Changing Behavior: Managing Real Choice Systems Change June 14, 2006 Presented by John McCracken, The University of Texas at Dallas >>: GOOD AFTERNOON WELCOME TO TODAY'S WEB CAST AND TELECONFERENCE CHANGING BEHAVIOR. I AM SHARON FINNEY WITH THE ILRU COMMUNITY LIVING PARTNERSHIP. I WILL BE YOUR MODERATOR TODAY. I WILL BE VOICING THE QUESTIONS TO OUR PRESENTER. BEFORE WE GET STARTED, I WANT TO REMIND YOU ABOUT SENDING AND ASKING QUESTIONS. IN ORDER TO SUBMIT A QUESTION, FOR THOSE OF YOU ON THE WEB CAST, THERE IS A WINDOW IN THE WEB CAST WHERE YOU CAN SUBMIT YOUR QUESTION, AND THOSE OF YOU THAT ARE ON THE TELECONFERENCE TODAY, OUR OPERATOR WILL PROMPT YOU TO ASK THOSE QUESTIONS. 4 VIA THE TELECONFERENCE. ALSO, ONE OTHER THING THAT YOU NEED TO BE AWARE OF IS THOSE OF YOU ON THE WEB TODAY, THE SLIDES, CAN YOU ZOOM THOSE SLIDES WITH THE ZOOM BUTTON AT THE TOP RIGHT-HAND SIDE OF YOUR SCREEN. THE SLIDES ARE ALSO AVAILABLE ON THE WEB PAGE, IF YOU WOULD LIKE TO PRINT THEM OUT AND VIEW THEM. AND SHOULD, FOR ANY REASON, YOUR SLIDES HAVE A VERY LONG PAUSE, JUST REFRESH YOUR SCREEN, AND THE SLIDES SHOULD PROGRESS. WE ALSO HAVE AN EVALUATION THAT WE WOULD APPRECIATE YOU COMPLETING THAT CAN BE FOUND ON THE WEB CAST PAGE. AND I WILL BE E-MAILING IT TO THOSE OF YOU THAT HAVE RSVPED AS WELL. WE REALLY WELCOME YOUR FEEDBACK. NOW, I'D LIKE TO INTRODUCE DARRELL JONES, OUR TRAINING PROGRAM COORDINATOR, WITH THE ILRU LIVING COMMUNITY PARTNERSHIP. GOOD AFTERNOON, DARRELL. >>: GOOD AFTERNOON, SHARON. THANK YOU. AND WELCOME TO ALL OF YOU. WE'RE AWFULLY GLAD THAT YOU COULD JOIN US. OUR OBJECTIVE WITH THIS PRESENTATION TODAY IS TO 5 INCREASE YOUR ABILITY TO SUCCESSFULLY LAUNCH AND IMPLEMENT A MAJOR CHANGE INITIATIVE. DR. MCCRACKEN WILL INTRODUCE A STRUCTURED FRAMEWORK FOR FRAMING YOUR INITIATIVE FOR CREATING ORGANIZATIONAL ALIGNMENT AND OVERCOMING RESISTANCE. YOU WILL LEARN PROVEN CHANGE TOOLS AND TECHNIQUES THAT WILL HELP YOU CHANGE PEOPLE'S BEHAVIOR AND EMBED THOSE CHANGES INTO THE ORGANIZATIONAL CULTURE. JOHN MCCRACKEN IS CLINICAL PROFESSOR OF HEALTH CARE MANAGEMENT AT THE UNIVERSITY OF TEXAS AT DALLAS AND FOUNDING DIRECTOR OF THE ALLIANCE FOR MEDICAL MANAGEMENT EDUCATION. WHICH IS A STRATEGIC PARTNERSHIP BETWEEN THE UNIVERSITY OF TEXAS AT DALLAS SCHOOL OF MANAGEMENT AND THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS. THE ALLIANCE OFFERS THE NATIONALLY RECOGNIZED GRADUATE PROGRAM IN MEDICAL MANAGEMENT FOR PHYSICIANS AND SENIOR CLINICAL ADMINISTRATORS AND CONDUCTS RESEARCH ON IMPORTANT OPERATIONAL AND PROCEDURAL ISSUES ON HEALTH CARE ORGANIZATIONS. DR. MCCRACKEN FORMERLY SERVED AT THE FACULTY OF THE COLUMBIA UNIVERSITY GRADUATE SCHOOL OF BUSINESS AS AN INVESTMENT BANKER WITH A MAJOR WALL STREET FIRM, AND AS A CORPORATE SENIOR FINANCIAL OFFICER. 6 HE ALSO HAS OVER A DECADE OF EXPERIENCE IN THE WORK OUT AND TURN AROUND MANAGEMENT OF DISTRESSED HEALTH CARE AND FINANCIAL SERVICE ORGANIZATIONS. HE WAS FORMERLY VICE CHAIRMAN OF THE FINANCE AND AUDIT COMMITTEE OF ST. PAUL MEDICAL CENTER AND A BOARD MEMBER OF INOVA HEALTH INCORPORATED, A 128 PHYSICIAN IPA AND TEXAS TRUE CHOICE, ONE OF THE STATE'S LARGEST PPOS. HE HOLDS A BA IN ECONOMICS FROM SOUTHERN METHODIST UNIVERSITY. A MASTER OF SCIENCE IN ECONOMICS FROM THE LONDON SCHOOL OF ECONOMICS AND A PH.D. FROM THE WARDEN SCHOOL OF THE UNIVERSITY OF PENNSYLVANIA. HE'S A RECIPIENT OF THE SCHOOL OF MANAGEMENT'S DISTINGUISHED TEACHING AWARD AND THE EXECUTIVE MBA PROGRAM'S MOST OUTSTANDING PROFESSOR AWARD. ON A PERSONAL NOTE, I HAD THE OPPORTUNITY TO HEAR DR. MCCRACKEN SPEAK ON MANAGING CHANGE LAST YEAR AT A SYSTEM'S TRANSFORMATION CONFERENCE. I THINK HE OFFERS GOOD TOOLS AND STRATEGIES FOR A NUMBER OF THE ORGANIZATIONAL CHALLENGES WE FACE IN BRINGING ABOUT THE SYSTEMS CHANGES WE WANT TO IMPROVE OPTIONS FOR HOME AND COMMUNITY BASED SERVICES FOR PEOPLE WITH DISABILITIES. SO ON THAT NOTE, I WILL TURN THIS OVER TO YOU 7 JOHN. >>: THANKS DARRELL I APPRECIATE IT. >>: WELCOME. GLAD TO HAVE YOU WITH US TODAY. LET ME GO THROUGH QUICKLY THE MECHANICS. WE WILL GO IN THIS WEB CAST UNTIL NO LATER THAN 3:30 CENTRAL TIME. WE WANT TO KEEP THIS DOWN TO 90 MINUTES. WE WILL BREAK FROM TIME TO TIME TO HAVE QUESTIONS. THE FOLKS THAT ARE ON THE TELEPHONE CAN CALL IN. THE FOLKS THAT ARE USING E-MAIL WILL SEND THEIR QUESTIONS TO SHARON. I TOLD BOTH SHARON AND DARRELL JUST TO BREAK IN AT ANY TIME, IF THERE SEEMS TO BE QUESTIONS COMING IN THAT ARE COMMON IN THE GROUP. ABOUT EVERY 20 OR 30 MINUTES WE WILL BREAK AND SEE WHERE WE STAND ON THIS. SO LET'S GET STARTED AND GET RIGHT INTO THIS THING AND GO TO SLIDE NUMBER 2. WE HAVE THE PRESENTATION OBJECTIVES. NOW, THE PURPOSE OF THIS PRESENTATION IS TO DO TWO THINGS. FIRST, TO GIVE YOU A STRUCTURED FRAMEWORK FOR THINKING THROUGH YOUR CHANGE PROJECT AS WELL AS THE 8 OBSTACLES THAT YOU'RE LIKELY TO ENCOUNTER. I WANT TO GIVE YOU A STRUCTURE OR FRAMEWORK. MORE IMPORTANT THAN THAT, WHAT WE REALLY WANT TO DO HERE TODAY IS GIVE YOU PROVEN CHANGE TOOLS AND TECHNIQUES FOR THE PURPOSE OF HELPING YOU LAUNCH AND SUSTAIN YOUR CHANGE PROJECT. FIRST, A WORD ABOUT THESE TOOLS. I'M GONNA PRESENT TO YOU THE CHANGE TOOLS THAT WERE DEVELOPED, OH, PROBABLY MAYBE A DECADE AND A HALF AGO ORIGINALLY BY JOHNSON & JOHNSON, GE AND MAJOR CORPORATIONS. THEY'RE USED FAIRLY EXTENSIVELY IN THE INDUSTRIAL WORLD. THEY REALLY HAVEN'T MADE THEIR WAY INTO HEALTH CARE VERY MUCH YET. WE HAVE A PROGRAM, A GRADUATE BUSINESS PROGRAM FOR PHYSICIANS HERE AT UTD, AND WE TAUGHT THESE CHANGE TOOLS TO PHYSICIANS, THE PHYSICIAN EXECUTIVES, AND THEY HAVE HAD VERY GOOD SUCCESS IN USING THEM IN ORDER TO LAUNCH AND SUSTAIN A CHANGE INITIATIVE. NOW, BEFORE WE GET TOO FAR INTO THIS, WE HAVE FIRST GOT TO DEFINE WHAT A CHANGE PROJECT IS. LET'S GO TO SLIDE NUMBER 3. ROB IS OUR TECHNICAL GUY HERE ON POINT, AND ROB IF ANYTHING VARIES IN MY VOLUME OR ANYTHING ELSE, JUST LET 9 ME KNOW, OKAY? GO TO SLIDE NUMBER 3 FOR OUR DEFINITION OF A CHANGE PROJECT. NOW, FOR PURPOSES HERE WE WILL DEFINE A CHANGE PROJECT AS ANYONE THAT MEETS THESE SIX CRITERIA. FIRST, IT'S GOT TO HAVE A DEFINED START AND A COMPLETION DATE. IF YOU DON'T HAVE A START AND YOU DON'T HAVE A COMPLETION DATE, IT'S A PROCESS. IT IS NOT A PROJECT. IT WILL GO ON FOREVER. THAT DOESN'T MEAN THE COMPLETION CAN'T CAN'T SLIP, BUT A PROJECT, A CHANGE PROJECT HAS ULTIMATELY GOT TO HAVE AN END TO IT. SECONDLY, IT CUTS ACROSS ORGANIZATIONAL BOUNDARIES. SOMETHING THAT HAPPENS IN A BUSINESS UNIT IT NOT FOR OUR PURPOSES A CHANGE PROJECT. OFTENTIMES YOU CAN GET THAT DONE THROUGH OLD AUTHORITY. WHEN YOU HAVE RESPONSIBILITY WITHOUT AUTHORITY; THAT IS WHEN YOU HAVE TO CUT ACROSS BOTH ORGANIZATIONS AND ORGANIZATIONAL BOUNDARIES THAT REALLY IS A CHANGE PROJECT. THE THIRD CRITERIA IS VERY IMPORTANT. THAT IS A 10 CHANGE PROJECT GENERATES OBSERVABLE AND MEASURABLE RESULTS. IF THE END PROJECT OR END PRODUCT IS NOT OBSERVABLE AND MEASURABLE, IT'S NOT, FOR OUR PURPOSES, A CHANGE PROJECT. A CHANGE PROJECT ALSO REQUIRES SIGNIFICANT CHANGES IN BOTH ATTITUDES AND THE WAY WORK IS PERFORMED. AS A CONSEQUENCE OF THAT IS INVARIABLE CREATES BOTH PASSIVE AND ACTIVE RESISTANCE. THE SUM OF THESE FIVE, START AND COMPLETION DATE, CUTTING ACROSS ORGANIZATIONAL BOUNDARIES, GENERATING OBSERVABLE AND MEASURABLE RESULTS, REQUIRING SIGNIFICANT CHANGE IN ATTITUDES AND THE WAY WORK IS PERFORMED, AND THE ACTIVE AND PASSIVE RESISTANCE OF A PROJECT LIKE THIS GENERATES, NECESSARILY REQUIRES A DEDICATED CHANGE TEAM T IS VERY SELDOM THAT AN INDIVIDUAL CAN TAKE ON A PROJECT LIKE THIS ALONE. SO THINK OF A CHANGE PROJECT AS SOMETHING THAT MEETS THESE SIX CRITERIA. ONE OF THE REAL CHALLENGES THAT YOU FACE IS REDUCING A LARGE SCALE INITIATIVE TO A SERIES OR A SET OF DEFINED CHANGE PROJECTS. I WAS LOOKING OVER SOME OF THE REAL CHOICE INITIATIVES THAT PEOPLE WERE WORKING ON, FOR EXAMPLE, INTEGRATING LONG-TERM SUPPORT WITH AFFORDING HOUSING. 