Change Acceleration Process (CAP) Workshop

Change Acceleration Process (CAP) Workshop

Session objectives • By the end of this workshop, you will be able to: • Understand and be able to explain the CAP model • Learn CAP tools and how they can be applied to your department/organization • Facilitate various CAP tools • Understand the role of the CAP Coach/Change Agent • Develop awareness and practice coaching/feedback techniques • Share best practices

Team assignment Introductions/Expectations/Ground Rules • Individual Introductions • Two learning goals/expectations for the session • Two ground rules for the session

Records ideas verbatim. • When flip chart is used, writes large enough so all can read. • Makes sure all flip charts are labeled and clear. • Guides the group through various activities to achieve objectives. • Ensures all group members participate. • Focuses group attention on what needs to be done. • Promotes discussion to help the group overcome differences and reach consensus. Scribe Leader • Leads initial discussion to allocate time to the agenda items. • Monitors agreed-upon timeframes and gives updates on use of time. Time Keeper • Maintains focus on agreed-upon processes being used. • Suggests techniques to help the group achieve goals. • Helps the group apply tools correctly. For example, when the group is brainstorming, make sure there is no evaluation.  • Leads presentation of group’s work to other groups. Process Checker Presenter Working as a team Summary of roles Clear Role Definitions Help Team Process!

SUCCESSFUL UNSUCCESSFUL Change Acceleration Process DESCRIBE THE CHANGE: In a few words, describe a successful change considering the following questions in your description: What did we want to change (performance, people, structure, etc.)? Who wanted the change to be made? Why was the change desired? DESCRIBE THE CHANGE: In a few words, describe an unsuccessful change considering the following questions in your description: What did we want to change (performance, people, structure, etc.)? Who wanted the change to be made? Why was the change desired?

Formula for results Q x A3 = E Q x A3 = E Quality X (Acceptance x Accountability x Alignment) = Effectiveness 62% of quality efforts fail (from lack of attention to the cultural and people sides of change – the “A”) Change Acceleration Process developed by GE to focus here

CAP Overview Effective Results (E) are equal to the Quality (Q) of the solution times the Acceptance (A) of the idea and Accountability (A) and Alignment (A) of the implementation Q x A3 = E A proven formula for results

Effective Leadership Practices QUALITY Technical Strategy ACCEPTANCE Cultural Strategy Implementing changeQ x A3 = E Change initiative focused on customer needs (target) Speed = Integrating Problem Solving with Engagement

Change Acceleration Process

Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Monitoring Progress Changing Systems & Structures

CAP Model Leading Change:Having a champion who sponsors the change. Leadership provides the time, passion and focus for the effort. Systems & Structures Creating a Shared Need The reason to change, whether driven by threat or opportunity, is instilled within the organization and widely shared through data, demonstration, demand or diagnosis. The need for change must exceed its resistance. Lead i ng Change Shaping a Vision The desired outcome of change is clear, legitimate, widely understood and shared. Mobilizing Commitment Key stakeholders are identified, resistance is analyzed, and actions are taken to gain strong commitment from key constituents to invest in the change and make it work. Making Change Last Once change is started, it endures and flourishes. Learnings are transferred throughout the organization. There is consistent, visible and tangible reinforcement of the change. Monitoring Progress Progress is real. Benchmarks are set and realize. Indicators are established to guarantee accountability. Changing Systems & Structures Making sure that the management practices are aligned to complement and reinforce the change (staffing, development, measures, rewards, communication, organizational design, resources, systems).

Setting Up for Success - Roles

Setting up for success Overview Why bother? • A good start is essential to long-term success • Even seemingly straightforward projects must be thoroughly scoped to ensure that attention is focused on essential elements and deliverables • Effective teams are formed only through deliberate actions, starting with clarification of roles, responsibilities and expectations • Clarify what we are after • A well-defined scope of work is needed for the project so that all parties understand and are committed to achieving success • An effective project has an execution structure and process • Clear roles, responsibilities and expectations for all parties (Team Sponsor, Team Leader, Team Members, CAP Coach, others) Time invested up front pays rich rewards down stream – go slow to go fast!

