The People Side of Change Managing Expectations Early to Eliminate - - PowerPoint PPT Presentation

The People Side of Change

Managing Expectations Early to Eliminate Workarounds Post Occupancy

Informing the transition process

Jennie Evans, RN, BS, EDAC, LEEP AP, Lean Six Sigma CE Associate Principal and Sr. Vice President HKS Architects Adeleh Nejati, PhD, MArch, EDAC Architect and Design Researcher HKS Architects Meredith Slosberg, MBA, FACHE, CSC Lean Six Sigma Green Belt Deployment Leader Organizational Effectiveness Akron Children's Hospital

Acknowledgment: Center for Advanced Design Research and Evaluation Principal Investigator: Upali Nanda

Objectives

Establish an understanding of: 1. The importance of perception and the need to address it in the design approach

• 2. How nurses’ perception to certain design attributes can affect
• perational efficiency and team work
• 3. How to recognize resistant behaviors and how to address

them on your project

• 4. Tools that can be applied to a design project, your team, or

within your firm

• 5. Opportunities to deploy change engagement directives during

the project planning and implementation process

• 6. Why change engagement is necessary, and effective, in all

planning and design projects, based on systematically collected data

275,000 sf patient care tower

• 75 bed NICU
• 39 room emergency department
• 6-OR outpatient surgery center
• High risk delivery area

Continuing to deliver on the promises that were written in 1890, our campus expansion will enhance the high quality, compassionate and family- centered care that we have delivered to the communities we serve for over 120 years.

Akron Children’s Hospital

Integrating Process into Design

Pre-Design Design Transition Occupancy

Visioning Emerging Trends Current to Future State Site Visits Site Visits

• Dept. Mock Ups

Spaghetti Diagrams Expectation Check Survey Ambassadors Pulse points Leadership Training Ambassadors Trials Post Design Mock-up Pulse Points Expectation Check Survey

The Design and Implementation Process

Akron: Integrating Design and Change Management

Existing ED Future ED 39 Rooms 27,907 DGSF 26 Rooms 21,800 SF

Future NICU Existing NICU 59 Beds 27,843 SF 63 Private / 6 Twin = 75 Beds 68,179 DGSF

• Preparedness must consider model of care and work flow differences in
• Team Collaboration
• Visibility
• Walking distances
• Care delivery processes
• Post-occupancies identify spaces are not always used as intended
• Communication pathways are not established
• Team collaboration / Devices are under utilized
• Decentralized work stations are not used
• Visibility of peers
• Nurse servers are not used
• Walking Distances

Recent survey of healthcare administrators cites failure to create buy-in as one of the top 2 barriers to sustainable change.

• American College of Healthcare Executives, Journal of Healthcare Management

Preparation & Post Design Adaptation

progress productivity (effort)

project management timeline human response to change

goal

change management area of impact endings exploration new beginnings Source: Pritchett LLC

Transition During Change

Pre-Design Design Transition Occupancy

Visioning Emerging Trends Current to Future State Site Visits Site Visits

• Dept. Mock Ups

Spaghetti Diagrams Expectation Check Survey Ambassadors Pulse points Leadership Training Ambassadors Trials Post Design Mock-up Pulse Points Expectation Check Survey

The Design and Implementation Process

Akron: Integrating Design and Change Management

Survey 1 Survey 2 June 2013 Oct 2013 May 2014

ED Timeline

Survey 3 Survey 4 Jan 2015 June 2015 1. Leader Training Starts 2. Trials Start 3. Town Halls 4. Pulse Points Start 5. Trauma Room Mock up 6. Ambassadors Design Phase Complete

1. Leader Training Starts 2. Focus Groups Survey 1 Survey 2 Design Phase Complete June 2013 Oct 2013 June 2014

NICU Timeline

Trials Start Survey 3 Survey 4 Nov 2015 June 2015

Leadership Training

• Awareness
• Language and storytelling
• Messaging
• On-going dialogue
• Values and Key Behaviors
• Pulse Points

• Formalize it
• Overt communicate
• Venues

− Daily Huddles − Staff meetings − Department meetings − Governance councils − Town halls − Focus groups − Email and intranet − Ambassadors − Surveys

