ponca city medical center change management by dr. tony lybarger

Ponca City Medical Center

Change Management

By Dr. Tony Lybarger

WARNING:

• The Joint Council on Not-For-Profit Public Speaker Accreditation requires that I put you on notice that information shared during my presentation may be dangerous to your mental health. Some participants have experienced symptoms of post-presentation-trauma-disorder.

• Dr. Tony Lybarger

Seven Practices of Successful Organizations:

• Employment Security• Selective Hiring of New Personnel• Self-managed Teams & Decentralized Decision Making• Comparatively High Compensation Contingent on

Organizational Performance (Pay-for-Performance)• Extensive Training (60 hours --- My number)• Reduced Status Distinctions & Barriers, including

Parking, Dress, Language & Office Arrangements • Extensive Sharing of Financial & Performance

Information Throughout the Organization

Introduction:

• Dennis asked that I visit with you about Change Management. In his note he mentioned the following changes:

• New CEO & CFO• Moving from construction mode to full utilization

of those new areas• Heavy emphasis on new physician recruitment• Stronger relationships with Deaconess and

Southcrest hospitals• Completion of hardwiring Studer initiatives• Stronger focus on execution and profitability

Change Management:How Do We Proceed?

• It seems (at least to me) there are two ways to organizationally approach the change process;

• [1] Deal with each challenge (trauma or opportunity) in isolation.

• [2] Create a high-performance healthcare organization that is fundamentally healthy and capable of reacting assertively to all types of challenges and traumas as a normal part of the business cycle.

• What do you think?

Three Questions:

• What to Change?

• What to Change to?

• How to create that Change?

What to Change?

• Administrative and organizational practices at PCMC that are not in alignment with characteristics of a high-performance healthcare organization.

What to Change to?

• A High-Performance Healthcare Organization.

What is a High-Performance Organization?

• A high-performance healthcare organization is excellent in so many areas of operation that it consistently outperforms most of its competitors for extended periods of time (sustainable competitive advantage).

Characteristics of High-Performance Organizations:

• Strategic Approach:• [1] Organization’s philosophy statement is consistent with its strategy.• [a] PCMC’s core values (5) are represented in the strategic plan.• [2] Managers and employees know what they need know about the

organization’s strategy in order to do their jobs.• [a] All employees have access to the strategic plan and understand

the role they play in achieving strategic goals.• [3] Organization-wide performance measures match the organizations

strategy.• [a] PCMC identifies 10 preferred work behaviors (PWBs) which if

exhibited correctly and consistently by employees (Hardwired) increases the probability of achieving strategic goals.

• [4] Employees act in ways that are consistent with the behaviors needed to execute the strategic plan.

• [a] 90% of PCMC employees exhibit PWBs correctly 90% of the time.• [b] All PCMC employees consistently do what they say they will do.


• Customer Approach:• [1] The organization believes that they exist primarily to serve their

customers.• [2] The organization strives to be the best in their region at providing

a high-quality service to their customers.• [a] 95 - 99% of customers rate their interaction with PMRC as

excellent.• [3] The organizations assesses and determines its customers future

needs.• [4] The organization exceeds customer expectations.• [a] 95% of all customers rate the quality of their interaction with

PMRC as excellent after discharge.• [b] 95% of customers are satisfied with their wait time for

service.• [c] 95% of customers (random sample/20 per day) surveyed

during their hospital stay are satisfied with their care.


• Leadership Approach:• [1] Everyone is clear about the organizations performance expectations.• [a] 95% of PCMC employees can verbalize their PWB’s.• [2] Executive Management, Department Managers & Supervisors “walk the talk.”• [a] BS walks and behavior talks.• [3] Employees believe that their behaviors affect the organization.• [a] Employees of PCMC act like owners rather than renters.• [4] HPOs had more innovative HR than LPOs. • [a] HR’s first priority is employee and patient satisfaction rather than compliance with

regulations.• [5] Management promotes the person who has the best skills and knowledge to do the job.• [a] Executive Management, Department Managers & Supervisors at PCMC create

organizational equity. Employees (all) get what they deserve.• [b] HPemployees receive rewards substantially different from LPemployees.• [c] LPemployees are coached (one strike), transferred (two strikes) or (three strikes) fired.• [6] Employees are comfortable with being able to express disagreement with the organization’s

policies and practices.• [a] Executive Management, Department Managers & Supervisors at PCMC create a

“Culture of Execution” which honors open and honest communication (Robust Dialogue).• [b] Crap sometimes roles uphill.• [c] Executive Management wants to know “what we do worst.”