11 CREATING BOTH STATE AND LOCAL INFRASTRUCTURE TO CREATE ACCESS TO AFFORDABLE HOUSING. THAT'S A GLOBAL PROJECT OR A GLOBAL INITIATIVE. THAT CAN BE BROKEN DOWN INTO SERIES OF DISCREET CHANGE PROJECTS TO DRAW BOUNDS AROUND. WE WILL TALK ABOUT DOING THAT IN A LITTLE BIT. LET ME TALK A LITTLE BIT ABOUT THE ROLE IN CHANGE MANAGEMENT. LET'S GO TO SLIDE NUMBER 4. I WANT YOU TO THINK OF A CHANGE PROJECT AS REALLY BEING A THREE-LEGGED STOOL, AS A METAPHORICAL THREE-LEGGED STOOL. ONE LEG IS TRAINING. YOU HAVE TO BE ABLE TO EXPLAIN YOUR OBJECTIVES. TELL PEOPLE WHAT YOU WANT TO DO. PROVIDE INFORMATION TO PEOPLE ON DESIRED OUTCOMES AND ACTIVITIES. IN OTHER WORDS, YOU ARE TELLING THEM WHAT YOU EXPECT OF THEM AND HOW TO ACHIEVE THOSE RESULTS. THAT'S TRAINING. THE SECOND LEG IS PROJECT MANAGEMENT. THAT'S ALL ABOUT METRICS OR MEASUREMENTS. THAT'S INVOLVES TRACKING AND MONITORING AND REPORTING PROGRESS. IT ESTABLISHES TIME LINES, CRITICAL PATHS, 12 PERFORMANCE STANDARD, MEASURES OF PROGRESS AND PRESCRIBES CORRECTIVE ACTION WHEN INVARIABLY THE TIME COMES WHEN YOU GET OFF COURSE. NOW, THE PROBLEM IS MOST CHANGE PROJECTS STOP THERE. YOU GO OUT AND EXPLAIN TO PEOPLE WHAT YOU WANT, TRAINING COMPONENT, THEN YOU PROVIDE MEASUREMENTS AND METRICS FOR SUCCESS. BROADCAST THAT. EXPECT CHANGE TO OCCUR. WELL, IT DOESN'T. AND THE REASON IS BECAUSE YOU LEFT THIS THIRD LEG OFF THE STOOL. THAT'S THE CHANGE MANAGEMENT. A CHANGE MANAGEMENT IS A VERY INTENSIVE FIELD BASED EXERCISE IN GETTING PEOPLE TO ACTUALLY CHANGE THEIR BEHAVIOR. IT FOCUSES ON COMMUNICATING INITIATIVE, ON DEALING WITH BOTH ACTIVE AND PASSIVE RESISTANCE AND EMBEDDING THE CHANGE INTO THE ORGANIZATIONAL CULTURE. THAT'S WHAT CHANGE MANAGEMENT IS. IF YOU FORGET THAT ASPECT, IF YOU RELY STRICTLY ON TRAINING AND PROJECT MANAGEMENT, GENERALLY YOU WILL NOT GET THERE. YOU CAN GET TEMPORARY CHANGE AND BEHAVIOR. 13 YOU CAN TRAIN PEOPLE AND SET EXPECTATIONS AS TO PERFORMANCE, BUT AS SOON AS YOU LEAVE OR TURN YOUR BACK, BEHAVIOR TENDS TO REVERT BACK TO ITS INITIAL STATE. I THINK ALL OF YOU HAVE PROBABLY HAD SOME EXPERIENCE WITH THAT. OKAY. WHAT IS CHANGE MANAGEMENT? WHAT WE'RE GONNA DO HERE IN THE NEXT SEVERAL MINUTES IS PROVIDE SOME SPECIFIC TOOLS AND TECHNIQUES YOU CAN USE IN CHANGE MANAGEMENT. I WON'T TALK ABOUT TRAINING OR PROJECT MANAGEMENT. I WILL TALK ABOUT TOOLS AND TECHNIQUES TO ACTUALLY GETTING PEOPLE TO CHANGE THEIR BEHAVIOR. THIS IS GRITTY. THIS IS NOT FROM 10 THOUSAND OR EVEN A THOUSAND FEET. THIS IS MUD-LEVEL STUFF. RIGHT NOW I HAVE A GRANT FROM THE TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION AND NOW THE DEPARTMENT OF PUBLIC SERVICES TO GO OUT INTO THE FIELD INTO THE TEXAS MENTAL HEALTH SYSTEM AND GET ROUGHLY 36 DIFFERENT REGIONS TO ADOPT A NEW MEDICATION ALGORITHM FOR THE TREATMENT OF MAJOR MENTAL DISORDERS. THAT MEANS YOU HAVE TO GET PEOPLE AT THE CLINIC 14 LEVEL TO FUNDAMENTALLY CHANGE THE WAY THEY DELIVER MENTAL HEALTH SERVICES. THESE ARE THE TOOLS ASK TECHNIQUES THAT -- AND TECHNIQUES WE'RE TEACHING TO THE STAFF AND USING IN THE FIELD TO TRY AND ACCOMPLISH THAT. ALL OF THE THINGS I WILL TALK ABOUT HERE TODAY ARE REALLY THE HAMMER AND SAW, SCREWDRIVER, AND PLIERS OF CHANGE MANAGEMENT. THIS IS NOT HEAVY CONCEPTION STUFF. THESE ARE ACTUALLY TOOLS THAT CAN YOU USE. ONE OTHER CAVEAT. YOU CAN TELL PEOPLE UNTIL YOU'RE BLUE IN THE FACE HOW YOU WANT THEM TO CHANGE, AND THEY WON'T DO IT. SECRET TO CHANGE MANAGEMENT IS TO GETTING PEOPLE TO SELF-DISCOVER THE NEED FOR CHANGE. THAT'S THE KEY. SO MOST OF THESE TOOLS THAT WE'RE GOING TO BE INTRODUCING TO YOU ARE REALLY BUILT AROUND THIS PARADIGM OF SELF-DISCOVERY. IF PEOPLE DON'T SELF-DISCOVER A NEED TO CHANGE, THEY'RE NOT GONNA DO IT. NOTWITHSTANDING ALL THE PERSUASIVE ARGUMENT YOU CAN MAKE AND MUSTER. A LOT OF TIMES WHEN YOU MEET WITH RESISTANCE YOU REITERATE THE PROJECT AND ITS IMPORTANCE OF WHY THEY 15 SHOULD CHANGE AND THAT REALLY DOESN'T RESINATE. WHAT REALLY RESINATES WITH PEOPLE IS SELF-DISCOVERY OF THEIR PERSONAL NEED TO CHANGE THEIR BEHAVIOR. THAT IS WHAT EVERYTHING WE WILL TALK ABOUT FROM NOW ON IS REALLY BUILT AROUND. LET'S GET INTO IT AND GO TO SLIDE NUMBER 5. THIS IS PROBABLY ABOUT AS HIGH-LEVEL AS WE'RE GOING TO GET IN THIS WHOLE DISCUSSION. BUT BASICALLY, THE FRAMEWORK FOR THESE CHANGE TOOLS IS BUILT AROUND SIX STEPS. THE PROCESS OF SELECTING A QUALIFIED CHANGE TEAM, THAT IS THIS GROUP OF PEOPLE, PROBABLY NUMBERING ANYWHERE FROM FOUR TO SIX, THAT'S THE IDEAL SIZE TO TRY TO IMPLEMENT THIS PROJECT. WE'RE NOT TALKING ABOUT A COMMITTEE. WE'RE TALKING ABOUT A CHANGE TEAM. HOW DO YOU PICK THE RIGHT PEOPLE? ENVISIONING SUCCESS AND IDENTIFYING OBSTACLES IS A FUNDAMENTAL ROLE OF CHANGE MANAGEMENT AND FRAMING AND COMMUNICATING THE INITIATIVE. HOW YOU FRAME AN INITIATIVE AND PRESENT IT TO YOUR COLLEAGUES AND TO THE PUBLIC AT LARGE BEARS -- HAS AN ENORMOUS IMPACT ON WHETHER OR NOT IT IS ACCEPTED OR NOT. THINK ABOUT THE POLITICAL DEBATE THAT GOES ON. 16 THE PERSON THAT SUCCESSFULLY FRAMES THE ISSUE IS THE ONE THAT GENERALLY WINS THE DEBATE. TWO POLITICIANS CAN TALK ABOUT EXACTLY THE SAME ISSUE, BUT THEY FRAME IT DIFFERENTLY. AND THE PERSON THAT WINS THE FRAME IS THE ONE THAT WINS THE DEBATE. CREATING ALIGNMENT AND ORGANIZATION SUPPORT. YOU'RE NOT GOING TO GET ANYWHERE IF YOU HAVE A LOT OF ACTIVE AND PASSIVE RESISTANCE PARTICULARLY IF IT COMES FROM KEY STAKEHOLDERS. HOW DO YOU DEAL WITH THAT. IDENTIFYING AND OVERCOMING THAT RESISTANCE AND THEN PRIORITIZING AND IDENTIFYING TASKS. THOSE ARE THE STEPS AND PROCESSES IN CHANGE MANAGEMENT. NOW, EACH ONE OF THOSE STEPS, IF YOU WILL, HAS A SET OF TOOLS ASSOCIATED WITH IT. THAT'S WHAT WE'RE GOING TO BE TALKING ABOUT. I WANT TO GIVE YOU KIND OF ONE OTHER BIT OF BACKGROUND HERE. LET'S GO TO SLIDE NUMBER 6. I'M GONNA KIND OF HOLD THAT THOUGHT OF CHANGE MANAGEMENT FOR JUST A MOMENT. AND LET ME INTRODUCE THIS THING CALLED ORGANIZATIONAL CULTURE. 17 NOW, LIBRARIES HAVE BEEN WRITTEN ON ORGANIZATIONAL CULTURE. THERE IS NO ONE WAY OF MEASURING OR EVEN DEFINING ORGANIZATIONAL CULTURE. I FOUND, THOUGH, THAT IN HEALTH CARE A VERY USEFUL WAY OF LOOKING AT AN ORGANIZATION IS BY MEASURING IT ALONG A COUPLE OF DIFFERENT DIMENSIONS. WE HAVE APPLIED A TOOL, AN INSTRUMENT THAT I USE TO MEASURE ORGANIZATIONAL CULTURE TO PROBABLY ABOUT, OH, I GUESS IN EXCESS OF A HUNDRED HEALTH CARE ORGANIZATIONS, MAINLY HOSPITALS AND ORGANIZATIONS. LARGE PRACTICES AND OTHER SOCIAL SERVICE AGENCIES THROUGHOUT THE WHOLE SOUTHWESTERN UNITED STATES. WE'RE ABLE TO ACTUALLY OBJECTIVELY SCORE THE ORGANIZATION. IT IS A LITTLE SURVEY WE GIVE TO THE INDIVIDUALS IN THE ORGANIZATION, JUST BASED UPON THE RESPONSES TO 22 QUESTIONS. WE'RE ABLE TO OBJECTIVELY SCORE AND PUT THEM ON THIS GRID. BUT I NEED TO EXPLAIN WHAT THE GRID LINES ARE. THE VERTICAL AXIS MEASURES SOCIABILITY. SOCIABILITY IS EXTREMELY PERSONALITY INSIDE ANY ORGANIZATION T IS THE GLUE THAT HOLDS THE ORGANIZATION TOGETHER. 18 MOST SOCIAL SERVICES AGENCIES, MOST HEALTH CARE AGENCIES AND CERTAINLY MOST GOVERNMENT AGENCIES ARE MARKED BY A HIGH DEGREE OF SOCIOABILITY. ON THE HORIZONTAL AXIS IS A MEASURE OF SOLIDARITY. THAT IS A MEASURE OF FOCUS ON ORGANIZATIONAL GOALS. THAT IS AN EXTENT TO WHICH WHETHER IT IS MARKET SHARE, FINANCIAL PERFORMANCE, PATIENT SAFETY, WHATEVER IT IS. THE MEASURE AND FOCUS AROUND ORGANIZATIONAL GOALS. THOSE ARE NOT MUTUALLY EXCLUSIVE. SOCIABILITY AND SOLIDARITY. WITHIN ANY ORGANIZATION, YOU WILL FIND VARYING DEGREES OF THE TWO. LET ME BRIEFLY DESCRIBE A FEW DIFFERENT ORGANIZATIONS, AND YOU MIGHT WANT TO THINK ABOUT WHERE YOUR ORGANIZATION FALLS ON THIS GRID AND HOW THAT EFFECTS YOUR CHANGE MANAGEMENT OR CHANGE EFFORTS. AN ORGANIZATION THAT IS MARKED BY A HIGH LEVEL OF SOCIALABILITY AND FAIRLY LOW FOCUS ON GOALS IS CALLED A NETWORK ORGANIZATION. THAT IS IN THE LEFT-HAND QUADRANT. THAT IS CHARACTERISTIC OF MOST OF YOUR ORGANIZATIONS. IT IS CERTAINLY CHARACTERISTIC OF COMMUNITY 19 HOSPITALS, SOCIAL SERVICES AGENCY, MENTAL HEALTH INDUSTRY. VIRTUALLY ALL -- NOT ALL. A VERY LARGE PERCENTAGE OF INSTITUTIONAL HEALTH CARE AND HEALTH DELIVERY ORGANIZATIONS REALLY FALL UP INTO THE UPPER LEFT-HAND QUADRANT. WHAT IS THE CHARACTERISTIC OF AN ORGANIZATION MARKED BY HIGH SOCIALABILITY AND FAIRLY LOW FOCUS ON ORGANIZATIONAL GOALS? FIRST, IT HAS GREAT SUSTAINING POWER. SOCIOABILITY IS THE GLUE THAT HOLDS AN ORGANIZATION TOGETHER. PEOPLE DON'T SEPARATE THEIR WORK LIFE AND PROFESSIONAL LIFE. IT ALL BLENDS. PEOPLE SUPPORT OTHERS WITHOUT DEMANDING SOMETHING IN RETURN. YOU KNOW PEOPLE WILL SUPPORT YOU WHEN IT IS NEEDED. ESSENTIALLY FRIENDLINESS AND THE SOCIOABILITY GIVES IT GREAT SUSTAINABILITY. THERE IS A DOWNSIDE, THOUGH. ONE, IS THAT ORGANIZATIONS MARKED BY HIGH SOCIOABILITY TOLERATE POOR PERFORMANCE. IT IS DIFFICULT TO CONFRONT PEOPLE ABOUT LOW 20 PERFORMANCE. THE HIGH PERFORMERS BEAR THE LOAD. THEY GET BURNED OUT. THE SECOND CHARACTERISTICS OF A NETWORK ORGANIZATION IT REQUIRES CONSENSUS BEFORE WORK CAN GET DONE. IF YOU DON'T HAVE CONSENSUS WITHIN THE ORGANIZATION, IT IS DIFFICULT TO MOVE FORWARD. BECAUSE OF THOSE TWO THINGS, IT'S VERY DIFFICULT FOR A NETWORK ORGANIZATION TO RESPOND TO ENVIRONMENTAL THREAT. THAT IS WHEN THE ENVIRONMENT CHANGES, WHEN THE BUSINESS ENVIRONMENT CHANGES, WHEN THERE BECOMES A NEED TO CHANGE OR MOVE, IT IS VERY DIFFICULT FOR A NETWORKED ORGANIZATION TO DO THAT. LET'S GO DOWN TO THE LOWER RIGHT-HAND CORNER OF A FOCUSED ORGANIZATION. THAT IS AN ORGANIZATION WHERE YOU'RE FOCUSED ON ORGANIZATIONAL GOALS, TYPICAL IS INVESTMENT BANKING FIRM, CONSULTING FIRM. EVEN HIGH END RETAILING. THAT IS WHERE THE ACTION IS FAST AND THE REWARDS FOR SUCCESS ARE HIGH. I WAS AN INVESTMENT BANKER FOR A FEW YEARS AND PEOPLE DIDN'T PARTICULARLY LIKE EACH OTHER WITHIN THE 21 ORGANIZATION, BUT THEY DIDN'T CARE. THEY WERE FOCUSED ON ORGANIZATIONAL GOALS. THE LEADERS OF FOCUSED ORGANIZATIONS HAVE A SIMPLE MODEL OF HUMAN BEHAVIOR. THIS IS WHAT YOU WILL DO AND THIS IS THE REWARD YOU GET FOR DOING IT. THE POINT HERE IS THAT CHANGE MANAGEMENT IS PRETTY SIMPLE IN A FOCUSED ORGANIZATION. CHANGE MANAGEMENT IS SIMPLY: THIS IS OUR OBJECTIVE, THIS IS WHAT WE WANT YOU TO DO, AND THIS IS WHAT YOU WILL GET AS A REWARD FOR DOING IT. CHANGE MANAGEMENT ACTUALLY IS PRETTY EFFECTIVE IN THOSE KINDS OF ORGANIZATIONS. THE PROBLEM IS THAT A FOCUSED ORGANIZATION CAN VERY EASILY MOVE OR MEMBERS CAN WALK IN LOCKSTEP RIGHT OFF THE EDGE OF THE CLIFF. BAD IDEAS, WHEN IMPLEMENTED -- IDEAS GET IMPLEMENTED QUICKLY AND A BAD IDEA CAN BE IMPLEMENTED AS EASILY AS A GOOD IDEA AND IT CAN LEAD TO DISASTER. I WILL TOUCH BRIEFLY THE OTHER TWO. THE FRAGMENTED ORGANIZATION IS TYPICAL OF WELL A UNIVERSITY OR A NEWSPAPER OFFICE OR OFTEN A LAW FIRM. OR A PHYSICIAN PRACTICE GROUP. THAT'S WHERE PEOPLE WORK AT THE INSTITUTION BUT FOR THEMSELVES. 