From Engagement to Commitment The Role of Leadership

From Engagement to Commitment: The Role of Leadership SAMHSA PBHCI Grantee Webinar & Discussion February 24, 2012

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Overall Agenda Topics Practical strategies for practical leaders • Specific and practical steps to promote and support the PBHCI initiative • Engaging the workforce • Understanding and responding to the common response of the workforce to significant change • Motivation vs. self efficacy (promoting support by motivation and confidence building strategies)

The Role of Leadership Main point: Leaders who employ research-informed approaches are more likely to activate the organization to support a change initiative: q Communicating for buy in (what is the message? Who delivers the message? How do we know if the workforce understands and values the message? What practical actions can the workforce take that promotes engagement of consumers? q How does an organization ensure that the workforce supports the aims of the PBHCI initiative? q How does the organization ensure that the primary care partners understand, value, and act in ways that are likely to engage consumers?

Leadership: Primary purpose is to guide an organization to adopt and sustain change The PBHCI project team role Executive/managerial/supervisory roles

8. Make the Changes Stick 7. Don’t Let Up 6. Short Term Wins Steps leaders take to successfully implement change 5. Empower Action 4. Build the Right Team 3. Communicate for Buy In 2. Get the Vision Right 1. Build a Sense of Urgency Based on the work of J. Kotter (2002) The Heart of Change.

1. Build a Sense of Urgency • Leadership Communication – Communicate to everyone – Organization “owns” the change – Content of the message • The change is important • The change is not easy • Everyone is part of making change successful • Reinforcing supportive actions on the part of the workforce • Confronting non-supportive actions • Pros of success and the cons of failure

Polling Question: Describe the degree to which the organization has communicated a sense of urgency q No urgency communicated around the PBHCI initiative q Some urgency q Moderate urgency q Clear and consistent communication of urgency q Optimal urgency including reinforcing supportive staff and confronting non-supportive staff

Strategies that work Please type in any example of an action taken by organizational leadership and/or the project team to communicate that the PBHCI project is urgent (critically important)

Examples of strategies to communicate urgency q Use of a variety of communication mechanisms q q Staff meetings In-service training One-on-one opportunities Newsletters q Message created by project team that stresses the critical importance of the PBHCI project q Survival in a changing healthcare system q Health homes q Accountability Care Organizations q Consistent with core mission of behavioral health and primary care services

2. Get the Vision Right • Developing a shared understanding of what it means to be part of an integrated system of care – Communicate a vision with clarity and consistency – Focus on a vision that bridges current practices with future practices • The vision guides the organization in deciding what to: – Keep doing – Stop doing – Start doing

Polling question: How would you describe the degree to which your organization and your primary care partners have a shared vision of the PBHCI initiative? q We have a clear and consistent shared vision of what it means to be an integrated healthcare system q There are some areas of shared understanding q There is little opportunity to develop a shared vision q We have a different and inconsistent vision of the PBHCI initiative from our primary care partners

Polling question: How would you describe the degree to which the workforce in your organization have a shared vision of the PBHCI initiative? q As a behavioral health organization we have a clear and consistent shared vision of what it means to be an integrated healthcare system q There are some areas of shared understanding q There is little opportunity to develop a shared vision q The workforce views the PBHCI grant opportunity in a way that doesn’t support the core aims of the initiative q We don’t know how the workforce views this initiative

Strategies that work Please type in any example of an action taken by leadership/project team to communicate a clear vision of the PBHCI project (how the organization will change as a result of the PBHCI project)

Examples of strategies to communicate a clear vision q Project team shapes a vision statement that is clear and focused that is promoted via: q Message boards q Posters q New employee orientation q Usual communication mechanisms employed by the organization q Informational brochures q Organizational website