• Processes & Structures:• [1] The organization places the highest priority on meeting customer

needs.• [a] Profit comes from service rather than service from profit.• [2] The organizations views information as something to be shared

rather than hoarded for the purpose of power and control. • [a] Executive Management, Department Managers &

Supervisors share information freely.• [3] The organization, as a result of its focus on customer

satisfaction, is more likely to use state-of-the-art customer-relationship technology.

• [4] Performance measures are leveraged to drive clarity and focus throughout the organization.

• [a] Information is gathered and disseminated related to employee performance and customer satisfaction.


• Values & Beliefs:• [1] Most employees (85%) think the organization is a good place to work.• [a] 10% of employees (LPOs) are uncomfortable with PMMC.• [b] 5% (very LPO) don’t like PCMC at all.• [c] What is a good place to work? (Post-it Exercise/Fortune List)• [2] Employees tend to be loyal to the facility and they tend to participate in

the organization’s social events.• [a] 80% of invited employees attend PCMC sponsored social events.• [3] The work environment fosters cohesiveness, loyalty and readiness to

change. Employees tend to be treated with dignity and respect and the employees treat the organization the same way.

• [4] Employees and supervisors have more freedom to use their own discretion related to changing procedures and processes to improve outcomes.

• [a] Employees are allowed to take risks and fail, within reasonable limits, without fear.

• [b] Every employee, within reasonable limits, is a decision maker.

What is a Good Place to Work?

Fortune 2008100 Best Places to Work:

• # 10 – Methodist Hospital (Houston) • Last year Methodist added a new program

called “No One Dies Alone,” in which employees volunteer time with terminal patients

• $78,746 average hourly annual pay • $88,972 average annual salaried• 11 hours of training per year (07)• 11% turnover

100 Best Places to Work:# 18

• OhioHealth (Columbus)

• Rewards everything: customer service, community service, stars of the month & perfect attendance

• $77,175 average hourly annual pay

• $108,143 average annual salaried

• 103 hours of training (07)

• 8% turnover


• Children’s Healthcare of Atlanta

• Provides backup care for children, elders & pet insurance

• $58,139 average hourly annual pay



• 9% turnover


• Griffin Hospital (Derby, Conn.)• Over 580 other hospitals have visited to learn

how Griffin provides exceptional patient service. There were 6,691 applications for 180 open positions

• 10% turnover• Average annual salaried not available• $68, 640 average annual hourly pay• 110 hours of training a year (07)


• Mayo Clinic (Rochester, Minn.)

• “Hire for Life” is the HR goal, and it seems to be working --- 17% of the workforce has been there 20 or more years


• 5% turnover

• Annual pay information not available


• Southern Ohio Medical Center (Portsmouth)

• Hospital provides home-based medical care & engages all employees in care giving. Even housekeepers are urged to ask patients how they can be of help.

• $82,077 average annual salaried pay• $58,407 average annual hourly pay• 4 % turnover


• Arkansas Children’s Hospital (Little Rock)

• They have invested more than$17 million in wages increases since 2001

• $62,860 average annual salaried pay

• $61,266 average annual hourly pay

• 8% turnover


• Healthways (Nashville, Tenn.)

• This disease-management company provides walking trails, bikes for rent, and easy-to-locate stairways for exercise

• $82,613 average annual salaried pay


• 13% turnover


• Lehigh Valley Hospital & Health Network (Allentown, Pa.)

• Employees pay nothing for healthcare and get bonuses tied to patient satisfaction scores & financial performance.