22 FAIRLY LOW SOCIABILITY AND NOT NOT MUCH FOCUS ON THE ORGANIZATION'S GOAL. AND THAT'S GOOD IN A PARTICULAR TYPE OF ORGANIZATION. IN A NEWSPAPER OFFICE IT IS NOTHING ABOUT A COLLECTION OF REPORTERS OUT TO GET THE STORY. A UNIVERSITY IS A PROFESSOR INTENT ON ADVANCING THEIR PROFESSIONAL CAREER. FRAGMENTED ORGANIZATIONS WORK OKAY. COMMUNAL IS A VERY RARE TYPE OF ORGANIZATION. THERE IS ONLY A VERY FEW. I HAVE ONLY SEEN A COUPLE IN HEALTH CARE, WHICH ARE MARKED BY HIGH SOCIABILITY BUT ALSO AND EQUALLY STRONG FOCUSED ON ORGANIZATIONAL GOALS. THERE IS AN INHERET CONFLICT. HIGH SOCIAL ABILITY REQUIRES IT BE TOLERATED BY HIGH SOLIDARITIES REQUIRES IT BE CONFRONTED. HIGH SOLIDARITY REQUIRES YOU TO ACT QUICKLY. AND SOCIABILITY REQUIRES GETTING BUY-IN BEFORE YOU VOTE. IT ENDS TO BE A FRAGILE TYPE OF CULTURE. THE REASON I HAVE GIVEN ALL THIS, LET'S GO TO SLIDE NUMBER 7 AND TAKE A LOOK AT IT. WHEN WE GO OUT AND MEASURE THE ORGANIZATIONAL CULTURE OF A HEALTH CARE ORGANIZATION AND PROBABLY YOUR 23 ORGANIZATION AS WELL, WE FIND OVERWHELMINGLY THEY FALL IN THAT CIRCLE OF NETWORKED ORGANIZATIONS. HIGH SOCIABILITY, LIKE EACH OTHER AND SUPPORT EACH OTHER BUT DOESN'T SEEM TO BE CONSENSUS AROUND ORGANIZATIONAL GOALS. IT TAKES FOREVER TO GET AGREEMENT WITHIN THE ORGANIZATION BEFORE IT MOVES. POOR PERFORMANCE DOES TEND TO GET TAL RATED. CHARACTERISTIC OF NOT JUST YOUR ORGANIZATION BUT CHARACTERISTIC OF ANY NETWORK ORGANIZATION. AS I SAID EARLIER, THERE IS A REASON THAT SOCIAL SERVICES ORGANIZATIONS AND HEALTH CARE ORGANIZATIONS TEND TO BE NETWORKED. AS I SAID, IT GIVES SUSTAINABILITY, AND THERE IS A LOT OF ADVANTAGES TO IT. WE HAVE POINTED OUT THE DISADVANTAGES. AS A CHANGE AGENT, WHAT YOU ARE TRYING TO DO ESSENTIALLY IS MOVE THE ORGANIZATION TO THE RIGHT ALONG THAT GRID. MOVE IT MORE TOWARD THE RIGHT BY INCREASING YOUR ORGANIZATION'S FOCUS ON OBJECTIVE. YOU'RE TRYING TO MOVE NETWORK ORGANIZATION TO THE RIGHT. THAT CAN BE DONE, BUT IT IS VERY SLOW WORK. I DON'T KNOW IF YOU NOTICED IN HEALTH CARE, 24 SOMETIMES YOU WILL FIND A FAILING COMMUNITY HOSPITAL, VERY LOW MARGIN OR NO MARGIN. ABOUT A THIRD OF THE COMMUNITY HOSPITALS IN THE UNITED STATES WILL BE UNPROFITABLE IN 2006. MANY TIMES, WHAT HAPPENS IS YOU'VE GOT A NETWORKED ORGANIZATION THAT JUST CAN'T FOCUS ON THE FINANCIAL PERFORMANCE OR THE THINGS IT NEEDS TO DO TO IMPROVE ITS FINANCIAL PERFORMANCE. THEY GET A NEW ADMINISTRATOR. THE ADMINISTRATOR COMES IN AND WITH A HEAVY HAND STARTS TRYING TO PUSH THE ORGANIZATION TOO FAR TO THE RIGHT. IMPLEMENTING PAY FOR PERFORMANCE, ACCOUNTABILITY, OR YOU NAME IT. WHAT HAPPENS IS THE ORGANIZATION, INSTEAD OF MOVING TO THE RIGHT ALONG THAT GRID, TENDS TO MOVE DOWN. IN OTHER WORDS, IT BECOMES MORE FRAGMENTED. IF YOU PUSH TOO HARD, IF YOU TRY TO PUSH PEOPLE OR AN ORGANIZATION BEYOND ITS CAPACITY OR BEYOND A CERTAIN SPEED, WHAT YOU WILL DO IS CAUSE IT TO DEVOLVE DOWN, YOU WILL CAUSE IT TO FRAGMENT. YOU HAVE PROBABLY SEEN, I CERTAINLY HAVE, ORGANIZATIONS WHERE THAT HAPPENS. IT HAPPENS IN HEALTH CARE AND OUTSIDE OF HEALTH 25 CARE, AS WELL. IF YOU HAD A FOCUSED ORGANIZATION LIKE A CONSULTING FIRM, LIKE AN INVESTMENT BANKING FIRM, YOU WOULDN'T NEED THESE CHANGE MANAGEMENT TOOLS. BUT YOU PROBABLY ARE WORKING WITH AN ORGANIZATION THAT MEETS THAT DEFINITION OF NETWORK. YOU'RE GONNA NEED SOME TOOLS THAT WILL HELP YOU MOVE THE ORGANIZATION TO THE RIGHT, TO INCREASE ORGANIZATIONAL FOCUS. BUT WITHOUT DESTROYING THE BONDS OF SOCIALABILITY THAT HOLD IT TOGETHER. THAT IS TOUGH WORK. IT REQUIRES TIME. SOMEONE ASKED JACK WELSH, THE RETIRED CEO OF GENERAL ELECTRIC HOW LONG IT TOOK HIM TO CHANGE GE'S ORGANIZATIONAL CULTURE. HE SAID IT TOOK SEVEN YEARS TO CHANGE THE CULTURE. HE HAD A PROFOUND EFFECT ON THE CULTURE. HE SAID CULTURAL CHANGE IS SOMETHING MEASURED IN YEARS, NOT MONTHS. NOW, I REALIZE YOU HAVE A PROJECT. AND YOU WANT TO GET THAT PROJECT IMPLEMENTED, AND YOU CAN'T WAIT FIVE YEARS TO DO IT, TO CHANGE THE ORGANIZATIONAL CULTURE. THE PURPOSE OF THIS PREAMBLE IS TO JUST GIVE YOU 26 THE YES, SIR OF THE TYPE OF CULTURE YOU'RE OPERATING IN AND TO BE COGNIZANT OF IT AND TRY TO RECOGNIZE ON THIS GRID WHERE YOUR PARTICULAR ORGANIZATION MIGHT FALL. OKAY. ENOUGH OF THE PREAMBLE. LET'S GET DOWN TO IT. LET'S ACTUALLY GO TO THE INDEX, THE LIST IN SLIDE NUMBER 8 OF THE CHANGE TOOLS AND TECHNIQUES INDEX. SLIDE NUMBER 8, WHAT YOU SEE IS NINE DIFFERENT -- EXCUSE ME. 11 DIFFERENT CHANGE TOOLS AND TECHNIQUES. I'M GONNA GO THROUGH THESE PRETTY QUICKLY. WHAT I DO WANT TO ADVISE YOU IS NOTWITHSTANDING HOW QUICKLY WE TOUCH ON THESE THINGS, YOU WILL BE ABLE TO USE THESE RIGHT AT THE END OF THIS TELECONFERENCE. I URGE YOU, ONCE YOU TAKE A LOOK AT ONE OF THESE THINGS, APPLY IT. USE IT IN YOUR OWN SETTING. SHARON AND DARRELL, BEFORE WE GET GOING, ARE THERE ANY QUESTIONS THAT SEEM TO HAVE COME IN FROM THE GROUP? GOOD TIME TO BREAK FOR JUST A MOMENT FOR QUESTIONS HERE, FOR WHAT WE'RE DOING. >>: ALL RIGHTY. SHEILA, CAN YOU CUE OUR AUDIENCE? 27 >>: OKAY. AT THIS TIME WE WILL OPEN THE FLOOR FOR QUESTIONS. IF YOU WOULD LIKE TO ASK A QUESTION, PLEASE PRESS THE STAR KEY FOLLOWED BY THE ONE KEY ON YOUR TOUCH TONE PHONE NOW. QUESTIONS WILL BE TAKEN IN THE ORDER IN WHICH THEY ARE RECEIVED. IF AT ANY TIME YOU WANT TO REMOVE YOURSELF FROM THE QUESTIONING QUEUE PRESS STAR 2. TO ASK A QUESTION, PRESS STAR 1. >>: I HAVE NOT RECEIVED ANY QUESTIONS YET, DR. MCCRACKEN. >>: AND THERE ARE NO QUESTIONS ON THE PHONE AT THIS TIME. >>: OKAY. YOU GUYS I'M SURE ARE EAGER TO GET INTO THIS STUFF. LET'S DO IT. LET'S GO TO SLIDE NUMBER 9. THE NEXT COUPLE OF THREE TOOLS WE WILL TALK ABOUT ARE LAUNCHING THE PROJECT. WE WILL ACTUALLY TALK ABOUT THREE TOOLS. SPONSORSHIP ALIGNMENT, SELECTING A COMPETENT TEAM, AND A TOOL CALLED BACKWARD IMAGING. THOSE ARE THE THREE TOOLS FOR GETTING STARTED. 28 SO LET'S GET INTO IT AND GO DIRECTLY TO SLIDE NUMBER 10. NOW, IN A COMPLEX CHANGE INITIATIVE, THERE ARE GOING TO BE POLITICAL ISSUES. THERE IS A QUESTION OF, WELL, IS THIS THE APPROPRIATE TIME TO DO THIS? WHAT RESOURCES DOES IT TAKE AWAY FROM OTHER INITIATIVES? HOW DOES IT EFFECT -- HOW MUCH DOES IT EFFECT BEHAVIOR WITHIN THE ORGANIZATION? INVARIABLY, IF YOU HAVE GOT A PROJECT, YOU HAVE TO HAVE A SPONSOR. A SPONSOR IS SOMEONE GENERALLY IN A SENIOR POSITION THAT HAS THE ABILITY TO ESSENTIALLY ACT AS A LIGHTNING ROD TO GET RESOURCES, GO AND TALK TO KEY PEOPLE AND ESSENTIALLY DEAL WITH THE POLITICAL HEAT THAT ANY OF THESE PROJECTS ARE NECESSARILY GOING TO GENERATE. IT IS VERY DIFFICULT FOR YOU TO TAKE ON A CHANGE PROJECT IF YOU DON'T HAVE A SPONSOR. IF THERE ISN'T ANYBODY OUT THERE IN THE ORGANIZATION, AND I MEAN A SENIOR PERSON, WILLING TO SUPPORT THIS. I MEAN MORE THAN JUST GIVE LIP SERVICE. WHAT YOU NEED TO DO IS SIT DOWN WITH THAT 29 INDIVIDUAL AND ASK THEM KEY QUESTIONS. NOW, I'M NOT SUGGESTING YOU SIT DOWN WITH A LIST AND JUST SIMPLY ASK ALL THESE QUESTIONS. BUT IN AN INFORMAL CONVERSATION, NOT DONE BY E-MAIL OR TELEPHONE. ASK A QUESTION OF THAT SPONSOR. MAYBE THIS IS THE CHIEF ADMINISTRATOR IN A HOSPITAL OR THE HEAD OF AN AGENCY. WOULD YOU DESCRIBE THIS INITIATIVE IN YOUR OWN WORDS, AND WHY IS IT IMPORTANT TO YOU? LISTEN TO THEIR RESPONSE. YOU ARE NOT IN THIS CONVERSATION TRYING TO PERSUADE PEOPLE TO BECOME A SPONSOR. YOU'RE LISTENING FOR THEIR LEVEL OF COMMITMENT TO YOUR PROJECT. WHAT'S OUTSIDE THE SCOPE OF THIS INITIATIVE? WHAT IS IT YOU DON'T WANT US TO GET INTO? THE THIRD QUESTION IS PROBABLY THE MOST IMPORTANT. YOU ASK THAT PERSON: WHAT ELSE IS ON YOUR AGENDA? WHERE DOES THIS PROJECT FIT IN? LISTEN CLOSELY TO THE ANSWER. IF THIS PERSON SAYS I HAVE GOT SEVEN