Setting up for success Roles Successful teams establish and clarify the following roles: • Team Sponsor • Legitimizes both the project and the team, and ensures that the right people are assigned to the team • Provides critical resources and helps ensure that Team Members have the time needed to complete the project • Helps remove roadblocks and resolve conflicts • Team Leader • Serves as the day-to-day leader of the team • Ensures that Team Sponsor is informed of team’s progress • Organizes the work of the team • CAP Coach/Change Agent • Helps Team Leader build an effective team process • Provides coaching on the application of CAP tools • Helps the team utilize CAP “Best Practices” developed by other teams Clarifying key roles prevents problems and confusion.

Setting up for success Team composition • Project team composition should: • Involve key stakeholders plus individuals who can contribute to and are necessary for the completion of the project • Be more process-based than functionally based • Represent a diagonal slice of the organization • Be based on complementary expertise and skills, not on availability • Involve people willing to make the investment necessary to participate fully in project Team Members serve as role models and leaders of change.

Setting up for success Team charter • Launch team with clear charter of responsibilities: • What processes are the team responsible for and why are they important to the organization? • What requirements or boundaries (non-negotiables) are givens for this team? • What is the reporting relationship to the sponsor? • What authority to act or decision-making influence does the team carry? • On what issues is the team expected to consult or inform the Team Sponsor? • What deliverables are expected? What milestones and timelines? • How will the team be measured? • What will success look like?

Setting up for success: Assignment Selecting a project exercise

Setting Up for Success – Project Definition

Project definition: Significance Project screening Project screening questions: Is there a significant, measurable benefit or a positive internal/external customer impact? Are data and measurement systems available? If not, would getting them be cost-effective? Can benefits be quantified? Is there a Team Sponsor/Champion willing to provide or help acquire resources and monitor the project? Is significant process improvement feasible? Can the project be done in a reasonable amount of time? Is the project translatable to other divisions/businesses? Can we involve the necessary span of stakeholders needed to gain acceptance as we conduct the project? Are resources available (or given time) to work on the project?

Project definition: Bounding Includes/Excludes chart Tool: Includes/Excludes chart –A process tool that challenges the team to clarify and agree on what is included and what is excluded in the scope of work. Dimensions can be added (What, Who, Where, etc.) to address aspects of the project the team feels essential to resolve (such as adding a dimension of key deliverables if this is an aspect that has little clarity and/or agreement associated with it). Uses:A simple tool to begin to define the boundaries for the project. Can easily be done in a storyboard fashion and could then be used to modify or extend the original contract with the Team Sponsor, and/or to orient new members to the team and the project. Timing:This tool can be used at an early meeting of the team to further clarify what has already been stated in the contract with the Team Sponsor. It can be used in an ongoing way to update the project scope as the project unfolds.

Project definition: Bounding Includes/Excludes chart Tips:This is a simple tool that lends itself to both storyboarding and to use as prework for a team meeting. As a prework assignment for Team Members, each might be asked to complete the chart prior to coming to the team meeting, and then use the meeting to identify areas of agreement and disagreement. After it has been completed, it could also serve as an effective tool for testing the scope of work with key stakeholders. Steps: 1. Individually complete the chart. 2. Distribute storyboard cards and ask Team Members to transfer a major point from each dimension to a card and place them on the wall-sized chart. 3. Discuss and resolve differences. 4. OPTION: You can save a bit of time by distributing the storyboard cards as part of a prework assignment and have people arrive at the meeting with their cards ready to be placed on the wall chart.

Project definition: Bounding Includes/Excludes chart Includes/Excludes WHAT, WHERE, WHEN, WHO and TIME boundaries: On a divided flip chart, write “Includes - - - Excludes” at the top. Down the left side write: WHAT, WHERE, WHEN, WHO, TIME. Ask the team to begin to define the project for each of the categories. Project Scope Includes Excludes What: When: Who: Where: Time:

Project Scope Includes Excludes Psych pts being boarded in ED ED Patients admitted to hospital bed Patients discharged From ED Only the ED at XYZ Hospital First shift in ED Second shift in the ED The bed assignment process The inpatient discharge process Rapid Evaluation Patients Paperwork to complete admission Other EDs in the System Cycle time from disposition to admit Project definition: Bounding Includes/Excludes chart: Example for ED cycle time reduction project