• $60,043 average annual hourly pay.• $69,256 average annual salaried• 88 hours of training (07)• 7% turnover


• Baptist Health South Florida (Coral Gables)

• Offers employees adoption aid (just increased from $4,000 to $10,000), three child care centers & nursing retention bonuses

• 11% turnover




100 Best Places to Work:Health Care

• # 10 – Methodist Hospital System• # 18 – OhioHealth • # 45 – Children’s Healthcare of Atlanta • # 49 – Griffin Hospital• # 59 – Mayo Clinic• # 75 – Southern Ohio Medical Center• # 76 – Arkansas Children’s Hospital • # 80 – Lehigh Valley Hospital• # 94 – Baptist Health South Florida

Summary of High-Performance Characteristics:

• PCMC’s core values (5) are represented in the strategic plan.• All employees have access to the strategic plan and understand the role they

play in achieving strategic goals.• PCMC identifies 10 preferred work behaviors (PWBs) which if exhibited

correctly and consistently by employees increases the probability of achieving strategic goals

• 90% of PCMC employees exhibit PWBs correctly 90% of the time• All PCMC employees consistently do what they say they will do.• 99% of customers rate their interaction with PMRC as excellent.• 95% of all customers rate the quality of their interaction with PMRC as excellent

after discharge.• 95% of customers are satisfied with their wait time for service.• Customers (random sample) are surveyed for level of satisfaction during their

hospital stay. • 95% of PCMC employees can verbalize their PWB’s• BS walks and behavior talks.• Employees of PCMC act like owners rather than renters.• HR’s first priority is employee and patient satisfaction rather than compliance

with regulations.

Summary of High-PerformanceCharacteristics:

• Executive Management, Department Managers & Supervisors at PCMC create organizational equity. Employees (all) get what they deserve.

• HPemployees receive rewards substantially different from LPemployees.• LPemployees are coached (one strike), transferred (two strikes) or (three strikes) fired.• Executive Management, Department Managers & Supervisors at PCMC create a “Culture of

Execution” which honors open and honest communication (Robust Dialogue).• Crap sometimes roles uphill.• Executive Management wants to know “what we do worst.”• Profit comes from service rather than service from profit.• Executive management, Department Managers & Supervisors share information freely.• Information is gathered and disseminated related to employee performance.• 80% of invited employees attend PCMC sponsored social events• Employee satisfaction surveys show that 85% of employees say PCMC is a good place to

work.• 10% of employees (LPEs) are uncomfortable with their relationship with PCMC.• 5% of employees (VLPEs) don’t like PCMC at all!• Employees are allowed to take risks and fail, within reasonable limits, without fear.• Every employee, within reasonable limits, is a decision maker. • High-performance healthcare organizations have competent Department Managers.

Culture and High-Performance in Healthcare Organizations:

• Hospitals with the best business practices (in particular, leadership and operational effectiveness) had the best workplace culture (employee satisfaction, loyalty, engagement & retention).

• Hospitals with the best workplace cultures had the highest patient satisfaction/loyalty scores.

• Hospitals with the highest patient satisfaction/loyalty scores were financially more successful than the average hospital and exhibited the best community stewardship.

Culture and High-Performance in Healthcare Organizations:

• The numbers don’t lie: Healthcare providers who earn high marks for the caliber of their organizational and department culture rank highest on overall performance outcomes and financial success.

• Hospitals with the best business practices (in particular, leadership and operational effectiveness) had the best workplace culture (employee satisfaction, loyalty, engagement and retention).

• Hospitals with the best workplace cultures had the highest patient satisfaction/loyalty scores.

• Hospitals with the highest satisfaction/loyalty (employee) scores were financially more successful than the average hospital and exhibited the best community stewardship.

Department Managers & High-Performance:

• Organizational researchers, for 50 years, have found the most important relationship within any organization is the one between the employee and her immediate supervisor.

Department Managers & Healthcare Organizations:

• Overall, the study found three “macro” drivers of performance that contributes most to a satisfied, loyal and engaged workforce.

• [1] Confidence in, and performance of executive leadership. (People with offices in the Executive Suite)

• [2] Front-line manager capability and performance. (Department Managers)

• [3] The degree of patient focus within the organization.

