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 operational 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

Akron Children’s Hospital 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. 275,000 sf patient care tower  75 bed NICU  39 room emergency department  6-OR outpatient surgery center  High risk delivery area

Integrating Process into Design

The Design and Implementation Process Akron: Integrating Design and Change Management Design Transition Occupancy Pre-Design Visioning Site Visits Leadership Training Expectation Emerging Trends Dept. Mock Ups Ambassadors Check Survey Current to Future State Spaghetti Diagrams Trials Ambassadors Site Visits Post Design Mock-up Pulse points Pulse Points Expectation Check Survey

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

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

Preparation & Post Design Adaptation 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 •

Transition During Change new beginnings exploration endings goal project management timeline productivity (effort) change management area of impact human response to change progress Source: Pritchett LLC

The Design and Implementation Process Akron: Integrating Design and Change Management Design Transition Occupancy Pre-Design Visioning Site Visits Leadership Training Expectation Emerging Trends Dept. Mock Ups Ambassadors Check Survey Current to Future State Spaghetti Diagrams Trials Ambassadors Site Visits Post Design Mock-up Pulse points Pulse Points Expectation Check Survey

ED Timeline June 2013 Design Phase Complete Oct 2013 Survey 1 May 2014 1. Leader Training Starts 2. Trials Start Survey 2 3. Town Halls 4. Pulse Points Start Jan 2015 5. Trauma Room Mock up 6. Ambassadors Survey 3 June 2015 Survey 4

NICU Timeline June 2013 Design Phase Complete Oct 2013 Trials Start Survey 1 June 2014 1. Leader Training Starts 2. Focus Groups Survey 2 Nov 2015 Survey 3 June 2015 Survey 4

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

Create a dialogue with all staff  Formalize it  Overt communicate  Venues − Daily Huddles − Staff meetings − Department meetings − Governance councils − Town halls − Focus groups − Email and intranet − Ambassadors − Surveys

NICU Focus Groups, Focused Voice Focus Groups Single room line of sight and patient safety 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 •

Ambassadors  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

Trials and Post-Design Mock-up • Respiratory • Fast Track • Distance to Transport • Suture Cart • Communication devices • Pulse Ox • Staffing Model • Supply carts

Example: ED Pulse Point Checks 11/14 Stake holder Issue Action RN -Develop/implement new FT/triage -Develop education and communication process plan -Development of staffing model for new -Continue use of ambassadors, tours ED and behaviors/values role out Physicians -Staffing -Develop education and communication -New roles/interactions with fellows plan -Room assignments -Recruitment -Even flow of patients through entire ED -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 -developing guidebook for RN/MHT staff new and revolving staff -scripting to communicate what to expect to families MAs Suture Staff -integrating suture staff in FT -continue to monitor, remind ED staff of -geographic separation creates some where suture staff may reside challenges in communication/touchdown space -uncertainty around change at satellites

Expectation Check Survey  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

ED Survey Demographic ED 1: N= 47 Job Role ED 2: N= 88 80.0 68.2 70.0 % of Participants 60.0 51.1 50.0 40.0 31.9 30.0 18.2 20.0 14.9 9.1 10.0 4.5 4.3 0.0 Leadership Medical staff Clinical staff Non-clinical staff ED 1 ED 2 Years of Experience 60.0 48.9 50.0 42.0 % of Participants 40.0 30.0 20.0 12.8 11.4 10.6 10.6 10.2 9.1 9.1 9.1 8.5 8.0 10.0 6.4 2.1 0.0 < 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs ED 1 ED 2

NICU Survey Demographic Job Role NICU 1: N= 49 100.0 NICU 2: N= 43 86.0 80.0 71.4 % of Participants 60.0 40.0 16.3 20.0 9.3 8.2 4.1 2.3 2.3 0.0 Leadership Medical staff Clinical staff Non-clinical staff NICU1 NICU2 Years of Experience 50.0 46.5 40.0 34.7 32.6 % of Participants 30.6 30.0 20.0 9.3 8.2 8.2 10.0 6.1 6.1 6.1 4.7 2.3 2.3 2.3 0.0 < 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs NICU1 NICU2

Conceptual Model Level of Preparedness Involvement and Make ready ahead Knowledge of time Type of Involvement in the Facility Design Adaptation Adjust to a new Type of Involvement in the state 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?

Summary Results for ED and NICU Surveys – Mean Comparison T-test: Significantly different from Survey 1 to 2 4.0 3.7 3.4 3.5 3.0 2.6 2.6 2.5 2.5 2.2 1.8 2.0 1.7 ED1 1.6 1.6 1.4 ED2 1.5 0.9 ED 1: N= 47 1.0 ED 2: N= 88 0.5 0.0 Years of Level of Level of Facility Level of Process Preparedness Adaptation Experience Involvement Knowledge Knowledge 5.0 4.6 4.5 4.5 4.0 3.5 3.0 2.7 2.6 2.5 2.2 2.1 2.0 NICU1 1.9 2.0 1.5 NICU2 1.4 1.4 1.4 1.5 NICU 1: N= 49 1.0 NICU 2: N= 43 0.5 0.0 Years of Level of Level of Facility Level of Preparedness Adaptation Experience Involvement Knowledge Process Knowledge

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!