3. Communicate for Buy In • Emphasize the benefits of adopting an integrated system of care for all stakeholders • Emphasize the down side of not planning for an integrated healthcare system • Involve and engage staff in sharing their ideas about how to successfully meet the aims of the PBHCI initiative – This assists staff to regain control, status, and personal meaning in the new direction • Emphasize the supports, resources, and tools available to support the adoption of practices and policies that support the aims of the PBHCI initiative

Polling Question: Which best describes the way in which the PBHCI opportunity has been presented? q Just another time limited grant q A way to pay for enhancements to our services q An opportunity to plan for a changing healthcare system and change the way we do business day to day

Lessons from Implementation Science: Why staff don’t always support a positive change process Staff are often concerned that a significant change will negatively affect: • The meaning they derive in their work (i. e. , will the change in role, function, activities be satisfying and professionally rewarding? ) • Their control over their work life (unwanted demands on time, energy, and autonomy) • Their status in the organization (affect on authority and position in the organization) Woodward, H. Shock Change (ref)

The workforce has finally found some balance and equilibrium to manage day-to-day functions

Practitioners have finally found a way to deal with all the paperwork

Now you want me to do what? ? ?

Understanding the Impact of Change on the Workforce It is not unusual for an organization’s leadership to believe that it is engaged in promoting strategic change and for its workforce to experience the innovation as shock change. When this occurs, implementation will be compromised. Woodward, H. and Woodward, M. B. (1994). Navigating Through Change. NY: Mc. Graw Hill.

Impact on the Workforce > Staff are often concerned that a significant change will negatively affect: > The meaning they derive in their work (i. e. , will the change in role, function, activities be satisfying and professionally rewarding? ) > Their control over their work life (unwanted demands on time, energy and autonomy) > Their status in the organization (affect on authority and position in the organization)

The Workforce > People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings” > The human stories behind the numbers influences the response of the workforce Kotter, J. P. And Cohen, D. S. (2002). The Heart of Change. Boston: Harvard Business School Press.

Polling Question: Describe the degree to which your organization/project team has communicated for buy in q Little communication about the benefits of the PBHCI initiative and little involvement of the workforce in achieving its aims q Some communication for buy in q Moderate degree of communication q Frequent and effective communication with and involvement of the workforce in the PBHCI initiative

Please type in any steps your organization/project team has taken to communicate for buy in that worked well

Examples of strategies to communicate for buy in q Staff meetings organized specifically to address common staff concerns about change q Message emphasizes… q Human stories and human cost associated with the status quo q Resources and supports to promote change q Benefits to all stakeholders q Acknowledge and reinforce staff who support the PBHCI project q Increase wellness opportunities for both staff and clients

4. Build the Right Core PBHCI Team • The PBHCI team includes • Key primary care decision makers • Committed leadership with responsibility and authority to guide the change process • Those affected by the change (consumers) • Those expected to carry out the change in day-to-day activities • Those with experience or knowledge related to accomplishing the aims of the PBHCI initiative • Those who can provide needed resources • Those whose values, interests, beliefs, and orientation aligns with the improvement effort (champions)

Polling Question: The degree to which the team responsible for meeting the aims of the PBHCI initiative includes the full range of participants q Our PBHCI implementation team is missing participants who could contribute to achieving the aims of the initiative (e. g. , key primary care leaders/staff, consumers) q Our PBHCI implementation team involves the key individuals needed to maximize achieving the aims of the PBHCI initiative

Examples of strategies to broaden the power of the project team q Create an organizational PBHCI steering committee and/or advisory group that includes members in addition to the project team that is likely to get the attention of organizational leadership , for example: q Community members q Families q Consumers q Board member q Additional primary care partners

5. Empower Action • The PBHCI implementation team has direct access to organizational leadership in a timely fashion. • The PBHCI team has time and resources to take on the serious tasks associated with adopting and sustaining the aims of the PBHCI initiative. • Leadership communicates to the entire organization that it stands behind the PBHCI implementation team. Leadership expects everyone will support the work of the PBHCI team (minimize “hoops to jump through to get a green light”).