OR EIGHT PROJECTS AND THIS MIGHT BE NUMBER 6. WELL, THAT IS A STRONG WARNING SIGN TO YOU. IF THIS IS NOT THE PRIORITY PROJECT FOR THAT 30 SPONSOR, YOU EITHER NEED TO BACK OFF THE PROJECT OR TRY TO FIND A SPONSOR FOR WHOM THIS IS REALLY IMPORTANT. NOW, IN MY CORPORATE LIFE AND SOME OF THE THINGS THAT I AM DOING IN HEALTH CARE NOW, THERE HAVE BEEN TIMES WHEN I HAVE HAD A SCENE OF EMINENTLY IMPORTANT PROJECTS. THINGS THAT I THOUGHT SHOULD BE DONE. I COULDN'T FIND A SENIOR PERSON THAT FELT THAT THIS WAS AN IMPORTANT PROJECT AND ONE THEY'RE WILLING TO SUPPORT. THIS IS NOT A MEMBER OF THE PROJECT CHANGE TEAM TO SPONSOR IT. IF YOU CAN'T FIND A SPONSOR, MY BEST ADVICE IS DON'T DO IT. SPEND YOUR TIME ON SOMETHING ELSE. WITHOUT THAT SPONSOR IN A KEY POINTS AND CHANGE PROJECT, CERTAINLY ONE THAT CUTS ACROSS ORGANIZATIONAL BOUNDARIES, YOU HAVEN'T GOT MUCH OF A CHANCE OF SUCCESS. THAT PERSON WHAT ROLE THEY SEE THEMSELVES PLAYING. HOW INVOLVED THEY WANT TO BE. SOME PEOPLE WILL WANT TO BE INTIMATELY INVOLVED. OTHERS WILL WANT TO BE INFORMED ON A PERIODIC BASIS. ASK THEM. 31 DON'T MAKE AN ASSUMPTION ON WHAT ROLE THEY WANT TO PLAY. ASK THEM WHAT KEY DECISIONS THEY WANT TO BE INVOLVED IN AND WHAT KEY DECISIONS THEY WANT TO MAKE THEMSELVES. AGAIN, DON'T ASSUME. ASK THE QUESTION. ONCE YOU ASK THE PERSON HOW IMPORTANT THEY THINK THIS THING IS, HOW IMPORTANT IT IS TO THEM, WHAT ROLE THEY WANT TO PLAY, WHAT DECISIONS THEY WANT TO BE INVOLVED IN, WHAT THEIR BIGGEST CONCERNS ARE, ONCE YOU HAVE ASKED THOSE QUESTIONS OF THE PERSON, HAVE THAT CONVERSATION, MAKE AN ASSESSMENT AGAIN AS I SAID AS TO HOW COMMITTED THEY ARE TO THIS THING. IF YOU BELIEVE THEY'RE COMMITTED, GO AHEAD. IF YOU DON'T BELIEVE THAT THEY'RE COMMITTED AND THAT'S A VERY BIG DAUGHTER-IN-LAW SIGNAL. AS I -- DANGER SIGNAL. I ADVISE YOU TO SOMEBODY WHO IS OR SIMPLY BACK OUT OF IT AND SPEND YOUR TIME DOING SOMETHING ELSE. LET'S ASSUME, FOR THE SAKE OF ARGUMENT THAT YOU HAVE A SPONSOR. NEXT THING YOU HAVE GOT TO DO IS PICK A CHANGE TEAM. LET ME RESERVE FOR A MOMENT THE CIRCUMSTANCES 32 WHERE YOU ALREADY HAVE A TEAM ASSEMBLED. I WILL GET TO THAT IN A MINUTE. LET'S SAY YOU ENJOY THE LUXURY OF ASSEMBLING A GROUP OF PEOPLE TO BE YOUR CORE CHANGE TEAM. THIS IS NOT A COMMITTEE. A COMMITTEE TO ME IS A GROUP OF PEOPLE WHO GETS TOGETHER EVERY TWO WEEKS AND TALKS AND DOES NOTHING IN BETWEEN. A CHANGE TEAM IS A GROUP OF FOUR TO SIX PEOPLE THAT IS RESPONSIBLE AND TAKES IT ON THEMSELVES TO TAKE ON THIS PROJECT, IN ADDITION TO THE OTHER ASSIGNMENT. VERY SELDOM DO YOU FIND PEOPLE TO LEAVE THEIR DAY JOB IN ORDER TO TAKE THE CHANGE ASSIGNMENT. THEY HAVE TO DO THIS IN ADDITION TO THE WORK THEY'RE ALREADY DOING. IT TAKES DEDICATED PEOPLE. HOW DO YOU FIND THEM? I TAKE A MATRIX, AS IN SLIDE NUMBER 11, TAKING A LOOK AT SLIDE NUMBER 11. AND FOR THE ROW HEADINGS IN THAT FIRST COLUMN THERE, THE ROW HEADINGS, WRITE DOWN ON EACH ROW, PARTICULAR COMPETENCIES AND INFLUENCING SKILLS YOU NEED IN ORDER TO GET THE PROJECT DONE. THIS TAKES SOME THOUGHT. GENERALLY, WHEN WE DO THIS EXERCISE , IT WILL TAKE 33 TWO TO THREE HOURS TO GET IT DONE. WHAT YOU DO IS WRITE DOWN WHAT PARTICULAR COMPETENCY AND KEY INFLUENCING SKILLS YOU NEED. FOR EXAMPLE, THERE MAY BE AN INDIVIDUAL OUTSIDE OF YOUR ORGANIZATION THAT REALLY HAS TO BUY INTO YOUR PROJECT FOR IT TO GO FORWARD. YOU WILL NEED SOMEBODY ON THE TEAM WHO EITHER HAS INFLUENCE WITH THAT PERSON OR KNOWS SOMEONE WHO HAS INFLUENCE WITH SOMEONE WHO HAS INFLUENCE. SECOND ORDER EFFECT. DON'T FORGET ABOUT KEY INFLUENCES. THERE ARE PEOPLE RESISTING. YOU WILL NEED SOMEBODY OR ACCESS TO SOMEBODY ON THE TEAM WHETHER IN A DIRECT ROLE OR SECONDARY ROLE WHO IS A KEY INFLUENCE OVER THOSE KEY STAKEHOLDERS. THERE ARE CERTAIN SKILLS YOU NEED. YOU MAY NEED FINANCIAL SKILLS OR MAY NEED SOMEONE INTIMATELY FAMILIAR WITH A PARTICULAR ADMINISTRATIVE PROCESS. YOU MAY NEED SOMEONE THAT HAS SOME LEGAL KNOWLEDGE. YOU MAY NEED SOMEONE WHO HAS SOME INTIMATE KNOWLEDGE OF ANOTHER ORGANIZATION AS PART OF YOUR INITIATIVE. WHATEVER IT IS, YOU GOT TO IDENTIFY THE PARTICULAR 34 SKILLS AND COMPETENCY. IN MOST OF THE PROJECTS I HAVE BEEN ASSOCIATED WITH, IT WILL BE ANYWHERE FROM ABOUT 10 TO 15. DON'T MAKE IT TOO GLOBAL. DON'T GET TOO GRANULAR. IDENTIFY 10 OR 15 KEY SKILLS AND COMPETENCIES THAT YOU NEED. IDENTIFY TEAM MEMBERS THAT HAVE THOSE SKILLS. WHAT IS THE MORE COMMON SITUATION? YOU HAVE A GROUP OF PEOPLE THAT ARE ON YOUR CHANGE TEAM OR HAVE BEEN ASSIGNED TO GET THIS PROJECT DONE. OFTENTIMES THEY WERE PUT THEIR SOMETIMES RELUCTANTLY BECAUSE OF THEIR ROLE, RESPONSIBILITY, TITLE OR POSITION IN THE ORGANIZATION. THAT ISN'T NECESSARILY THE RIGHT TEAM. HERE IS A PROCESS FOR SELF-DISCOVERING WHETHER YOU HAVE THE RIGHT PEOPLE OR NOT. LET'S SAY YOU HAVE THE FIVE PEOPLE AROUND THE TABLE. THESE ARE THE ONES RESPONSIBLE FOR THIS PROJECT. PERHAPS THIS IS ONE OF THE FIRST MEETINGS YOU HAVE ON THE PROJECT. AS A GROUP, IDENTIFY WHAT KEY COMPETENCES OR INFLUENCES WILL BE NECESSARY TO SUCCESSFULLY IMPLEMENT THIS PROJECT. 35 JUST TRY TO IDENTIFY THEM. NOW, SECOND STEP, HAVE EACH TEAM MEMBER WRITE THEIR NAMES IN THE TOP ROW. THAT IS IN EACH BOX ALONG THE TOP ROW. HAVE THEM TO PUT THEIR NAME IN THERE. THEN, WHAT I DO, IS WE WILL INVITE EACH TEAM MEMBER, EACH INDIVIDUAL, WALK UP TO THE GRID, THIS WAS DONE ON A FLIP CHART, AND TO TAKE A MARKER AND TO SELF-SCORE THEIR PARTICULAR COMPETENCY OR INFLUENCE ALONG EACH ROW HEADING AS EITHER HIGH, MEDIUM OR LOW. PEOPLE, IN OTHER WORDS WILL BE ABLE TO PUT IN AN H, M, OR L IN THEIR PARTICULAR COLUMN TO ASSESS -- SELF-ASSESS -- REMEMBER THAT TERM SELF-DISCOVERY. THIS IS SELF-ASSESSMENT, HOW COMPETENT THEY ARE WITH THAT PARTICULAR SKILL OR INFLUENCE. WHAT WILL HAPPEN AFTER THE GRID IS FILLED OUT. WHAT YOU WILL FIND IS PERHAPS ALONG A PARTICULAR ROW YOU WILL SEE A SERIES OF LS WHERE EVERYBODY ON THIS TEAM IS LOW IN THAT PARTICULAR SKILL OR INFLUENCE. WELL, THAT TELLS YOU THAT YOU NEED A KEY PERSON, ANOTHER KEY PERSON. THE OTHER MORE COMMON IS THAT YOU WILL FIND TWO OR THREE INDIVIDUALS THAT HAVE THE SAME SKILL SET. IN OTHER WORDS, THEY'LL BE VIRTUALLY MIRROR IMAGES OF EACH OTHER. 36 THAT GIVES AN OPPORTUNITY FOR INDIVIDUALS TO BOW OUT OF THE TEAM AND SAY LOOK, MARY HERE HAS THE SAME SET OF SKILLS AND COMPETENCIES AS I DO AS REGARDS TO THIS PARTICULAR PROJECT, BUT WE'RE LOW HERE. NOBODY SEEMS TO UNDERSTAND THIS PARTICULAR PROCESS OR THAT ORGANIZATION OVER THERE. SO LET ME BOW OUT OF THIS GROUP AND FIND SOMEBODY AND HELP YOU FIND SOMEBODY WHO MEETS THAT PARTICULAR COMPETENCY. YOU CAN HAVE A DISCUSSION AROUND THE TABLE BASED NOT ON ROLE, RESPONSIBILITY, OR TITLE BUT ON THE COMPETENCIES AND SKILLS NEEDED TO GET THE PROJECT DONE. THIS IS A FORMAL FRAMEWORK OR STRUCTURE THAT WILL ALLOW YOU TO DO THAT. IT IS VERY IMPORTANT THAT I DON'T ASSESS YOUR SKILLS OR THAT MARY DOESN'T ASSESS TOM'S SKILLS. TOM WALKS UP TO THIS GRID, AGAIN, ON A FLIP CHART AND SELF-ASSESSES HIS SKILLS OR HIS AS HIGH, MEDIUM, OR LOW, HIS COMPETENCIES ALONG EACH OF THE DIMENSIONS IDENTIFIED. IDENTIFY THE DIMENSIONS FIRST. HAVE THE TEAM MEMBERS SELF-ASSESS THEMSELVES AND THEN HAVE A GENERAL DISCUSSION AS TO WHETHER OR NOT YOU NEED ADDITIONAL PEOPLE OR WHETHER YOU NEED SOME DIFFERENT PEOPLE ON THE TEAM. 37 OKAY. LET'S GO TO THE SECOND TOOL AROUND PICKING A QUALIFIED TEAM. GO TO SLIDE NUMBER 12. HOW MANY TIMES HAVE YOU BEEN HANDED A PROJECT. WHAT HAPPENS IS YOU CALL A MEETING AND WITHIN 10 MINUTES YOU ARE DISCUSSING THE PROJECT, PERHAPS GIVING PEOPLE SAMES, SAYING YOU DO THIS AND YOU DO THAT. YOU BEGIN TALKING ABOUT THE PROJECT. THAT'S THE WRONG THING TO DO. THESE ARE COMPLEX PROJECTS. YOU ARE GOING TO BE WORKING TOGETHER AS A TEAM FOR SIX OR NINE MONTHS OR EVEN AS LONG AS A YEAR. YOU DON'T START THIS PROCESS BY TALKING ABOUT THE PROJECT. WHAT YOU START TALKING ABOUT ARE PEOPLE'S GOALS AND OBJECTIVES, PERSONAL GOALS AND OBJECTIVES. IF YOU ARE THE PROJECT LEADER, GO AROUND THE TABLE AND SAY, WELL, WHAT ARE YOUR PARTICULAR CONCERNS ABOUT THE PROJECT? LET'S GET ALL THE CONCERNS UP ON THE TABLE. BY THE WAY, AS YOU DO THIS, ALWAYS DO IT ON A FLIP CHART. FACILITATE ALL OF THESE TOOLS ON THE FLIP CHART. THE PROBLEM IS IF YOU ARE SITTING AT A DESK OR 38 TABLE WITH A GROUP OF PEOPLE AND YOU ARE WRITING ALL OF THIS DOWN ON AN EIGHT AND A HALF OR 11 PIECE OF PAPER OR NOTEPAD, NOBODY KNOWS OR CAN SEE WHAT YOU ARE WRITING. THEY DON'T KNOW IF YOU'RE WRITING WHAT THEY SAY. IF YOU ARE STANDING IN FRONT OF A FLIP CHART, SOMEONE PRESENTS AN IDEA OR CONCERN AND WRITE IT DOWN IN A BULLET FORMAT, PEOPLE KNOW THEY'VE BEEN HEARD. AS A MEETING SKILL, THIS KEEPS MEETINGS MUCH SHORTER BECAUSE PEOPLE ARE MORE LOATHED TO SAY SOMETHING SILLER OR SOMETHING THEY DON'T BELIEVE WHEN THEY KNOW IT WILL BE WRITTEN DOWN ON A FLIP CHART FOR ALL TO SEE F YOU WRITE IT ON THE NOTEPAD YOU COULD WRITE DOWN ANYTHING AND THEY WOULDN'T KNOW IT. PEOPLE TEND TO STRAY AND RAMBLE. WRITE THEIR WORDS DOWN ON THE FLIP CHART WILL KEEP THEM FOCUSED. ASK PEOPLE WHAT THE CONCERNS ARE. A SECOND QUESTION IS WHAT ARE THE EXPECTATIONS? WHAT DO YOU WANT OUT OF THIS PROJECT? SURE, YOU WANT TO GET THE PROJECT DONE. EVERYBODY COMES WITH AN AGENDA. I DON'T MEAN THAT IN A PAJORATIVE SENSE. YOU ARE ASKING PEOPLE TO WORK ON THIS PROJECT TEAM IN ADDITION TO THE WORK RESPONSIBILITIES. 