Change Management

Change Management

Howard B. Fleishon, MD, FACR, MMM

Vice Chair, Govt. Relations Commission
Board of Chancellors
American College of Radiology
 Change Management

Process of developing a planned approach

to change an organization.
Typically the objective is to maximize the
collective benefits for all people involved in
the change and minimize the risk of failure
of implementing the change.
 Key Process Choices

Build Build
Credibility Coalition Training Metrics

A Communication
Plan
Pace and
Involvement
Build
Organizational
Capacity
B
 Organizational Dynamics
Definitions of Success

Transition will be Successful

Change Agent will Survive
Reduced Expenditure of Political Capital
Transition will have Staying Power
Acceptable Costs
 Case Study
16 man radiology group. New (3 year) physician
leader decides retirement structure needs to be
modified. He/she researches different models,
hires consultants, engages lawyers and comes
up with a plan without consulting the President or
others in the group. Plan is presented to the
group at a regular shareholder meeting. Result is
contentious debate, lots of finger
pointing/accusations and people walking out.
Plan was eventually adopted by minimum
required vote. Process was considered
successful by young physician leader.
 Case Study
Large, well-respected Radiology group is
approached by dominant hospital network to
sell practice to the network and become
hospital employees. Group elects not to sell
practice. Hospital network terminates contract
and forms foundation employment model for
their radiology departments. First group
leader leaves the practice. New leader takes
over. Two years later, due to mounting
financial pressures, group strikes a deal with
the network and sells the practice.
 Change: Difficult... And Necessary
There is nothing more The rate of change is
difficult to take in not going to slow
hand, more perilous down anytime soon. If
to conduct or more anything, competition
uncertain in its
success, than to take in most industries will
the lead in the probably speed up
introduction of a new even more in the next
order of things. few decades.
Niccolo Machiavelli John Kotter (1996)
(1532)
 History of the Theory of Change

Freeze / Unfreeze / Refreeze Model

Kubler-Ross Model
The Kotter Model
The Fifth Discipline
TOC and Change
 Kotter Model
Change process needs to go through a
series of phases
Critical mistakes in any of the phases can
have devastating impact
Kotters
Change
Model
 #1 Sense of Urgency

Make the status quo more dangerous

than launching into the unknown
Essential to establish cooperation of a
critical mass of people
Demands leadership: managements job is
to minimize risk and to keep the current
system operating
Benchmark: 75%of management is ready
to move forward
 #2 Powerful Guiding Coalition

Power: titles, information, expertise,

reputations and relationships
Often needs to exist at least partially
outside established hierarchy
Without powerful coalition for change,
opposition will eventually gather itself and
stop the change.
 #3 Vision
Picture of a future state that is easy to
communicate and appeals to stakeholders
Needs to be effectively communicated in
five minutes or less
 #4 Communicating the Vision
Effective plan to communicate the vision
Senior executives need to act consistent
with the vision. Walk the Talk
New vision needs to be incorporated in
operations of the company
Use every possible channel to
communicate the vision
 #5 Enable Action
Remove obstacles to new vision
Monuments
Organizational structure
Managers who are not on board with the
new vision.
 #6 Create Short Term Wins
Create short terms wins that are
meaningful to sustain momentum
Wins need to unambiguous
Reward the people who created the short
term win
#7 Dont Assume Victory Prematurely
Change needs to sink into a companys
culture
Declaring victory too soon kills momentum
momentum
Change comes to a halt and traditional
steps creep back in
 #8 Anchor Change

Needs to become the new Way we do

things around here
New behaviors need to become rooted in
social norms and shared values of the
company
Management needs to personify the new
approach
Any succession changes need to reflect
the transformation
 Leading Significant Change
Two generic problems leaders face:
Power and Politics
Individual anxiety and resistance
 Managing the Political Dynamics
Ask yourself:
Who has the power to make or break the
change?
Who controls critical resources or expertise?
How will the change affect these individuals
and how will they react to the change?
Who will gain or lose something?
What are the relationships among those
affected?
 Reaction to Change
Attitudes towards change result from a
complex interplay of emotions and
cognitive processes.
Everyone reacts to change differently.

Positive: Negative:
Opportunity Instability
Rejuvenation Upheaval
Progress Unpredictability
Innovation Threat
Growth Disorientation
Reasons for Individual Resistance to Change

Costs

Saving Face

Forces
for Fear of Unknown
Change
Breaking Routines

Incongruent Systems

Disruptive Team Dynamics

 Change Levers

Networking Technical
Communication Relationships
Training Cultural
 Using Change Levers: Potential Steps
Stage 1: Awareness
Change target is aware of the change
Stage 2: Interest
Change target is curious about the change
Open to information
Stage 3: Trial
Change target is prepared to:
evaluate the costs and benefits of the innovation
Assess the innovations probability of success
Stage 4: Adoption
Target adopts the innovation and uses it regularly
 Context for Change

U
r
g
e
n
c
y

Credibility of Change Agent

 Change Leadership
A change leader must play multiple roles

Architect
Coach

Mentor

And know when to play which role

 Why Do Change Efforts Fail?
Execution is really the critical part of a
successful strategy. Getting it done,
getting it done right, getting it done better
than the next person is far more important
than dreaming up new visions of the
future.

Lou Gerstner
Former Chairman & CEO IBM
"No one has to change. Survival is
optional.

W. Edwards Deming
Companies Dont Change,
People Do

Alan Berson
 Change: Summary
Organizational change management is important to
plan and manage.
Susceptibility to change depends on the urgency of
the situation and the influence and credibility of the
change agent.
Individuals vary in their response to change.
Understanding individual receptivity is important when
deciding how to allocate change resources.
There are a variety of change levers. No one lever
works effectively in all situations. The sequence of
levers is important.
Professional and social networks are important when
facilitating change. Sometimes convincing groups can
be more powerful than targeting individuals.