and figure out what you need to do to reengage others.
  49. 49. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Use Yourself Differently • Pay attention • Set a great example • Celebrate and learn from what is going well • Talk about why you think this is important • Ask questions • Listen • Reflect in action
  50. 50. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential CONCEPT #5 Reflect in Action Get on the Balcony and Dance
  51. 51. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Balcony AND Dance Floor Over focus on Balcony Over focus on Dance floor
  52. 52. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Question #4 What Do I Do Next? • Use yourself differently • Keep people who are making progress engaged and figure out what you need to do to reengage others.
  53. 53. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential What do you need to do to make progress? What can you do to lower the distress on the factions that are above the limit of tolerance? How can you maintain engagement of factions that are currently engaged in trying to make progress? What can you do to raise the distress to a productive level for the factions below the level of learning? Begin to Plot a Strategy
  54. 54. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Think about a time when the heat was too high. What did you do to bring things to a productive level of tension so progress could be made?
  55. 55. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Lower the Heat • Validate feelings; acknowledge loss • Simplify and clarify • Restore, add or reallocate resources
  56. 56. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Think about a time when the heat was too low. What did you do to bring things to a productive level of tension so progress could be made?
  57. 57. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Raising the Heat • Raise the standards • Increase accountability • Change the task to something more motivating • Refocus on higher, more widely shared and yet compelling purpose
  58. 58. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential PRODUCTIVE RANGE HOLDING ENVIRONMENT Work avoidance Threshold of learning Limit of tolerance Technical challenge Time Adaptive Challenge Based on R. Heifetz and M. Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108. Work avoidance Tensionofchange Are You Reading the Signals People are Sending You? Work Avoidance Signals Being Out of Productive Zone
  59. 59. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Resistance (passive or active) • A signal that you are losing influence and are exceeding the amount of loss and uncertainty they can tolerate. • Clarify your intentions • Refine your approach to the tensions between perspectives (conflicts) inherent in the issue • Try again to help the group make progress
  60. 60. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Exercising leadership requires keeping an experimental mindset • Work avoidance looks the same when the heat is too high or when the heat is too low. • Keep rechecking your assumptions. • What looks like laziness may be exhaustion. • If what you try makes things worse try the opposite.
  61. 61. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Nobody misbehaves from a place of strength Start with Compassion When you don’t know what to try first, lower the heat • Validate feelings; acknowledge loss • Simplify and clarify o Address the technical aspects o Break the problem into parts • Restore, add or reallocate resources o Temporarily reclaim responsibility for tough issues o Give your attention o Take stock of what is available o Allot more time, enrich knowledge and skills
  62. 62. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential CONCEPTS • Productive range of tension • Difference between technical and adaptive work • Difference between role of authority and the exercise of leadership • Work avoidance as a signal of being outside the productive zone • Reflect in action
  63. 63. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Leading Adaptive Change Four Questions What is the work? Who cares about the work? How are people who care about the work reacting to it? What do I do next? - Use your self differently - Regulate the heat
  64. 64. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Technical vs. Adaptive work Clear answers, minimal uncertainty Straightforward, few big choices Execute via precise instructions Requires hands, feet, mouths Focus on task Linear, demands precision Runs smoothly No clear answers, often high uncertainty Time-consuming, difficult choices ( losses) Demands lots of conversations Requires hearts, eyes and ears Focus on people connected to task Spiral with feedback loops, demands creativity Conflict and distress 64
  65. 65. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Thank you!! 65
  66. 66. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Healthcare Analytics Summit 15 Here’s a sneak preview … Industry-leading Speakers Jim Collins Best-selling author of Good to Great, Great by Choice, Built to Last, and How the Mighty Fall Ed Catmull Co-founder of Pixar President of Pixar and Walt Disney Animation Studios Daryl Morey Houston Rockets General Manager and Managing Director of Basketball Operations Amir Rubin Stanford Health Care President and CEO Timothy G. Ferris, MD, MPH Partners HealthCare Senior Vice President of Population Health Management Timothy Sielaff, MD, PhD, FACS Allina Health Chief Medical Officer Summit highlights 3-day Agenda We’ve increased the time of this year’s summit to allow for more sessions, topics, and networking. CME Accreditation for Clinicians This activity has been approved for AMA PRA Category 1 Credits™. More Case Study Sessions Health system case studies addressing even more clinical, technical, operational, and financial examples. Hands-On Experiences Examples, vignettes, and audience-based activities demonstrate principles in fun and memorable ways. Analytics-Driven Engagement Real-time polling, networking, Q&A, and gamification experiences; plus, i-beacon location technology. Networking Experience networking options that use analytics creatively to help you find and connect with others. Pre-Summit Classes and Training An early half-day of pre-session classes and training options specifically for Health Catalyst clients. 3X the sessions 8 keynotes, 25 breakouts, 25-40 analytics walkabout mini-sessions f Early Registration Pricing, Optimized For Teams Buy 1 (save $300) $395/Pass (through May 31) Buy 3 (save $1,098) $329/Pass (through May 31) Buy 5 (save $2,000) $295/Pass (through May 31)

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