39 THEY HAVE EXPECTATIONS REASONS FOR DOING THAT. MAYBE THEY WANT TO LEARN ABOUT PROJECT MANAGEMENT OR LEARN SOMETHING ABOUT INFLUENCING BEHAVIOR OR MAYBE WANT TO LEARN SOMETHING ABOUT OTHER DEPARTMENTS WITHIN THE ORGANIZATION OR WITHIN OTHER ORGANIZATIONS. EVERYBODY HAS EXPECTATIONS ABOUT A PROJECT, PERSONAL EXPECTATIONS. IT IS VERY IMPORTANT TO GET THOSE OUT. AND TO BE SURE AS THE TEAM LEADER HERE THAT OVER THE COURSE OF THIS PROJECT THAT PEOPLE'S EXPECTATIONS ARE MET, THAT THEY ACTUALLY GET OUT OF IT WHAT THEY WANT. SET GROUND RULES, IDENTIFY ROLES FOR THE PEOPLE. ASKING PEOPLE WHAT THEY HAVE TO OFFER AND WHAT THEY WANT TO LEARN IS A WORTHWHILE EXERCISE. SIT DOWN FOR THE FIRST 45 MINUTES, LET'S SAY YOU HAVE A FIVE-PERSON OR SEVEN-PERSON TEAM HERE. SIT DOWN FOR THE FIRST 45 MINUTES, AT LEAST THE FIRST TIME YOU MEET OR EARLY IN THE TEAM'S FORMATION TO ANY THROUGH THESE TYPICAL START-UP DISCUSSIONS. YOU ARE NOT TALKING ABOUT THE PROJECT. YOU ARE TALKING ABOUT PEOPLE'S CONCERNS, EXPECTATIONS, DESIRES, WHAT THEY HAVE TO OFFER. BY THE WAY, I THINK THERE IS ONE THING THAT IS REAL IMPORTANT TO UNDERSTAND. 40 LET'S GO TO SLIDE 13. THAT IS THIS DEFINITION OF CONSENSUS. ADDRESS THAT REALLY EARLY ON. A LOT OF TIME CONSENSUS IN A NETWORKED ORGANIZATION AND ONE MARKED BY HIGH SOCIABILITY MEANS EVERYBODY AGREES. YOU HAVE TO GET ON THE TABLE AND GET AGREEMENT AROUND THE FACT THAT CONSENSUS IS NOT NECESSARILY UNAMIMITY. IT MEANS I UNDERSTAND YOUR POINT OF VIEW AND I BELIEVE YOU UNDERSTAND MY POINT OF VIEW. EVEN THOUGH THAT WOULDN'T NECESSARILY BE THE WAY I WOULD DO IT IF I RAN THINGS MYSELF I WILL SUPPORT THIS DECISION 100% BECAUSE IT WAS ARRIVED AT IN A FAIR AND OPEN MANNER. EARLY ON, GET YOUR TEAM MEMBERS TO AGREE TO THAT AND A DEFINITION OF CONSENSUS. IT WILL SAVE YOU UNTOLD GRIEVE DOWN THE ROAD. IF THERE ARE PEOPLE THAT BELIEVE YOU CAN'T GO FORWARD WITHOUT MY CONCEPT, YOU WILL ULTIMATELY NEVER GET THE PROJECT DONE. OKAY. WE ARE STILL LAUNCHING THE PROJECT. LET'S GO TO THE FINAL TOOL OF LAUNCHING THE PROJECT ON SLIDE NUMBER 14. 41 WHAT I CALL BACKWARD IMAGING. THIS IS A VERY IMPORTANT TOOL. YOU'RE DOING THIS INSIDE YOUR TEAM. IN THE CHANGE TEAM ITSELF. THIS IS WHAT YOU DO. YOU TELL THEM, IMAGINE A POINT IN THE FUTURE FOR YOUR PROJECT OR INITIATIVE WHERE THIS HAS BEEN VERY SUCCESSFUL. YOU'RE PUTTING YOURSELF INTO THE FUTURE. FIND WORDS THAT DESCRIBE WHAT YOU SEE, HEAR, AND FEEL AS YOU OBSERVE YOUR COLLEAGUES FUNCTIONING AROUND YOU. NOW, THIS IS VERY IMPORTANT HERE. DON'T SAY COSTS HAVE BEEN REDUCED 20%. CYCLE TIME HAS BEEN IMPROVED THIS MUCH. WE PUT THIS MANY PATIENTS THROUGH THE ORGANIZATION. DON'T USE NUMBERS. PEOPLE ARE TURNED OFF BY NUMBERS. I'M A FINANCE GUY AND THAT IS MY TRAINING. NUMBERS AREN'T LATIN FOR ME. I KNOW MOST PEOPLE AREN'T MOTIVATED BY NUMBERS. YOUR COLLEAGUES DON'T COME TO WORK TO TRY TO IMPROVE PERFORMANCE BY 20%. THAT IS NOT WHAT TURNS THEM ON. 42 USE THIS AS AN OPPORTUNITY TO GIVE A NARRATIVE DESCRIPTION OF HOW LIFE IS IMPROVED IN THE ORGANIZATION FOR BOTH PARTICIPANTS AND CUSTOMERS AND PATIENTS. HOW HAS LIFE IMPROVED BY THE SUCCESSFUL IMPLEMENTATION OF THIS PROJECT. YOU ARE NOT ASKING IF IT IS SUCCESSFUL, YOU ARE IMAGINE YOURSELF IN THE FUTURE WHERE IT HAS BEEN SUCCESSFUL. YOU'RE BACKWARD IMAGING WHAT IT LOOKS LIKE NOW AS A RESULT OF THAT SUCCESS. AS I SAID, AVOID NUMBERS TO ALL EXTENTS POSSIBLE AND USE NARRATIVE DESCRIPTIONS, ADJECTIVES TO DESCRIBE WHAT THE ORGANIZATION LOOKS LIKE. THAT IS WHAT INCENTIVIZES PEOPLE AND TURNS PEOPLE ON. SECOND ASPECT OF THIS OR SECOND ELEMENT OF BACKWARD IMAGING, NOW, AFTER YOU HAVE REACHED CONSENSUOUS ON WHAT THIS NEW AND IMPROVED FUTURE WILL LOOK LIKE, LET'S NOT GET NEVER WORLDLY HERE. LET'S BE REALISTIC. WHAT I WOULD DO AFTER REACHING CONSENSUS IS WRITE A PARAGRAPH DESCRIPTION OF WHAT THIS CHANGE HAS BROUGHT. NOW, AS A TEAM, IDENTIFY THE TOP THREE TO FIVE OBSTACLES THAT YOU HAVE HAD TO OVERCOME. 43 AGAIN, THIS IS LOOKING BACKWARD, THAT YOU HAD TO OVERCOME IN ORDER TO GET THIS THING SUCCESSFULLY IMPLEMENTED. SO AGAIN, A FLIP CHART IN FRONT OF YOU AND YOUR TEAM SITTING AROUND YOU. YOU DO A NARRATIVE DESCRIPTION OF WHAT SUCCESS LOOKS LIKE. HAVING DONE THAT, THIS IS STEPWISE, HAVING DONE THAT AND FINISHED IT AND REACHED CONSENSUS ON IT AND WORKS WITH IT, NOW, WHAT ARE THE TOP THREE TO FIVE OBSTACLES YOU HAD TO OVERCOME TO GET THERE? IT IS VERY IMPORTANT TO IDENTIFY THOSE AND BE AS SPECIFIC AS YOU CAN. HERE IS WHERE YOU WILL FIND OUT THAT YOUR TEAM MEMBERS OFTEN HAVE DIFFERENT PERCEPTIONS OF WHAT THIS PROJECT IS. SIMPLY BECAUSE THEY IDENTIFY AND GIVE DIFFERENT LEVELS OF IMPORTANCE TO DIFFERENT OBSTACLES. THIS BACKWARD IMAGING EXERCISE SHOULD TAKE YOU ANYWHERE FROM ONE TO TWO HOURS WITH YOUR TEAM. BUT IT IS A VERY IMPORTANT POINT OR VERY IMPORTANT ELEMENT OF LAUNCHING THIS INITIATIVE AND CREATING THE -- BEGINNING TO CREATE ALIGNMENT WITHIN THE TEAM AS TO WHAT YOU ARE ABOUT. LET'S GO. 44 I HAVE INTRODUCED THAT WORD CREATING ALIGNMENT. LET'S GET MORE SPECIFIC. SLIDE NUMBER 15 CREATING ALIGNMENT INTRODUCES THE NEXT SET OF TOOLS WE WILL BE TALKING ABOUT. ESSENTIALLY, IT INTRODUCES THREE TOOLS. THIS IS NOT THREATEN OPPORTUNITY MATRIX AND THE ELEVATOR SPEECH. ALL OF THOSE ARE TOOLS FOR CREATING ALIGNMENT WITHIN THE TEAM AND WITHIN THE ORGANIZATION. LET ME GO THROUGH THESE THREE TOOLS AND THEN WE WILL TAKE A PAUSE FOR QUESTIONS. LET'S GO TO SLIDE NUMBER 16. AND WE'LL INTRODUCE THIS ONE. HE IS A HIGH-TECH NAME IF YOU EVER HEARD ONE. IS, IS NOT. THE PURPOSE OF THIS TOOL IS METAPHORICALLY TO DRAW A BOX AND DETERMINE WHAT'S INSIDE THAT BOX AND MORE IMPORTANTLY WHAT'S OUTSIDE IT. WHAT IS ACTUALLY IN THIS PROJECT AND WHAT IS OUTSIDE IT? ALL OF US HAVE BEEN SUBJECT TO SCOPE (INAUDIBLE) WHERE WE START OFF ON A PROJECT AND YOU THINK EVERYBODY IS ON THE SAME PAGE AS TO WHAT THIS IS AND BEFORE YOU TURN AROUND AND START TO -- AND PRETTY SOON IT BECOMES THE SIZE OF WORLD HUNGER AND YOU CAN'T GET YOUR ARMS 45 AROUND IT ANYMORE AND IT DIES A SLOW DEATH. THAT IS A COMMON EXPERIENCE. THIS TOOL IS DESIGNED IN ORDER TO TRY TO RESIST THAT. THIS IS WHAT YOU DO. YOU GET A FLIP CHART. AGAIN, EVERYTHING IS DONE ON A FLIP CHART. THEN YOU SAY WHAT IS THIS PROJECT, REALISTICALLY. WHAT IS INSIDE THE SCOPE OF IT? WHAT CAN WE SAY THAT THIS PROJECT IS? NOW, THIS IS VERY IMPORTANT. BEING REALISTIC HERE. NOT A MARKETING OR PUFF PIECE OR FOR THE PURPOSE OF TRYING TO SELL IT. IT IS TO TRY TO DETERMINE WHAT THIS PROJECT REALLY IS. IT IS GOING TO BE DIFFICULT AND MEET LOTS OF RESISTANCE. IT IS GOING TO REQUIRE A FUNDAMENTAL CHANGE IN BEHAVIOR AND ATTITUDES AROUND HERE. IT IS GOING TO SLOW US DOWN. BY THE WAY, EVERY CHANGE PROJECT WORTHY OF THE NAME RESULTS IN AN INITIAL DECLINE IN PRODUCTIVITY. I KNOW THAT EXECUTIVE MANAGEMENT OR STATE GOVERNMENTS AND BUREAUCRACIES SAY WE NEED TO DO THIS IN 46 ORDER TO IMPROVE PRODUCTIVITY. WE ASSUME THAT PRODUCTIVITY IMPROVEMENT THAT INCREASE IN PATIENT SATISFACTION WILL START FROM THE DAY THAT YOU BEGIN THE IMPLEMENTATION. IT'S NOT. ANY CHANGE PROJECT IS GOING TO RESULT IN A REDUCTION IN PRODUCTIVITY AS PEOPLE LEARN NEW WAYS, AS THEY ESSENTIALLY TRAVEL PARALLEL PATHS, THE OLD WAY AND THE NEW WAY AT THE SAME TIME. LIKE THE CIRCUS ACROBAT THAT RIDES AROUND THE RING WITH 1 FOOT ON TWO HORSES. THAT PERIOD IS CHARACTERISTIC OF ANY PERIOD. IS, IS NOT WILL HELP YOU REDUCE THAT PERIOD. THIS PROJECT IS ABOUT BEING ABLE TO PROVIDE MORE CHOICE, MORE PATIENCE. PUT THE GOOD THINGS IN HERE. IT IS ABOUT PROVIDING A PEER SUPPORT AND RECOVERY SPECIALIST TRAINING. IT IS ABOUT IMPROVING THE QUALITY OF CARE THAT WE PROVIDE. NOW, GET ALL THE ISS OUT FIRST. NOT THE IS NOT. IDENTIFY ALL THE THINGS THAT YOUR PROJECT IS. THIS EXERCISE SHOULDN'T TAKE LONG. IF YOU HAVE GOT A GOOD TEAM OF PEOPLE AND GOT A 47 FAIRLY GOOD HANDLE ON YOUR PROJECT, YOU CAN DO THIS IN HALF AN HOUR. THEN YOU FLIP THE PAGE. YOU WRITE AT THE TOP OF THE PAGE "IS NOT." NOW, WHAT IS OUTSIDE OF THE SCOPE OF THIS PROJECT? THIS IS WHERE YOU WILL MEET DIFFERENCE OF OPINION AND A LOT OF RESISTANCE. WHAT YOU WILL FIND IS NOTWITHSTANDING HOW YOU DEFINE THIS THING, THERE IS STILL PEOPLE THAT HAVE A DIFFERENT IDEA AS TO HOW THIS PROJECT IS REALLY GOING TO PLAY OUT. AGAIN, DON'T