Create a dialogue with all staff

NICU Focus Groups, Focused Voice

Fears

• Loneliness
• Lack of help from fellow nurses
• Increased dependence on technology
• Looking incompetent for asking for help

Leadership Advocacy

• Communication technology
• Simulation time
• Parent/family expectations

Single room line of sight and patient safety

Focus Groups

• When town halls don’t work
• Prn/evenings/week-ends/tight shifts
• 1:10 ratio
• Flash drives or intranet
• Consistent regular messaging from leadership to staff and back
• Regular meetings for Ambassadors

Ambassadors

Trials and Post-Design Mock-up

• Respiratory
• Fast Track
• Distance to Transport
• Suture Cart
• Communication devices
• Pulse Ox
• Staffing Model
• Supply carts

Stake holder Issue Action RN

• Develop/implement new FT/triage

process

• Development of staffing model for new

ED

• Develop education and communication

plan

• Continue use of ambassadors, tours

and behaviors/values role out Physicians

• Staffing
• New roles/interactions with fellows
• Room assignments
• Even flow of patients through entire ED
• Develop education and communication

plan

• Recruitment
• Consider flow/teamwork when

developing new FT/triage process NPs Registration/Secretaries Respiratory Integrating Transport in ED operation

• continue presence at huddles in ED
• Global plan around integrating into

services in new building Mental Health Technicians

• maintaining consistent processes with

new and revolving staff

• developing guidebook for RN/MHT staff
• scripting to communicate what to

expect to families MAs Suture Staff

• integrating suture staff in FT
• geographic separation creates some

challenges in communication/touchdown space

• uncertainty around change at satellites
• continue to monitor, remind ED staff of

where suture staff may reside

Example: ED Pulse Point Checks 11/14

• To do a regular check in with the staff

to assess their perceptions, expectations and level of preparedness for the move

• To use the survey results to inform

specific change engagement initiatives

• To analyze the survey to understand

how involvement in the design of the new facility, and new processes, contributes to staff preparedness and adaptation for the new move

Expectation Check Survey

ED 1: N= 47 ED 2: N= 88

14.9 51.1 31.9 4.3 4.5 9.1 68.2 18.2 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 Leadership Medical staff Clinical staff Non-clinical staff

% of Participants

Job Role

ED 1 ED 2 12.8 6.4 48.9 10.6 8.5 2.1 10.6 9.1 11.4 42.0 9.1 8.0 10.2 9.1 0.0 10.0 20.0 30.0 40.0 50.0 60.0 < 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs

% of Participants

Years of Experience

ED 1 ED 2

ED Survey Demographic

16.3 8.2 71.4 4.1 9.3 2.3 86.0 2.3 0.0 20.0 40.0 60.0 80.0 100.0 Leadership Medical staff Clinical staff Non-clinical staff

% of Participants

Job Role

NICU1 NICU2 8.2 6.1 30.6 6.1 6.1 8.2 34.7 2.3 2.3 46.5 9.3 2.3 4.7 32.6 0.0 10.0 20.0 30.0 40.0 50.0 < 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs

% of Participants

Years of Experience

NICU1 NICU2

NICU 1: N= 49 NICU 2: N= 43

NICU Survey Demographic

Level of Involvement and Knowledge Type of Involvement in the Facility Design Type of Involvement in the Process Design Perception of Preparedness How prepared do you feel to work in the new environment? Perception of Adaptation To what extent do you feel your involvement in/ knowledge of design will help you adapt to your new environment? Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

Conceptual Model

3.4 1.4 1.8 1.6 2.2 2.5 3.7 0.9 1.7 1.6 2.6 2.6 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Years of Experience Level of Involvement Level of Facility Knowledge Level of Process Knowledge Preparedness Adaptation ED1 ED2

Summary Results for ED and NICU Surveys – Mean Comparison

T-test: Significantly different from Survey 1 to 2

NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88

4.6 1.4 2.0 1.4 1.9 2.6 4.5 1.4 2.2 1.5 2.1 2.7 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Years of Experience Level of Involvement Level of Facility Knowledge Level of Process Knowledge Preparedness Adaptation NICU1 NICU2

Key Learnings: Survey 1 and 2 Differences

Importance of involvement in design phase will be a recurring theme today For ED, a range of activities informed preparedness including:

• 10 trials
• Ambassadors
• Leadership training
• Interactive mock-up of trauma room

Some leadership/staff trust issues were more

• pressing. Only a small core group involved.

