Leadership Pearls for the Physician Champion

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Leadership presentation given at Epic System's 2009 National User Group Meeting, September 2009

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  • Probably the least technical presentation you have ever heard at UGM, but potentially one of the most important you will ever hear at UGM. People think that your project is a computer project with a little leadership sprinkled in, when in reality, it is a leadership project that just happens to be about computers. This is probably the least technical, but potentially the most important presentation you will hear at this conference. You may think that implementing an inpatient electronic medical record is a “computer project with a little leadership sprinkled in”, when in reality, it is a “leadership project that just happens to be about computers”. Physicians have a notorious reputation for resisting change, and this may very well be the largest change they will experience in their careers. It is essential that the “Physician Champion” of this change develop and use strong leadership skills in order for this transition to be a success.
  • Leadership Pearls for the Physician Champion

    1. 1. Leadership “Pearls” for the Physician Champion Jon Zlabek, MD, FACP Gundersen Lutheran Medical Center La Crosse, WI [email_address]
    2. 2. Learning Objectives <ul><li>Learn the components of strong vision casting </li></ul><ul><li>Improve your understanding of organizational change </li></ul><ul><li>Understand the importance of strategic team structures </li></ul><ul><li>Learn the importance of your leadership development </li></ul>
    3. 6. Gundersen Lutheran Service Area
    4. 7. <ul><ul><li>Clinic founded in 1891; Hospital in 1902 </li></ul></ul><ul><ul><li>7,009 Employees </li></ul></ul><ul><ul><ul><li>693 providers employed/434 medical staff </li></ul></ul></ul><ul><ul><li>325 Bed Tertiary Medical Center </li></ul></ul><ul><ul><li>Service area covers 19 counties in Wisconsin, Minnesota, and Iowa with 45 clinic locations </li></ul></ul><ul><ul><li>Western Campus of the University of Wisconsin Medical and Nursing Schools </li></ul></ul><ul><ul><li>Five Residency Programs </li></ul></ul><ul><ul><ul><li>Minimally invasive surgery fellowship </li></ul></ul></ul>Gundersen Lutheran Health System
    5. 8. Warning! Your Organization is Unique!
    6. 9. Our Go-Live <ul><li>Went live on November 1, 2008: </li></ul><ul><ul><li>EpicCare Inpatient Spring 2008 </li></ul></ul><ul><ul><ul><li>Including provider documentation </li></ul></ul></ul><ul><ul><li>ASAP </li></ul></ul><ul><ul><li>Pharmacy </li></ul></ul><ul><ul><li>ADT, Registration, HIM and Billing </li></ul></ul><ul><li>Went live with CPOE February 4, 2009 </li></ul><ul><li>Have a home-grown ambulatory system </li></ul>
    7. 11. Your Role: The Leadership Pyramid Develop Yourself As A Leader Lead Others Develop Other Leaders
    8. 12. The Power of Effective Vision Casting
    9. 13. The Power of Vision <ul><li>Ways to “lead”: </li></ul><ul><ul><li>Authoritarian decree </li></ul></ul><ul><ul><li>Micromanagement </li></ul></ul><ul><ul><li>Through Vision </li></ul></ul>Leading Change – John P. Kotter
    10. 14. The Power of Vision <ul><li>Vision is a clear mental picture of what could be, fueled by the conviction that it should be </li></ul><ul><li>Vision is a view of the preferred future </li></ul>Visioneering – Andy Stanley
    11. 15. The Power of Vision <ul><li>It always stands in contrast to the world as it is </li></ul><ul><li>Vision demands change </li></ul>Visioneering – Andy Stanley
    12. 16. The Power of Vision <ul><li>Vision creates change by directing, aligning, and inspiring action </li></ul><ul><li>It gives focus </li></ul><ul><li>It guides and simplifies decision making </li></ul>Leading Change – John P. Kotter
    13. 17. The Power of Vision <ul><li>Vision motivates to action, even if the initial steps are painful and require sacrifice </li></ul><ul><li>A good vision has the “Eye of the Tiger” </li></ul><ul><ul><li>Ambitious, but attainable goals </li></ul></ul>Leading Change – John P. Kotter
    14. 18. The Power of Vision <ul><li>A clear, focused vision allows us to experience ahead of time the emotions associated with our anticipated future </li></ul><ul><li>These emotions reinforce our commitment to the vision </li></ul>Visioneering – Andy Stanley