DO THE IS AND IS NOT SIZE BY SIDE AT THE -- SIDE BY SIDE AT THE SAME TIME. DON'T DO A MIRROR IMAGE OF THE IS. IF THE IS, IS GOING TO CREATE A LOT OF RESISTANCE. DON'T WRITE OVER HERE IS NOT IS GOING TO BE EASY. THINK IN TERMS OF WHAT REALLY IS OUTSIDE OF THE SCOPE OF THIS PROJECT. I HAVE SEEN PEOPLE SPEND THREE TIMES AS LONG ON THE IS NOT PORTION AS THE IS. IT IS IMPORTANT TO GO THROUGH THIS THE SUCCESS OF YOUR PROJECT WILL BE AS DEPENDENT IN MY OPINION OR DEPENDENT IN MY OPINION ON WHAT YOU AGREE IS OUTSIDE THE SCOPE SIZE WHAT IS CONTAINED WITHIN THE SCOPE. WE ALL TEND TO FOCUS ON WHAT THE PROJECT IS, BUT 48 WE DON'T GIVE ENOUGH TIME TO WHAT IT IS NOT. THIS IS WHERE YOU WILL SAVE YOURSELF GRIEF IN TERMS OF SCOPE CREEP LATER ON. LET'S SAY WITHIN THE GROUP YOU HAVE IDENTIFIED WHAT THE PROJECT IS AND WHAT IT IS NOT. HOW DO YOU GO ABOUT START SELLING IT TO THE ORGANIZATION. WHAT IS THE TYPICAL RESPONSE IN YOU GO OUT AND GIVE PEOPLE METRICS. THIS WILL IMPROVE THE PERFORMANCE BY 20%, INCREASE PATIENT SATISFACTION, INCREASES ACCESS AND QUALITY OF CARE WE PROVIDE. YOU SIT BACK AND WONDER WHY THAT ISN'T SUFFICIENT TO MOTIVATE THE BEHAVIOR CHANGE. WELL, VERY SIMPLE REASON. THEY HAVE TO DISCOVER THE CHANGE. YOU CAN PROVIDE ALL THE METRICS, ALL THE ARGUMENTS AND LOGIC IN THE WORLD. THAT'S NOT SUFFICIENT TO GET PEOPLE TO CHANGE. THAT IS NECESSARY. PEOPLE WILL NOT CHANGE IN A CURVE CHANGE -- INCUR CHANGE AND AGGREGATION AND THE CHANGE OF PAIN IF THE RESULTS ARE NOT MEASURABLE AND OBSERVABLE AND NOT WORTH THE GAMBLE. EVEN IF THEY ARE, THERE IS ANOTHER CONDITION THAT 49 IS EQUALLY IMPORTANT. THAT IS SELF-DISCOVERY. HERE IS A TOOL TO GETTING PEOPLE TO SELF-DISCOVER THE NEED FOR CHANGE. GO TO SLIDE NUMBER 17. THREATEN OPPORTUNITY METHODS. SOME OF YOU HEARD THE TEAM SWAT, STRENGTHS, WEAKNESSES, OPPORTUNITIES, AND THREATS. THAT IS A STRATEGIC PLANNING TOOL. THIS IS NOT. THIS IS A PURE TOOL FOR HELPING PEOPLE SELF-DISCOVER THE NEED FOR CHANGE. I WILL TELL YOU A LITTLE ABOUT THE TOOLS AND TECHNIQUES AS WE GO THROUGH THIS THING. WE HAVE TO USE THIS TOOLS IN ORDER TO BE SUCCESSFUL IN ORDER TO IMPLEMENT THIS STUFF. YOU START OFF AND SAY LET'S BE REALISTIC AND TALK TO A GROUP OF PEOPLE, AN AUDIENCE OF 15 OR 20 PEOPLE. SOME MIGHT BE WELL ON YOUR SIDE. SOME MIGHT KNOW NOTHING ABOUT THE PROJECT AND MAYBE A HANDFUL OF PEOPLE KNOW THEY'RE NOT SUPPORTIVE OF IT YOU NORMALLY STAND UP AND GIVE THEM THE ARGUMENTS IN FAVOR. YOU WILL NOT DO THAT. YOU WILL GO THROUGH THE PROCESS OF SELF-DISCOVERY. 50 I WILL GET A FLIP CHART AND PUT THEM SIDE BY SIDE. I START OFF IN THE UPPER LEFT-HAND QUADRANT. I DON'T ACTUALLY DRAW ANYTHING ON THE FLIP CHART YET I WILL PUT SOMETHING IN THE UPPER LEFT HAND CORNER AND SAY SHORT TERM THREATS. MAYBE PUT THREAT AT THE TOP OF THE PAGE AND ON THE LEFT-HAND SIDE AT THE TOP SAY SHORT TERM. YOU SAY IF WE DO THIS PROJECT WHAT KIND OF PAIN, AGGRAVATION, COSTS, ARE WE GOING TO HAVE TO BEAR FOR THE NEXT NINE MONTHS? IF WE DO THE PROJECT. WHAT KIND OF PAIN, RESISTANCE, THREATS WILL WE HAVE TO BEAR FOR THE NEXT NINE MONTHS. LET PEOPLE COME UP WITH THEM. THEY WILL. PARTICULARLY IF YOU HAVE PEOPLE THAT ARE RESISTANT TO THIS THING. THEY WILL SAY IT WILL CREATE. PEOPLE WILL NEVER GO ALONG IF THEY FEEL CUT OFF. THEY NEED TO FEEL THAT THEIR IDEAS OF THE THREATS HAVE BEEN LISTED ON THE PAGE. AS THE FACILITATOR, WRITE EVERYTHING DOWN. AFTER YOU PULL ALL THE BAD STUFF OUT, ALL THE ANGST TAKE YOUR PEN AND DRAW A LINE ACROSS THE PAGE. DON'T DO THAT UNTIL ALL THE OBJECTIONS COME OUT. 51 IF YOU DRAW A LINE HORIZONTALLY ACROSS THE PAGE, THAT IS AN IMPLIED SUGGESTION THAT WE WON'T TAKE ANY MORE OBJECTIONS BEYOND THE MIDDLE OF THE PAGE. WE WANT PEOPLE TO FEEL THEY ARE HEARD. DRAW A HORIZONTAL LINE ACROSS THE PAGE AFTER THEY GET THE SHORT TERM EVENTS OUT. THEN SAY, OKAY, ONCE THIS PROJECT IS SUCCESSFUL, REMEMBER, YOU JUST -- YOUR PRIOR CONVERSATION WAS IF WE DO THE PROJECT. NOW YOU SAY ONCE THIS PROJECT IS SUCCESSFUL, WHAT WILL BE THE THREATS AND PAIN THAT WE MIGHT SUFFER 12 MONTHS AND BEYOND? NOTICE THERE IS THE GAP BETWEEN THE SIX AND MONTH MONTHS YOU HAD IN THE SHORT TERM AND THE 12 MONTHS YOU TALK ABOUT IN THE LONG-TERM. THE PURPOSE OF THAT IS THERE IS ALWAYS AN ENGINEER IN THE GROUP SOMEBODY VERY GRANULAR TO GET INTO ARGUMENTATION ABOUT WHETHER THE 11TH MONTH IS SHORT TERM OR LONG-TERM. PUT A GAP IN THERE AND SAY ONCE THE PROJECT IS SUCCESSFUL WHAT ARE THE LONG-TERM THREATS. WELL, YOU MIGHT FIND A COUPLE OR THREE. FOR THE MOST PART. YOU ARE NOT SAYING IF WE DO IT. YOU WILL SAY ONCE IT IS SUCCESSFUL, WHAT ARE THE 52 LONG-TERM THREATS. THERE WILL BE A FEW. NOW WE GO TO QUADRANT NUMBER 3, THE UPPER RIGHT-HAND CORNER AND SAY (AUDIO DIFFICULTY. REDIALING NOW). >>: DO THIS AFTER EVERYTHING IS UP THERE ON THE PAGE. YOU STEP BACK AND YOU LOOK AT THE AUDIENCE AND SAY OKAY, YOU TELL ME. IS THE GAIN WORTH THE PAIN? YOU ARE DOING TWO THINGS. WHEN PEOPLE OBJECT TO YOUR PROJECT, OFTEN TIME ITS IS BECAUSE THEY ARE FOCUSING ON THE SHORT RUN THREATS LOSS. PEOPLE ALWAYS DO THAT. THEY ALWAYS FOCUS ON THAT. THIS IS A WAY FOR YOU TO GET THEM TO FOCUS ON THE LONG-TERM. THAT IS WHERE YOU WANT THEIR ATTENTION. ESPECIALLY THE REASON TO DO ONE OF THOSE PROJECTS IS BECAUSE OF THE LONG-TERM BENEFIT. SECONDLY THEY MUST SELF-DISCOVER THAT THAT LONG-TERM GAIN REALLY IS WORTH THE SHORT TERM PAIN. YOU CAN'T PERSUADE THEM THROUGH LOGIC OTHERWISE. 53 THEY HAVE TO SELF-DISCOVER THIS. THE NUMBER OF TIMES I HAVE DONE THIS, I CAN'T COUNT. BUT I CAN TELL YOU THE NUMBER OF TIMES WHEN WE HAD THE PAIN OUTWEIGH THE GAIN HAS BEEN VERY SELDOM. EVEN AMONG OBJECTORS. PEOPLE REALIZE THE LONG-TERM GAIN IS WORTH SHORT TERM PAIN. DOES THIS IMMEDIATELY PUT THEM INTO YOUR CAMP? NO, NOT NECESSARILY WHAT IT DOES IS THIS IS REALLY BEGINS TO SHIFT PEOPLE FOCUSED ON THE LONG-TERM WHICH IS WHERE YOU WANT IT. SLIDE NUMBER 18 IS AN EXAMPLE OF A PHYSICIAN GROUP INITIATIVE THAT WE WENT THROUGH. AND THESE ARE BULLET POINTS THEY CAME UP WITH. WE DID THE SHORT TERM FIRST ON A BLANK PAGE. THAT WAS SIX TO NINE MONTHS AND I DREW A LINE ACROSS THE PAGE. AND HAD THE LONG-TERM AND THERE WROONT TOO MUCH -- WEREN'T TOO MUCH. IN TERMS OF SHORT TERM OPPORTUNITIES NOT TOO MUCH. AND AGAIN, LONG-TERM OPPORTUNITIES THERE WAS MORE OF THEM. AS I SAID, WE DREW THAT RED LETTER PAIN ACROSS THE UPPER RIGHT-HAND PROJECT AND GAIN ACROSS THE LOWER 54 RIGHT AND SAID IS IT WORTH IT? DO YOU WANT TO GO FORWARD WITH THIS THING? IF PEOPLE SAY NO AND THERE IS AN HONEST REFLECTION UP THERE ON THE PAGES OF THE SHORT TERM PAIN AND THE LONG-TERM GAIN AND IF THEY STILL SAY NO, YOU ARE NOT GOING TO GET THIS PROJECT DONE. I DON'T CARE WHAT KIND OF METRIC OUTCOMES THERE ARE OR WHO IS DRIVING IT. IF THE PEOPLE WHOSE BEHAVIOR HAS TO CHANGE CAN OBJECTIVELY LOOK AT THAT PAGE, AT THOSE TWO PAGES UP ON THE WALL AND SAY THE GAIN IS NOT WORTH IT, IF THEY REALLY CAN SAY THAT, YOU'RE NOT GOING TO GET THIS PROJECT DONE. TIME TO PUT THE PENCILS DOWN AND GO OFF AND DO SOMETHING ELSE WITH YOUR TIME. YOU WILL BE SURPRISED HOW OFTEN THIS REALLY IS EFFECTIVE AT GETTING PEOPLE. LET'S GO ON TO THE THIRD AND FINAL TOOL OF CREATING ALIGNMENT. THIS IS SOMETHING CALLED THE ELEVATOR SPEECH. WHERE IS THAT NAME COME FROM? FIRST LET ME TELL YOU THE PURPOSE. I WILL TELL YOU AN INTERESTING STORY ABOUT WHERE THE NAME COMES FROM. THE PURPOSE OF THE ELEVATOROR SPEECH IS FOR ALL OF 55 THE MEMBERS ON THE TEAM TO SING OUT OF THE SAME HIM NAL. GIVE THE SAME MESSAGE THROUGHOUT THE ORGANIZATION. IF YOU TOOK YOUR PROJECT TEAM RIGHT NOW AND SENT THEM OUT INTO THE ORGANIZATION TO DESCRIBE YOUR INITIATIVE, PEOPLE HEARING IT WOULD PROBABLY GET SEVERAL DIFFERENT VERSIONS. AS A MATTER OF FACT IF THEY COMPARED NOTES, THEY PROBABLY IN MANY CASES WOULDN'T KNOW YOU WERE TALKING ABOUT THE SAME PROJECT. HOW DO YOU GET PEOPLE TO SING THE SAME SONG? WELL, THE ELEVATOR SPEECH. HOLD THAT THOUGHT FOR A MINUTE. WHERE DID THAT NAME COME FROM? IT IS A TRUE STORY. BACK ABOUT 12, 14 YEARS AGO, I THINK IT WAS AROUND 1992, THE VICE PRESIDENT OF MARKETING AT GENERAL ELECTRIC GOT INTO THE ELEVATOR IN THE MAIN OFFICE IN NEW YORK CITY AND STARTED TO RIDE UP, AND LO AND BEHOLD, JACK WELSH WHO WAS THE CHAIRMAN OF THE GENERAL ELECTRIC OR CEO GOT INTO THE ELEVATOR WITH HIM. HUGE ORGANIZATION. THE TWO DIDN'T KNOW EACH OTHER. WELSH WAS GOING TO THE 32ND FLOOR. AND HE TURNED AND SAID TELL ME WHAT IS GOING ON IN 56 MARKETING. WELL, FOR 32 FLOORS THE MARKETING EXECUTIVE STUMBLED AND BUMBLED AND SAID WE ARE DOING THIS AND THIS IS MORE IMPORTANT AND I FORGET ABOUT THIS. THE ELEVATOR GOT TO THE 32ND FLOOR, THE DOOR OPENED. WELSH WALKED OUT AND SAID HAVE A NICE DAY AND THE DOORS CLOSED. THE MARKETING EXECUTIVE WAS FURIOUS WITH HIMSELF. RODE UP TWO MORE FLOORS TO HIS OFFICE