Leadership matters!

27.7 31.9 29.8 10.6 8.0 36.4 39.8 15.9 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Not at all A little bit Moderately so Very much so % of Participants ED1 ED2 32.7 44.9 18.4 4.1 14.0 65.1 16.3 2.3 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Not at all A little bit Moderately so Very much so % of Participants NICU1 NICU2

NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88

How prepared do you feel to work in the new environment?

23.4 21.3 36.2 19.1 10.2 39.8 33.0 17.0 0.0 10.0 20.0 30.0 40.0 50.0 Not at all A little bit Moderately so Very much so % of Participants ED1 ED2 10.2 42.9 28.6 18.4 7.0 39.5 30.2 23.3 0.0 10.0 20.0 30.0 40.0 50.0 Not at all A little bit Moderately so Very much so % of Participants NICU1 NICU2

NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88

To what extent do you feel your involvement in/ knowledge of design will help you adapt to your new environment?

Level of involvement in the facility design Level of Knowledge of New Facility Level of Knowledge of New Process Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

[S1, S2] [S1]

ED Survey Result

Level of Involvement & Knowledge

[S1] [S2] Correlation Prediction Survey 1 Survey 2

Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

[S1, S2]

Level of Knowledge of New Facility Level of Knowledge of New Process Level of involvement in the facility design

NICU Survey Result

Level of Involvement & Knowledge

[S1] [S2] Correlation Prediction Survey 1 Survey 2

Level of involvement in the facility design Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

Level of Knowledge

Process Facility

ED only

Summary Result

Level of Involvement & Knowledge

Key Learnings: Level of Involvement

Being involved in facility design was key:

• To increase knowledge of process and knowledge of environment
• To increase ED’s perceptions of both preparedness and adaptation
• To increase NICU’s perception of adaptation but not preparedness

This points to how the future design configuration affects the current model of care. The new NICU design has a huge impact on current model of care. The new ED is a larger space but has less impact on the model of care. Preparedness and adaptation seem to be more closely aligned when the new model

• f care is similar to the old model of care.

Key Learnings: Knowledge of Facility and Process

Knowledge of facility and knowledge of process did not have the same impact on each group.

• Knowledge of process and facility increased NICU’s perception of

their ability to be ready ahead of time.

• Knowledge of facility increased ED’s perception of their ability to

adjust to the new space.

• Knowledge of process increased ED’s perception of their ability to

be ready ahead of time. Since our goal is to have our employees ready to utilize the space in a way that is congruent with intended use we need to pay attention to providing them with both types of information. However, one group may need a certain type of information more than the other and at different times in the transition process.

Pre-Design Design Transition Occupancy

Types of Involvement

Part of design team Tour mock up Patient care processes Choosing design options Workshop report outs Regular communication Part of design team Tour mock up Patient care processes Choosing design options Workshop report outs Regular communication Trialing new equip/ tech Trial new equip/tech Leadership training Focus groups Regular communication Trial new equip/tech Leadership training Focus groups Regular communication

13 23 9 6 7 27 7 20 4 9 11 69 10 20 30 40 50 60 70 80 Part of the Design Team Tour Mock-up Create Patient Care Processes Choose Design Options Attend Workshops report outs Regular Communication Number of Participants ED1 ED2 10 13 10 16 8 38 5 13 7 6 3 39 10 20 30 40 50 60 70 80 Part of the Design Team Tour Mock-up Create Patient Care Processes Choose Design Options Attend Workshops report outs Regular Communication Number of Participants NICU1 NICU2

NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88

What “type” of Involvement is Facility Design Most Effective?

NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88

What “type” of Involvement is Process Design Most Effective?

46.9 14.3 28.6 44.2 9.3 34.9 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Trial of New Equipment & Technology Leadership Training Focus Groups

% of Participants

NICU1 NICU2 23.4 21.3 31.9 35.2 6.8 12.5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Trial of New Equipment & Technology Leadership Training Focus Groups

% of Participants

ED1 ED2

Involved in trialing new equipment and technology

Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

Involved in leadership training Involved in focus groups Part of the design team Toured the mock up Involved in creating the patient care processes in the new department Involved in choosing unit design options for the new department Attended the workshop report outs either in person or via webex Receive and read regular communication

• n your unit

design Type of Involvement in Facility Design Type of Involvement in Process Design [S1] [S1] [S2] Prediction Survey 1 Survey 2

ED Results

What “type” of Involvement is Most Effective?

Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

[S2] Involved in trialing new equipment and technology Involved in leadership training Involved in focus groups Part of the design team Toured the mock up Involved in creating the patient care processes in the new department Involved in choosing unit design options for the new department Attended the workshop report outs either in person or via webex Receive and read regular communication

• n your unit

design [S1] [S2] Prediction Survey 1 Survey 2 Type of Involvement in Facility Design Type of Involvement in Process Design

NICU Results

What “type” of Involvement is Most Effective?

Part of the design team

Preparedness Make ready ahead

• f time

Adaptation Adjust to a new state

• Touring the mock up
• Creating the patient

care processes

• Attending the

workshop report outs

ED

• Trialing new equip/

tech

• Leadership training
• Focus groups

NICU ED & NICU

Summary Result

Type of Involvement

Process design involvement is more critical when the model

• f care changes

Key Learnings: Type of Involvement

• Being part of design team led to both more adaptation and

preparedness for ED and NICU

• ED’s involvement in design activities led to more adaptation
• NICU’s involvement in process activities led to more

preparedness

We’ve said this multiple times. Being actively involved in the design phase of the project matters when it comes to being prepared and adapting to a new space.

Type of involvement produces different results. Understanding the type of involvement that leads to either adaptation or preparedness help leaders select the best activities for change engagement.

Summary of ED Qualitative Results

ED1 and ED2 ED1 ED2 Excited about Newness, clean environment, more space, better patient flow and processes. Concerned about Proximity to main hospital, adjusting to changes, staffing issues Lack of involvement in design, not enough computers. Communications Facility designers Should have Involved more staff, considered PICU and or locations, design issues. Management/ senior leadership should have Involved more staff, considered PICU and or locations Design issues Comments Looking forward to prepare for move, see new building, staffing.

Summary of NICU Qualitative Results

NICU1 and NICU2 NICU1 NICU2 Excited about Private rooms, clean and new environment Windows New equipment Concerned about Staffing, patient safety Size of unit vis-à-vis response time, not able to see babies constantly, how to get help in emergent situations, not having enough time with babies (parent satisfaction), distance between patients and supplies Nurse safety, staff morale, proximity of staff Facility designers Should have Involved more staff members Designed private rooms and pods Made rooms smaller Management/ senior leadership should have Considered staffing Involved more staff Be concerned about staff concerns Comments Familiarize with space and processes before moving, tour facility, staffing Have concerns addressed Discuss workflow and processes, practice on new communication system

Pre-Design Design Transition Occupancy

The Design and Implementation Process

Akron: Integrating Design and Change Management

Visioning Emerging Trends Current to Future State Site Visits Site Visits

• Dept. Mock Ups

Spaghetti Diagrams Expectation Check Survey Ambassadors Pulse points Leadership Training Ambassadors Trials Post Design Mock-up Pulse Points Expectation Check Survey

progress productivity (effort)

project management timeline human response to change

GO LIVE

endings exploration new beginnings

human response to change post go-live!

Source: Pritchett 2013 and Meredith Slosberg 2014

Transition During Change and Post GO-LIVE

Design Team

• Recommend the need for pre-

design operational planning with cross-functional teams

• Choose design team members

who will serve as ambassadors

• Provide job descriptions
• Implement initiatives to engage

staff who are not at design table

• Collect responses to specific

questions

• Post images / drawings
• Communicate
• Solicit constant feedback

The Organization Cannot be What the People Are Not Healthcare Leadership

• Integrate Change Engagement

concepts into the design/project plans

• Create early dialogue with all

staff and continue through post go-live − go to the people − use many modalities

• Establish ambassador program

− how to get many voices while maintain a small decision-making group

• Establish pulse point checks and

continue three to six months post occupancy

Future Studies

• What interventions help staff prepare and

adapt and when should they be implemented?

• What kind of ripple effect do these results

(with the staff) have on the patient and family?

• What role does leadership play in the staff’s

willingness to adapt and be prepared?

• What design process is the most effective for

preparing staff for their new environment?

Questions and Discussion