Project definition: Bounding In/Out of the frame Tool: In/Out of the Frame -This is a visual tool based on the analogy of a picture frame. It challenges the team to identify those aspects of the project (the type and extent of end results or deliverables, the people impacted, timing, product lines impacted, sites involved, etc.) that are in the frame (meaning clearly within the scope of work), out of the frame, or half-in-half-out (meaning this is either up for debate, or some aspects are in the scope of work but only in a partial way). Uses:Not as complex as SIPOC/COPIS, but useful when you feel there are many boundary issues facing the team (differences of opinion as to what is and isn’t in the scope of work). Timing:As with the Includes/Excludes chart, this tool can be used at an early meeting of the team to further clarify what has already been stated in the contract with the Team Sponsor. It can be used in an ongoing way to update the project scope as the project unfolds.

Project definition: Bounding In/Out of the frame In the Frame/Out of the Frame Flip Charts Draw a large square "picture frame" on a flip chart (or use tape on a wall) and use this metaphor to help the team identify what falls inside the picture of their project and what falls out. This may be in terms of type and extent of end results, people impacted, timeframe, product lines, sites, etc.

Project definition: Bounding In/Out of the frame: Example for ED cycle time reduction project Rapid Evaluation Pts Inpatient Discharge Process Patients Discharged From ED First Shift In ED XYZ Emergency Room Physician Staffing Plan New ED FTEs Admitted Patients Bed Assignment Process ED Staffing Plan Pts Boarded in The ED Other Emergency Rooms Paperwork Needed to Admit Cycle Time From Disposition

Project definition: Alignment 15 Words Tool: 15 Words Flip Chart – This is an alignment tool that challenges Team Members to define the project in specific terms and then check for common elements among Team Members’ definitions. Each Team Member is given a flip chart page and marker. They must write, in 15 words or less, the project definition. Post all and check for agreement. By circling and clarifying all unclear words, underlining key words/themes, and identifying language where there is disagreement, the team can then move to draft a project statement with team alignment. Uses:A simple tool to begin to define the boundaries for the project and to test for alignment. Can easily be used to refine the outcomes/deliverables of the project by asking "What does it look like?" or "How will we know it when we have it?" Timing:This tool can be used at an early meeting of the team to further clarify project definition. Can aid in the development of a contract with the Team Sponsor.

PROJECT DEFINITION PROJECT DEFINITION PROJECT DEFINITION Project definition: Alignment 15 Words 15 Words Flip Chart Each Team Member is given a flip chart page and marker. They must write, in 15 words or less, the project definition. Post all and check for agreement. Team Members should double check all “fuzzy” or unclear words by circling them and clarifying understanding among the group (add words if necessary). Underline common words, themes and phrases. Language that creates concern within Team Members should be identified and addressed. Teams then can draft one statement. • __ Underline key phrases • Circle unclear Check heartburn

Setting Up for Success – Building the Team

Setting up for success: Building the team Contracting Sample Template Date _____________________________ Team Sponsor CAP Coach Project title Team Leader Project rationale Team Members Key deliverables Critical milestones Customers/suppliers who must be involved Constraints (money, people, time, technology) Things out of project scope How the project will be measured How the team will be measured When the team must check with Sponsor When the team has full authority to act When the sponsor has the right to veto (Note: This is only a sample contract; add/delete sections as required to fit the project.)

Role definition: Building the team Team Charter Checklist Tips:Don’t hesitate to add to or delete items from this basic checklist. Use this charter to orient new Team Members and to help the team maintain an effective group process when the project becomes especially challenging or when conflicts arise. Steps: 1. Distribute copies of the checklist to all Team Members prior to a team meeting to discuss these questions; invite Team Members to add to the checklist. 2. Meet as a group to discuss and resolve issues related to the checklist. 3. Share certain aspects with Team Sponsor if appropriate. 4. OPTION: This chartering discussion may be more effective when combined with some traditional forms of team-building activities.