AND SAID I WILL NEVER DO THAT AGAIN. IF I EVER GET THE OPPORTUNITY TO TELL PEOPLE WHAT I AM DOING, I'M GONNA HAVE AN ELEVATOR SPEECH READY. THAT'S WHERE THE TERM ELEVATOR SPEECH CAME FROM. VERY WIDELY USED. HERE IS THE BASIC ELEMENTS. LET'S GO TO SLIDE NUMBER 19. AN ELEVATOR SPEECH -- WELL, SOME PEOPLE LIKE TO MAKE IT 90 SECONDS TO TWO MINUTES LONG. I LIKE MY ELEVATOR SPEECHES, I DO ALL THE TIME, TO BE ABOUT 30 TO 45 SECONDS. AN ELEVATOR SPEECH IS SOMETHING YOU DELIVER IN A CONVERSATIONAL VOICE, TALKING WITH PEOPLE AS YOU ARE WALKING DOWN THE HALL, STANDING IN THE LUNCH LINE, ON THE WAY TO THE PARKING LOT. 57 IT'S VERY CASUAL. NOT AN ASKED SPEECH IN THE SENSE OF THE WORD. IT IS CONVERSATIONAL. HEY, MARY. I HEAR YOU GUYS ARE WORKING ON SOMETHING. WHAT IS THAT? MARY DELIVERS THE ELEVATOR SPEECH. NOW, AN ELEVATOR SPEECH HAS FOUR ELEMENTS. THIS IS WHAT OUR PROJECT IS ABOUT. HERE IS WHY IT IS IMPORTANT. HERE IS WHAT SUCCESS WILL LOOK LIKE. AND THIS IS WHAT WE NEED FROM YOU. THOSE ARE THE FOUR ELEMENTS. ANY GOOD ELEVATOR SPEECH HAS THAT. BY THE WAY HAVE YOU HAD AN ELEVATOR SPEECH GIVEN TO YOU? YOU BET. EVERY TELEVISION AND RADIO COMMERCIAL HAVE YOU EVER HEARD FOLLOWS THAT FORMAT. THINK ABOUT THE AT AND T LONG DISTANCE COMMERCIAL. YOU SEE A TELEPHONE ON A DESK. GRANDMA IS PICKING UP A TELEPHONE ON A SPLIT SCREEN AND TRYING TO CALL GRANDDAUGHTER. THAT'S WHY IT IS IMPORTANT. GRANDMA GETS THROUGH AND THE GRANDDAUGHTER SMILES 58 A GREAT BIG SMILE. WHAT SUCCESS WILL LOOK LIKE. HERE IS WHAT WE NEED FROM YOU. AND ATT FLASHES ITS 1 (800) NUMBER UP ON THE SCREEN AND SAYS CALL AT & T. WHETHER YOU SELL CARS OR BEER OR HOME LOANS. IT IS SUCCESSFUL. YOU KNOW IMMEDIATELY WHAT THE PRODUCT IS. THEY TELL YOU WHY IT IS IMPORTANT. THINK ABOUT THE MUSTANG YOU SEE DRIVING ALONG AND THE YOUNG GUY PULLS UP TO A STOPLIGHT AND THE PRETTY GIRL STANDING ON THE CORNER SMILES AT HIM. THAT IS WHY -- WHAT SUCCESS WILL LOOK LIKE. THIS IS WHAT WE NEED FROM YOU. BUY A FORD. ANY 30-SECOND COMMERCIAL HAS THOSE FOUR ELEMENTS IN IT. IN THAT ORDER. DON'T START AN ELEVATOR SPEECH BY TALKING ABOUT WHAT'S WRONG AND WHAT YOU'RE GONNA FIX. LET ME GIVE YOU AN EXAMPLE. ONE OF THE PROJECTS I WAS WORKING ON IS ONE TO TRY TO GET CLINICIANS DEALING WITH NATIONS WITH MENTAL HEALTH PROBLEMS TO TAKE THE TIME TO EXPLAIN TO THE PATIENTS AND THEIR FAMILY WHAT THE TREATMENT PLAN WAS, 59 WHAT THE MEDICATION SIDE EFFECTS MIGHT BE, WHAT THEY NEEDED FROM THE PATIENT IN ORDER TO ACTUALLY DEAL WITH THE DISEASE. MOST OF THE TIME MENTAL HEALTH PROFESSIONALS DON'T DO THAT. THEY TREAT THE PATIENTS LIKE THEY ARE A VESSEL FOR THE PRESENTATION OF AN INTERESTING DISEASE STATE. WELL, YOU HAVE GOT TO TAKE TIME. IT IS AN EFFORT TO TRY TO BE ABLE TO BRING THESE PATIENTS ALONG AND TO ACTUALLY TALK ABOUT A TREATMENT PLAN AND MEDICATION SIDE EFFECTS AND WHAT THEY NEED FROM THEM AND BE ABLE TO DO THIS WITH BOTH THE PATIENTS AND THEIR FAMILIES. WE MET A LOT OF RESISTANCE WITH THAT PROJECT. THE FOLKS ACTUALLY DELIVERING THE SERVICE SAYS MY GOSH WE HAVE TO SEE PATIENTS ON A 20-MINUTE TURN WE DON'T HAVE TIME TO DEAL WITH A LOT OF RESISTANCE. AN ELEVATOR SPEECH WOULD NOT TALK ABOUT ALL THE PROBLEMS THAT CONTRAINDICATED DRUGS CREATED. IT WOULD START OFF AND SAY OUR PROJECT IS HELPING PATIENTS AND BE BETTER COPRODUCERS OF THEIR CARE. IT IS IMPORTANT BECAUSE UNLESS PATIENTS ARE AWARE OF TREATMENT PLAN AND MEDICATION SIDE EFFECTS THEY CAN'T REALLY COOPERATE IN THEIR TREATMENT. IF WE ARE SUCCESSFUL IN THIS PROJECT, WHAT WE'RE 60 GONNA BE ABLE TO DO IS HAVE MUCH SHORTER TREATMENT PLAN OR MUCH REDUCED TREATMENT PERIOD, BETTER OUTCOMES FROM THE PATIENTS, AND A MORE COOPERATIVE ATTITUDE ON THE PART OF THE PATIENTS. WHAT I NEED FROM YOU, DR. SMITH, IS A FEW MINUTES TO KIND OF EXPLAIN THIS IN MORE DETAIL TO GET YOUR IDEAS ON THIS. A GOOD ELEVATOR SPEECH MIGHT HAVE NO MORE THAN ONE OR TWO SENTENCES ASSOCIATED WITH EACH OF THE 4 POINTS. YOU ARE NOT TRYING TO EXPLAIN THE DETAILS OF THE PROJECT. YOU ARE TRYING TO GET PEOPLE UNDERSTANDING WHAT YOUR PROJECT IS ABOUT. YOU CAN ASK DIFFERENT INDIVIDUALS, WHAT WE NEED DR. SMITH, IS SOME OF YOUR TIME NEXT WEEK TO GET IDEAS AND INPUT ON HOW TO STRUCTURE THIS. WHAT WE MIGHT NEED FROM YOU MRS. JONES IS AN INTRODUCTION TO THIS PERSON. WE HAVE TO HAVE A BOARD ON THIS PROJECT. YOUR STAFF, YOUR CHANGE TEAM NEEDS TO WRITE AN ELEVATOR SPEECH. THAT IS VERY IMPORTANT. LET'S MOVE ALONG BECAUSE THE CLOCK IS TICKING. AND GET TO THIS PROBLEM OF RESISTANCE. 61 >>: JOHN. EXCUSE ME. THIS IS DARRELL. >>: OKAY. >>: SINCE WE HAVE ABOUT 15 MINUTES LEFT, I WONDERED IF WE COULD TAKE A BREAK FOR SOME QUESTIONS? >>: SURE. >>: I ACTUALLY HAD ONE THAT I WANTED TO ASK ON BEHALF OF -- IT'S KIND OF A COMPOSITE QUESTION FROM SEVERAL PEOPLE WHO I HAVE WORKED WITH OVER THE PAST SEVERAL YEARS HAVE HAD THIS ISSUE. AND IT HAS TO DO WITH FOLKS WHO ARE PROJECT DIRECTORS, PROJECT COORDINATORS WHO FEEL THAT THEY ARE NOT SUPPORTED BY THE SUPERIORS WITHIN THEIR ORGANIZATION. THEY MAY HAVE BEEN HANDED A PROJECT THAT WAS ACTUALLY APPROVED BY THE UPPER ECHELON, BUT IN TERMS OF THE DAY-TO-DAY SUPPORT, THEY FEEL LIKE THAT SUPPORT IS NOT THERE. >>: THAT IS WHAT THAT PROJECT SPONSOR IS SUPPOSED TO DO. 62 IT SOUNDS LIKE -- I HAVE SEEN PROJECTS WHERE YOU HAVE GOT SOMEONE WHO HAS BEEN GIVEN AN ORDER BECAUSE THE PERSON THAT GAVE THE ORDER WAS THEMSELVES GIVEN AN ORDER, AND MUCH REMOVED FROM THE ORGANIZATION. BUT NOBODY IS REALLY IN FAVOR OF IT. THERE IS NO RAIN MAKER WILLING TO STAND UP AND SAY I REALLY SUPPORT THIS PROJECT AND I'M GOING TO TAKE HEAT AND HELP THE PROJECT TEAM AS NECESSARY. IF YOU HAVEN'T GOT THAT PERSON ON BOARD, YOU'RE NOT GOING TO BE SUCCESSFUL. IN OTHER WORDS, IF THIS IS JUST A COMMAND TO DO OR CARRY OUT A PROJECT THAT IS NOT TKLY -- PARTICULARLY IMPORTANT TO ANYBODY IN THE ORGANIZATION, IT'S NOT GOING TO WORK. >>: DO YOU HAVE ANY SUGGESTIONS ABOUT THE STRATEGY TO CREATE THAT SPONSOR. IF THE PROJECT ALREADY EXISTS, BUT THE GRANT IS THERE, EVERYTHING IS IN PLACE, THE STAFF TEAM IS IN PLACE TO TRY TO -- >>: THAT IS A VERY DIFFICULT QUESTION. IF THE SPONSOR IS NOT THERE, I MEAN, IF THE SPONSOR TRULY ISN'T THERE, IF THERE IS NO SPONSOR ON THE PROJECT, NOTWITHSTANDING THAT YOU HAVE A GRANT AND A TEAM, JUST LIKE HAVING A CAR WITH NO ENGINE. IT IS REALLY NOT GONNA GO. 63 I DON'T KNOW HOW TO PUT IT OTHERWISE. IT IS VERY DIFFICULT FOR ANY COMPLEX CHANGE PROJECTS, FOR A CHANGE TEAM TO GO IN ALONE AND TO DO THIS WITHOUT THE ACTIVE SUPPORT AND TRY BUY IN OF SOME SENIOR PEOPLE IN THE ORGANIZATION. BY THAT I MEAN THAT IS DIFFERENT FROM BEING ORDERED TO DO IT BECAUSE YOU GOT A GRANT. I HAVE SEEN -- YOU HAVE SEEN PROJECTS FAIL NOTWITHSTANDING THAT THEY'RE FUNDED. LET ME DRAW A DISTINCTION, DARRELL, BETWEEN A SPONSOR AND HAVING RESISTANCE FROM KEY PEOPLE IN THE ORGANIZATION. OKAY? THERE IS A DIFFERENCE BETWEEN THAT. THE LATTER QUESTION, YEAH, YOU CAN DEAL WITH THAT. AND HANDLE THAT. THAT IS THE WHOLE SUBJECT OF THE TOPIC IF YOU WILL THAT WE WILL TURN TO IN JUST A MOMENT. AS THAT SPONSOR, YOU HAVE GOT -- I WILL BE HONEST WITH YOU. IF YOU HAVE A BATTLE THAT I DON'T THINK CAN BE WON. >>: OKAY. WELL, THAT'S NOT VERY ENCOURAGING. >>: NO. 64 BUT FIRST POINT, FIRST RULE OF CHANGE MANAGE SUBMIT TO SEE REALITY CLEARLY. DON'T FOOL YOURSELF. NOW, YOU CAN GO OUT AND TRY TO ENLIST A SPONSOR. BUT IF YOU HAVE TO TALK THEM INTO IT, IT'S A VERY WEAK SITUATION. >>: IF YOU HAVE A TEAM THAT IS COMING TOGETHER WITH A CLEAR MESSAGE AND A CLEAR ELEVATOR SPEECH THAT REALLY KNOWS ITS PURPOSE, HAS A CLEAR SENSE OF POTENTIAL OUTCOMES FROM THE PROJECT, HOW CAN THAT BE USED, PERHAPS TO INFLUENCE UPWARD WITHIN AN ORGANIZATION? >>: THAT REALLY OPENS THE DOOR TO THE NEXT HANDFUL OF CHANGE TOOLS. LET ME GET INTO THOSE AND SEE IF I ANSWER YOUR QUESTION BY GOING THROUGH THOSE. >>: OKAY. WE HAVE 10 MINUTES LEFT. >>: I'M GOING TO -- THIS WILL BE THE LAST TOOL THAT WE'LL COVER. >>: OKAY. >>: IDENTIFYING AND OVERCOMING RESISTANCE IS ON 65 SLIDE 20. SLIDE 21 IS A SIMPLE GRAPHIC THAT IS CHARACTERISTIC OF ATTITUDES IN MOST ORGANIZATIONS. THE PURPOSE OF THIS IS -- I THINK MOST OF YOU RECOGNIZE THIS. IN ANY ORGANIZATION, ABOUT FIVE TO 10% OF THE PEOPLE ARE INVADERS. THEY GET -- INNOVATORS. THEY GET IT QUICKLY AND GET A BOARD AND MOVE QUICKLY. THERE IS ANOTHER 10% THAT ARE EARLY ADOPTERS THAT ARE EASY TO BRING ALONG. HERE IS WHERE YOU START HAVING TO TROT OUT THE CHANGE TOOL. THE EARLY MAJORITY. 35%. THEY NEED WORK. THEY NEED TO BE BROUGHT ALONG THROUGH THE ELEVATOR SPEECH, THREAT AND OPPORTUNITY MATRIX AND SOME OF THE OTHER TOOLS. BUT YOU WILL BE ABLE TO GET THEM EVENTUALLY. WHERE YOU'RE GONNA SPEND 70% OF YOUR TIME IS ON THAT 35% THAT I CALL THE LATE MAJORITY, THE PEOPLE YOU HAVE TO DRAG THROUGH THE MUD TO GET THERE. IT IS TRUE IN ANY ORGANIZATION. 