The Trifecta Index:Leadership =‘s Performance

• Job Satisfaction – I am satisfied with my job.• Organizational Loyalty – I am willing to

recommend my organization to friends as a great place to work.

• Professional Engagement – I see my profession in a positive light and encourage others to consider my career.

• Effective front-line leadership contributes to higher job satisfaction, loyalty and professional engagement.

Front-Line Management & Employee Retention:

• My manager or immediate supervisor is effective at retaining good staff.

• My manager or immediate supervisor seems to care about me.

• My manager or immediate supervisor is receptive to staff suggestions.

• When front-line managers are respected and effective, employees tend to want to stay with their organization for longer periods of time.

Front-Line Leadership & Patient Satisfaction:

• There is a positive relationship between effective front-line leadership performance (as evaluated by staff) and increased patient satisfaction.

Front-Line Manager Performance & Budget Targets:

• Departments led by ineffective performing front-line managers missed budget projections by an average of 8.3%.

• Departments led by somewhat effective front-line managers missed budget targets by an average of 6.7%.

• Departments led by effective front-line managers missed budget targets by an average of .4%

• Departments led by highly-effective front-line managers consistently hit their projected budget targets.

Department Managers & Performance:

• High-performance healthcare organizations have competent Department Managers.

Can PCMC Employees Manage Change? YES!

• People don’t think themselves into a new way of acting. People act themselves into a new way of thinking. (Ex 89)

• Identify PWB’s --- then reward employees who exhibit those behaviors correctly/consistently and coach, transfer or fire those employees that don’t.

• The foundation for changing behavior is linking rewards to performance and making that linkage transparent. (Ex 92)

• If you, the leaders, at PCMC reward and promote people that Execute, the end result will be a “Culture of Execution.” (Ex 92)

How To Create Change at PCMC?

• People don’t think themselves into a new way of acting. People act themselves into a new way of thinking. (Ex 89)

• Tell people what results you expect.• Discuss how to get those results.• Reward people for getting those results.• For those people coming up short, provide

coaching, withdraw rewards, move them to other jobs or fire them.

• (EX 86)

Best Hospitals 2008:Characteristics

• Index of Hospital Quality (IHQ): The IHQ describes the interrelationships between [1] structure, [2] process and [3] outcomes.

• [1] Structure refers to resources related directly to patient care. Examples of structural measures include intensity of nursing staffing, availability of desirable technologies and patient services.

• [2] Process of care delivery encompasses diagnosis, treatment, prevention and patient education.

• [3] Outcomes relates to mortality.

Best Hospitals in America:2008

• [1] Johns Hopkins Hospital (Baltimore• [2] Mayo Clinic (Rochester)• [3] Ronald Reagan UCLA Medical Center• [4] Cleveland Clinic• [5] Massachusetts General Hospital• [6] New York-Presbyterian Univ Hospital• [7] Unvi of California San Fran Med Center• [8] Duke University Med Center (Durham)• [10] Hospital of the Univ of Pennsylvania• [10] Univ of Washington Med Cnter (Seattle)

Best Hospitals in America:2008

• [12] Barnes-Jewish Hospital (St. Louis)• [13] Univ of Michigan Hosps (Ann Arbor) • [14] Univ of Pittsburg Med Center• [15] Vanderbilt Univ Med Cnter (Nashville)• [16] Stanford Hosps & Clinics (Stanford)• [17] Univ of Chicago Medical Center• [18] Cedars-Sinai Med Center (Los Angeles)• [19] Yale-New Haven Hospitals (New Haven)

References:

• Fortune 2008 Best Places to Work• Execution by Larry Bossidy & Ram Charan• How to Build a High-Performance Organization:

American Management Association• The Connection Between Organizational Culture

and Performance in Healthcare Organizations: Healthcare Performance Solutions

• U.S. News Best Hospitals 2008• Hardwiring Excellence by Quint Studer• The Baptist Health Care Journey to Excellence

by Al Stubblefield

ponca city medical center change management by dr. tony lybarger

Documents

organization slide

profitability slide

performance organizations

highperformance organization

tony lybarger slide

pcmc employees

change process

strategic plan