Polling Question: How empowered is your team? q Marginally empowered q Somewhat empowered q Moderately empowered q Mostly empowered q Exceptional degree of empowerment and support from leadership

Examples of strategies the project team may take to increase empowerment q Reduce burden on leadership q Shape the message, develop a practical plan, and create informational tools that helps leadership in promoting the PBHCI project q Create a steering/advisory group with key stakeholders that influence leadership q Keep leadership informed about the project, especially positive gains

6. Short Term Wins • Have short term action steps that are observable and meaningful • Have a system in place to communicate across the organization • • Short term action steps that are observable and meaningful Progress towards the aims of the initiative Short term wins Data as well as the human stories behind the data • Reinforce positive changes and acknowledge how everyone contributes to positive outcomes

Polling questions: Describe the degree to which your organization communicates short term wins q Little information about the progress of the PBHCI initiative is communicated organization wide q Some communication about short term wins q Moderate communication about short term wins q Regular communication about short tern wins communicated throughout the organization

Please type in any example of an action taken by leadership/project team to communicate positive findings associated with the PBHCI project

Examples of strategies to communicate short term wins q Use available communication mechanisms to inform the organization about successes in the form of data and/or benefit to participants q Recognition/award type events highlighting positive outcomes q Broadly advertise ways in which your organization is performing well in the PBHCI project q Post positive outcomes in visible areas using easy to understand graphs

7. Don’t Let Up • Expect the process to be non-linear with bumps along the way (bumps are inevitable and signs you’re making real change) • There will be inevitable forces at work to resist the change and return to the more comfortable habit state • Keep an eye on the process at all times • Have a system in place to ensure that the PBHCI initiative is a high priority goal of the organization

Polling: Describe the degree to which leadership keeps their eye on the PBHCI initiative q Little attention paid to the PBHCI initiative on an ongoing basis q Some attention q Moderate attention q Mostly regular and consistent attention and support of the PBHCI initiative q A top priority of the organization - barriers and obstacles addressed quickly

Please type in any example of an action taken by leadership/project team to ensure that there is a continuous focus on the PBHCI project

Examples of strategies to keep a focus on the PBHCI project q Establish regular and consistent meeting times of the PBHCI project team q Build in regular reporting on the project in regularly occurring organizational meetings (executive meetings, QA reports)

8. Make the Changes Stick Institutionalize changes you wish to sustain (policy and procedural requirements) • Change performance expectations • Change performance standards to support the change • Change documentation requirements • Use data to provide continuous feedback on performance • Visibly reinforce and recognize positive changes • Align changes with reliable fiscal streams

Polling question: Degree to which the organization has made changes to policy, documentation and performance expectations of the workforce q No major changes to policy, procedures, documentation or performance expectations q Some changes q Moderate changes q Major changes

Please type in any example of an action taken by leadership to make changes that support the aims of the PBHCI project stick!

Examples of strategies to keep a focus on the PBHCI project q Financial/billing systems to support PBHCI related services q Institute workforce/personnel changes q Orientation of new employees q Hiring practices q Staff performance standards q Change in staffing patterns and supervisory roles q Expansion of student training q Activating consumers (peer advisory council) q Integrated medical record

To ask your question over the phone please use the “raise your hand” button and we will open up your lines for you to ask your question to the group. (left) To ask your question via the chat please type your questions into the question box and we will address your questions. (right)

Continuing the Conversation: 2012 SAMHSA PBHCI Grantee Meeting Grantee Organization CEO Session CEOs from PBHCI grantee organizations will participate in a special discussion focused on their organization’s strategic goals, leadership, and long-term vision for their PBHCI program, and how it coalesces with their readiness for changes to healthcare delivery

Thank You! For immediate technical assistance needs, general questions, or additional information, contact: Emma Green Training & Technical Assistance Coordinator emmag@thenationalcouncil. org (202) 684 -7457, Ext. 251