66 THAT IS WHERE YOU WILL MEET MOST OF YOUR TIME AND RESISTANCE AND EFFORT. THEN THERE IS A GROUP OF RESISTORS OF PEOPLE THAT WILL NEVER GO ALONG WITH YOU, PERIOD, END OF STATEMENT. YOUR ONLY HOPE IS THAT THOSE RESISTORS ARE NOT IN A POSITION TO BLOCK YOUR PROJECT. NOW, GO TO SLIDE NUMBER 22. WE WILL GO THROUGH THIS PRETTY QUICKLY. BUT IT IS IMPORTANT. RESISTANCE TO CHANGE. THE REASON PROJECTS FAIL IS BECAUSE OF RESISTANCE, NOT BECAUSE OF TECHNICAL REASONS. HUMAN RESISTANCE. THERE IS ACT AND I HAVE PASSIVE. ACTIVE RESISTANCE IS WHEN SOMEBODY STANDS UP AND SAYS NO, I DON'T GO ALONG WITH THIS BECAUSE IT IS TAKING TIME AWAY FROM MY PROJECT, IT IS THIS OR THAT. THEY STATE IT PUBLICLY. YOU CAN DEAL WITH IT. YOU CAN STAND THEM UP ON A STAND UP BASIS. IT IS THE PASSIVE RESISTANCE WHERE THEY SAY THIS IS A GOOD IDEA BUT THEY GO BACK TO THE OFFICE AND NEVER DO ANYTHING DIFFERENT. IT IS LIKE AN ICEBERG. IT IS THE 20% ABOVE THE WATER YOU CAN SEE AND DEAL 67 WITH. IT IS THE 80% BELOW THE WATER THAT SANK THE TITANIC. THIS IS HOW YOU DEAL WITH BOTH OF THEM. GO TO SLIDE NUMBER 2. -- EXCUSE ME. NUMBER 23. DRAW A GRID ON THE WALL. NOW, GUYS, KEEP THIS CONFIDENTIAL. DON'T LET THIS OUT. I HAD ONE DISASTROUS SITUATION IN MY PROFESSIONAL LIFE WHERE THIS GOT OUT AND IT JUST SANK THE PROJECT. WRITE DOWN THE NAMES ON THAT LEFT-HAND COLUMN OF ALL THE KEY STAKEHOLDERS. THOSE ARE THE REAL KEY PEOPLE YOU HAVE TO BRING INTO THE FOLD IF YOU WILL BE SUCCESSFUL. THEN WHAT I WOULD LIKE YOU TO DO IS PUT A LITTLE BLACK DOT ON THE MATRIX WHERE YOU THINK THE PERSON IS WITH REGARDS TO THIS PROJECT. A LITTLE CIRCLE WHERE THEY NEED TO BE FOR THE PROJECT TO BE SUCCESSFUL. EVERYBODY DOESN'T NEED TO BE STRONGLY FAVORED. WHERE THEY NEED TO BE AND AN ARROW BETWEEN THE TWO. GO TO SLIDE FEBRUARY 24TH, AND YOU WILL SEE WHAT A 68 COMPLETED DIAGRAM LOOKS LIKE. LOOK AT THAT SLIDE, NUMBER 24. LOOK AT DR. COAL. HE'S STRONGLY AGAINST. THIS IS WHAT YOU BELIEVE. YOU DON'T KNOW THAT. HE HAS TO BE STRONGLY SUPPORTIVE TO GET THE JOB DONE. YOU DRAW THE ARROW AND THAT SHOWS HOW FAR YOU HAVE TO MOVE HIM. JUST LOOK AT THAT SLIDE. WOULD YOU TAKE THAT PROJECT ON? NO WAY. MAYBE YOU CAN PULL ONE OR TWO PEOPLE A FEW BLOCKS, BUT YOU CAN'T MOVE THAT MANY PEOPLE THAT FAR. IF YOU HAVE GOT THAT MUCH RESISTANCE, STRONGLY AGAINST AND MODERATELY AGAINST THAT YOU HAVE TO MOVE PEOPLE TOTALLY TO THE OTHER CAMP, YOU WILL NOT BE ABLE TO DO IT. LET'S TAKE A LOOK AT THE NEXT SLIDE, THOUGH. SLIDE NUMBER 25. HERE IS ANOTHER EXAMPLE. LOOK AT THAT ONE. THIS IS AN EXAMPLE, AGAIN, YOU DON'T KNOW WHERE DR. COLE IS, YOU THINK HE MIGHT BE MODERATELY 69 SUPPORTIVE, BUT HE'S GOT TO BE STRONGLY SUPPORTIVE IN ORDER TO GET THE PROJECT DONE SO THAT IS HOW YOU DRAW IT. LOOK AT THAT ONE. YEAH, YOU CAN GET THAT PROJECT DONE. THAT IS A PROBABILITY. NOW, LAST POINT I'M GONNA MAKE HERE. WHAT DO YOU DO IN ORDER TO BE ABLE TO INFLUENCE THOSE PEOPLE? THIS IS VERY IMPORTANT POINT. A LOT OF TIMES PEOPLE ARE AGAINST YOUR PROJECT NOT ON THE MERITS OF THE PROJECT BUT BECAUSE OF SOMETHING YOU'RE TOTALLY UNAWARE OF. BECAUSE IT DRAWS RESOURCES AWAY FROM SOMETHING THEY THINK IS IMPORTANT, BECAUSE IT DIVERTS ENERGY AWAY FROM SOMETHING THAT THEY'RE DOING. BECAUSE OF A NUMBER OF REASONS THAT YOU'RE NOT REALLY FAMILIAR WITH. GO TO SLIDE NUMBER 26. THIS IS HOW YOU DEAL WITH T WHAT YOU DO IS YOU IDENTIFY A GROUP OF PEOPLE -- THESE MIGHT BE PEOPLE ON YOUR CHANGE TEAM OR COULD BE PEOPLE WITHIN THE ORGANIZATION WHO ARE SYMPATHETIC. IF THEY GO AND THEY SIT DOWN WITH EACH OF THE KEY STAKEHOLDERS ON YOUR LIST AND THEY BRIEF THEM AND TALK 70 TO THEM ABOUT THE PROJECT. NOT TRYING TO PERSUADE THEM. WHAT THEY ARE REALLY TRYING TO DO IS DETERMINE WHAT THEY STAKEHOLDER'S ISSUES AND CONCERNS ARE WITH THE PROJECT. IN ORDER, YOU REALLY WANT TO BE ABLE TO IDENTIFY WHERE THESE KEY STAKEHOLDERS REALLY ARE ON THE PROJECT. AND WHAT THEIR ISSUES AND CONCERNS ARE. GO TO SLIDE NUMBER 27. WHAT I'LL ACTUALLY DO IS I'LL MAKE A CARD, SIX BY EIGHT CARD FOR EACH ONE OF THE KEY STAKEHOLDERS INVOLVED IN AN INITIATIVE AND I WILL WRITE DOWN ON THE CARD WHAT THE ISSUES AND CONCERNS ARE AND TRY AND COME UP WITH AN INFLUENCE STRATEGY TO DEAL WITH THEM. THAT INFLUENCING STRATEGY IS NOT TRYING TO PERSUADE THEM OF THE MERITS OF THE PROJECT. YOU TRIED DO THAT AND IT DIDN'T WORK. INFLUENCES STRATEGIES ARE IF YOU SUPPORT ME ON THIS INITIATIVE I CAN HELP YOU WITH THIS. BY THE WAY, THIS TECHNIQUE IS SOMETHING THAT MEMBERS OF CONGRESS USE QUITE FREQUENTLY. IN DEVELOPING INFLUENCING STRATEGIES. YOU CAN BE CREATIVE IN COMING UP WITH DIFFERENT STRATEGIES TO INFLUENCE THESE PEOPLE, ONCE YOU KNOW WHAT THEIR ISSUES AND CONCERNS ARE. 71 THAT'S WHY I SAID ON THE PREVIOUS SLIDE YOU SENT PEOPLE OUT TO TALK TO THE KEY STAKEHOLDERS. NOT TO PERSUADE THEM. THAT IS A MISTAKE TO TRY TO WALK INTO SOMEBODY'S OFFICE AND PERSUADE THEM. NO, TRY TO GET THEIR ISSUES ASK CONCERNS OUT AND BRING THAT -- ISSUES AND CONCERNS OUT AND BRING THAT BACK TO THE CHANGE TEAM AND SIT DOWN AND COME UP WITH A STRATEGY. AGAIN, BE CREATIVE HERE. YOU WILL BE AMAZED AT HOW OFTENTIMES YOU MISESTIMATE WHAT PEOPLES PROBLEMS AND CONCERNS ARE. SURE, YOU SAY THEY'RE NOT GOING ALONG WITH IT. NO, THAT'S NOT THE ISSUE. THE ISSUE IS CAUSING THEM NOT TO GO ALONG WITH IT. WHAT REALLY IS THE ISSUE OR CONCERN IN THEIR WORDS. NOT YOURS. THEIR WORDS. ONCE YOU UNDERSTAND THAT, YOU CAN COME UP WITH AN INFLUENCING STRATEGY. >>: EXCUSE ME, JOHN. THIS IS SHARON. I'M SORRY TO INTERRUPT. 72 WE HAVE A FEW MINUTES LEFT. I WANTED TO GIVE OUR AUDIENCE AN OPPORTUNITY IF THEY HAVE QUESTIONS ON THE TELECONFERENCE AND ON THE WEB, THEY CAN E-MAIL THEIR QUESTION IN THE E-MAIL BOX. >>: SURE. GO RIGHT AHEAD. >>: AND FOR THOSE THAT ARE ON THE TELEPHONE, IF THE OPERATOR COULD GIVE THEM THE INSTRUCTIONS NOW. >>: THE ONES THAT ARE ON THE TELEPHONE, JUST SIMPLY MAKE THE CONNECTION LIVE, THEY CAN ASK THE QUESTION THEMSELVES. >>: THANK YOU. >>: AGAIN, IF YOU WOULD LIKE TO ASK A QUESTION PLEASE PRESS THE STAR KEY FOLLOWED BY THE ONE KEY ON YOUR TOUCH TONE PHONE NOW. >>: THAT WILL UNMUTE THE PHONE SO JUST PILE IN HERE. ANYBODY GOT ANY QUESTION OR OBSERVATION OR PERSONAL EXPERIENCE, SHARE IT FOR THE GOOD OF THE GROUP. >>: OKAY; SIR, THERE ARE NO FURTHER QUESTIONS AT THIS TIME. 73 >>: ARE YOU GUYS SHELL-SHOCKED? DON'T WANT TO DO THAT. YOU KNOW, THIS IS HARD WORK. IT IS LIKE WADING THROUGH MUD. IT IS NOT WRITING A MEMO DETAILING WHAT YOU WANT PEOPLE TO DO. AND SENDING IT OUT TO THEM AND EXPECT TOGETHER TO CHANGE. THIS IS ABOUT GETTING PEOPLE TO SELF-DISCOVER THE NEED THE CHANGE THEIR BEHAVIOR. CHANGE THEIR ATTITUDE. CHANGE THE WAY THEY DO THEIR WORK. THEY'RE NOT GONNA DO THIS BASED UPON SWEET REASONING. EVEN BASED UPON THE BENEFIT TO THE ORGANIZATION OR HEAVEN FORBID EVEN BASED UPON THE BENEFIT TO THE PATIENT OR CUSTOMER. THEY WILL DO IT FOR WHATEVER REASONS PEOPLE HAVE, THOSE ARE IMPORTANT, NOT TO DIMINISH THEM. BUT FOR WHATEVER PEOPLE REASONS, NOT SELFISH REASON. WHATEVER REASON THEY NEED TO DISCOVER THAT THIS NEEDS TO BE DONE. YOUR ROLE AS A CHANGE AGENT OR MANAGER IS TO USE THESE CHANGE TECHNIQUES TO HELP THEM DO JUST THAT. 74 IT WORKS. YOU CAN GO OUT AND DO THESE THINGS AND IMPLEMENT THESE THINGS, AND YOU WILL BE SURPRISED HOW MUCH YOU WILL BE ABLE TO INFLUENCE BEHAVIOR AND WILLINGNESS OF YOUR COLLEAGUES TO GO ALONG. IT WILL NOT HAPPEN OVERNIGHT. THERE IS NO MAGIC TRANSFORMATION WHERE PEOPLE SLAP THEIR HEADS AND SAY I SEE THE ERRORS OF MY WAYS. NO, IT TAKES TIME AND COMMITMENT ON YOUR PART. THAT IS WHY ANY CHANGE PROJECT WORTH DOING IS A SIX TO NINE MONTH COMMITMENT AT THE VERY LEAST. BUT IF YOU KEEP AT IT, YOU KEEP USING IT, MORE OFTEN THAN THAT, YOU WILL BE SUCCESSFUL. >>: JOHN, THANK YOU VERY MUCH. WE'RE JUST ABOUT OUT OF TIME. I REALLY APPRECIATE THE PRESENTATION TODAY. I HOPE FOLKS LEARNED A LOT. AND IT WAS VERY INFORMATIVE. >>: IF ANYBODY WANTS TO HANG ON, ON THE TELEPHONE, I WILL STAY HERE AS LONG AS ANYBODY HAS QUESTIONS OR OBSERVATIONS. >>: THANK YOU. ALSO I WANTED TO SHARE WITH OUR AUDIENCE THAT WE 75 WILL ARCHIVE THIS PRESENTATION. FOR THOSE OF YOU WHOSE COLLEAGUES WEREN'T ABLE TO MAKE IT. WE WILL HAVE THE ARCHIVE UP ON THE WEBSITE. ALSO THE EVALUATION IF YOU WILL TAKE A MOMENT AND COMPLETE THAT. IT TOO IS ON THE WEBSITE. WE WILL LIKE TO ACKNOWLEDGE THE CENTERS FOR MEDICARE AND MEDICAID SERVICES WHICH FUNDS THIS PROJECT. WE WOULD ALSO LIKE TO THANK THE ILRU WEB CAST TEAM AND OUR CART PROVIDER TODAY COMMUNIQUE. THANK YOU ALL ON THE WEB AND ON THE TELECONFERENCE FOR JOINING US. >>: THANKS VERY MUCH SHARON AND DARRELL AND ROB. I REALLY DO APPRECIATE ALL YOUR HELP. >>: THANK YOU. HAVE A GREAT DAY. >>: OKAY. SHOULD HANG AROUND OR -- >>: LET'S ASK SHEILA. >>: EVERYONE HAS DISCONNECTED.