Role definition: Building the team Team Charter Checklist • TEAM CHARTER CHECKLIST • Key Result Areas ___ In what areas are results absolutely essential? ___ What milestones must be met? How will the team be measured? • Boundaries ___ Who outside our team must we involve, inform or consult with? ___ What decisions need approval from someone outside our team? ___ What is not in our scope of work (though others might think it is)? ___ What authority does the team have to act independently? • Roles and Responsibilities ___ What is the reporting relationship to the Team Sponsor? ___ What role and area(s) of responsibility does each Team Member have? ___ What unique responsibilities does the Team Leader have? ___ Who will serve as the timekeeper, recorder, facilitator, etc. during team meetings? • Guiding Principles ___ What behaviors are we going to hold one another accountable for that are essential to creating an effective team environment? • Operating Agreements ___ How will the team make decisions, resolve conflicts? ___ What are acceptable/unacceptable levels of involvement? ___ How often and how long will we meet as a team?

Purpose & Outcomes We understand and agree on our project mission and the desired outcome (vision). Customer & Needs We know who the project stakeholders are, what they require, and why this project is really needed. G Goals & Deliverables We have identified specific, measurable & prioritized project goals & deliverables linked to our business goals. Project Scope Definition We understand/agree on what is in/out of our project scope & tasks. The project scope is “set.” Roles & Responsibilities We have defined & agreed on our roles, responsibilities, required skills & resources for the project team. R Authority & Autonomy Our team is clear on the degree of authority/influence we have to meet our project mission. Critical Success Factors We know & are focusing on the key factors needed to meet the project goals & mission. Plans & Activities We have an effective game plan to follow that includes the right tasks, clearly defined/assigned. Monitoring & Measures We have an effective monitoring process & specific metrics linked to progress & goals. P Schedule/Milestones We have defined our project schedule and know what the key phases & milestones are. Team Operating Agreement We have shared expectations, agreed & followed guidelines for how our team works together. Interpersonal/Team I We have the necessary relationships, trust, openness, participation & behaviors for a healthy & productive team. Role definition: Building the team GRPI Checklist Expanded Version of the Tool:Useful when a more detailed look at team elements is required. 0% 50% 100%

Role definition: Building the team Decisions and dynamics - Consensus definition Consensus = agreeing to proceed with no hidden reservations It does NOT mean that everyone agrees. It does mean that everyone agrees to implement and actively support the decision and that this decision is the best one under the circumstances. They will personally live with the decision because they believe their reservations and concerns were heard and considered.

CAP Coach/Change Agents

Advice from CAP coaches/change agents • Be patient • Don’t try to do everything • Have realistic expectations • Concentrate on doing 2 – 3 things really well • Shadow with an experienced facilitator • Have a plan • Contract with Team Sponsor/Manager on expectations • Establish how Coach and Team Leader will work together • Let participants have 95% of the air time • Be flexible using tools • Use tools and deal with topics that are important to the participants • If this isn’t working, try a new approach • Decide when & where to intervene in the session • Use tool as the vehicle to stimulate discussion • Sense of humor helps What would you add to this list?

{ T TOOLS { I INFORMATION { P PLANNING { S SHARING CAP coaches/change agents tips • Be aware that tools are just tools • Prepare and provide examples • Be attentive to team’s needs, alter tool order if needed • Clarify your role prior to the session start • Challenge the team, ask “What If” questions • Ask open-ended questions • Set ground rules • Do not rush • Be flexible • Help the team define the technical side of the project • Make sure the team has the right skill mix • Be a source of network information - Best Practices • Share success stories • Make easy what seems difficult

Creating a Shared Need

Creating a Shared Need Overview Why bother? • Forces any resistance or apathy to be addressed head-on • Validates why the project is important and critical to do • Builds the momentum needed to get the change initiative launched • Clarifies what we are after • Develops a shared recognition, by both the team and key constituents, of the need and logic for change • Increases dissatisfaction with the status quo (greater than the natural resistance to change) • Creates the ability to frame the need for change as both a threat and an opportunity Creating a Shared Need produces the “WAKE UP CALL,” building early momentum for the change initiative.

Creating a Shared Need Tools Creating a Shared Need Tools • Shared Needs Assessment • Threat vs. Opportunity Matrix (Appeals to Right Side) • Three “D’s” Matrix (Appeals to left side) • Data • Demonstration • Demand

Creating a Shared Need Assessment To what extent: • Are all members of the project team aligned in terms of the need for change? • Have we framed the need for change in such a way to reflect the concerns of customers and key suppliers? • Would each Team Member deliver essentially the same message regarding the need for change if asked by someone outside of the team? • The key stakeholders affected by this initiative, and how much importance does each give to the initiative? • Can we help others increase their sense of the need for change? Creating a Shared Need involves framing the need to appeal to the interest of key stakeholders.

Creating a Shared Need Threat vs. Opportunity Matrix Tool: Threat vs. Opportunity Matrix– Best Practice organizations know how to frame the need for change as more than a short-term threat. They work to find ways to frame the need as a threat and opportunity over both the short and long-term. By doing so, they begin to get the attention of key stakeholders in a fashion that ensures their involvement beyond what can be gained from a short-term sense of urgency. • Uses: Building the case for change is one of the first and most important tasks of the team. This simple tool helps the team discover how to frame the need for change more broadly and perhaps break some old habits about change only as it applies to a short-term threat.

Creating a Shared Need Threat vs. Opportunity Matrix • Steps: 1. Determine short-term and long-term goals for the project ( example: 3 months, 6 months) • 2. Working individually, identify 2 – 3 items for each of the 4 quadrants. Share and record responses on a flip chart and discuss similarities and differences. • 3. OPTION: Individuals then write a 3 – 4 sentence statement of the need for change using language that speaks to as many of the 4 quadrants as possible. • 4. OPTION: Team Members read their statements and the team debates and discusses each to create a statement that encompasses the best of each individual effort. This statement is then modified to appeal to key constituent groups (physicians, nursing, administration, patients, community, etc.). • 5. OPTION: Though most teams find this discussion fairly straightforward, some struggle with the degree of specificity required to really frame the need for change along both dimensions. Therefore, it may be useful to begin this discussion and then table it for additional work once the vision has been articulated and the key stakeholders have been identified. It is not unusual to find a team finally ready to use this tool after they have worked on the vision and begun to do a stakeholder analysis. • .

Threat Opportunity Short Term Long Term Creating a Shared Need Threat vs. Opportunity Matrix

Creating a Shared Need Threat vs. Opportunity Matrix: Example for ED cycle time reduction project Threat (Of Doing Nothing) Opportunity (With Success) Dissatisfied ED Patients Unhappy ED Staff Members Compromised Quality of Care Diversion: Loss to XYZ Bottom Line LWOBS: Loss to XYZ Bottom Line Physician Complaints Continue Cycle Times will Decrease Pt Satisfaction Rates Improves ED Staff Satisfaction Improves Diversion Rate Decreases LWOBS Rates Decrease Short Term: Up to Six Months Cycle Time Goals Accomplished XYZ Emergency Reaches Growth Goals Staff Turnover at All Time Low Level Employer of Choice Best Place to Practice ED Medicine XYZ ED Best Performing in System Patients Go to Other Emerg Depts Staff Members Quit and Leave Physicians Stop Referring to XYZ ED XYZ Closes the Emergency Room Due to Significant Losses Community Reputation Long Term: Beyond Six Months

Creating a Shared Need Pitfalls Teams can potentially derail when they: • Fail to check for alignment and build true consensus • Assume the need for change is obvious • Fail to frame the need for change in a meaningful way • Assume that when others fail to appreciate the need for change it's "their" problem • Fail to search beneath the surface for root causes • Underestimate the resistance to change Avoiding these pitfalls early on in the change initiative saves valuable time and effort!

Shaping a Vision

Shaping a Vision Overview Why bother? • Visions paint a picture that appeals to both the head and the heart, and answer the question, "Why change?" • Clear statement of the future state helps gain genuine commitment • A well-articulated vision helps establish the milestones to monitor progress and change Systems & Structures • Clarifies what we are after • Demonstrates a clear statement about the outcomes of the change effort • Identifies a view of the future state that is: • Customer-focused • Not just one person's dream • Challenging • Evolving, not static • Easy to understand • Behavioral and actionable Visions provide direction and motivation for change.

Change Acceleration Process (CAP) Workshop