    15. 19. Communicating the Change Vision <ul><li>How to cast a compelling vision: </li></ul><ul><li>Define the problem – What problem is my vision designed to solve? </li></ul><ul><li>Offer a solution – Your vision is the solution to the problem. </li></ul><ul><li>Tell them why to act. </li></ul><ul><li>Tell them why to act NOW . </li></ul>Visioneering – Andy Stanley
    16. 20. Communicating the Change Vision <ul><li>Simple and clear </li></ul><ul><li>Stories and examples </li></ul><ul><li>Multiple forums </li></ul><ul><li>Give-and-take communication </li></ul><ul><li>Explain perceived inconsistencies </li></ul><ul><li>Repetition – let them chew on it </li></ul>Leading Change – John P. Kotter
    17. 21. Communicating the Change Vision <ul><li>If you and those around you cannot describe the vision driving the change in less than 5 minutes AND elicit understanding and passion in the person you are talking with, you have a vision problem </li></ul><ul><ul><li>The elevator talk </li></ul></ul>
    18. 22. Communicating the Change Vision <ul><li>Vision leaks! </li></ul><ul><li>You must recast vision once a month or when there is a bump in the road, whichever comes first </li></ul>
    19. 23. Who Can I Blame? <ul><li>“ . . . if the followers don’t get it, it’s because the leader hasn’t delivered it. And if the followers don’t own it, it’s because we’ve not made it accessible enough to own it . . .” </li></ul><ul><li>“ . . . as much as we want to blame the followers, the buck stops right here . . .” </li></ul>Making Vision Stick - Andy Stanley
    20. 24. Recommended Reading Visioneering Pastor Andy Stanley
    21. 25. Selected Principles of Organizational Change
    22. 26. “ If you don’t like change, you’re going to like irrelevance even less.” General Eric Shinseki U.S. Army Chief of Staff
    23. 27. The Basics of Change <ul><li>Change is unavoidable </li></ul><ul><li>The pace of change will only get faster </li></ul><ul><li>Resistance to change is universal </li></ul><ul><li>A quick poll . . . </li></ul>Developing the Leader Within You – John C. Maxwell
    24. 28. The Basics of Change <ul><li>You need to know: </li></ul><ul><li>The technical requirements of change </li></ul><ul><li>The attitude and motivational demands that bring it about </li></ul><ul><ul><li>Don’t blow off the psychology of change! </li></ul></ul>Developing the Leader Within You – John C. Maxwell
    25. 29. 2% Innovators 10% Early Adopters 60% Middle Adopters 20% Late Adopters 8% Laggards Developing the Leader Within You – John C. Maxwell
    26. 30. The Kubler-Ross Model Marc Wright www.simply-communicate.com
    27. 31. Why People Resist Change <ul><li>They didn’t initiate it and aren’t involved with the process </li></ul><ul><ul><li>Changing vs “being” changed </li></ul></ul><ul><li>Habits and routines are threatened </li></ul><ul><li>Fear of the unknown </li></ul>Developing the Leader Within You – John C. Maxwell
    28. 32. Why People Resist Change <ul><li>Satisfaction with the status quo </li></ul><ul><li>The purpose of the change is unclear </li></ul><ul><li>Change creates fear of failure </li></ul><ul><li>Lack of respect for the leader </li></ul><ul><ul><li>They view the change according to the way they view the “change agent” </li></ul></ul>Developing the Leader Within You – John C. Maxwell
    29. 33. When Do People Change? <ul><li>Leaders create an atmosphere that causes at least one of these to occur: </li></ul><ul><ul><li>People hurt enough that they have to change </li></ul></ul><ul><ul><li>People learn enough that they want to change </li></ul></ul><ul><ul><li>People receive enough that they are able to change </li></ul></ul>Developing the Leader Within You – John C. Maxwell
    30. 34. Creating a Change Climate <ul><li>Understand the history of your organization </li></ul><ul><li>Develop trust with those you are leading </li></ul><ul><li>Place influencers in leadership positions and get them on board early in the process </li></ul>Developing the Leader Within You – John C. Maxwell
    31. 35. Creating a Change Climate <ul><li>Show people how the change will benefit them </li></ul><ul><li>Give people ownership of the change </li></ul><ul><ul><li>Ask those affected to be involved </li></ul></ul><ul><ul><li>Decisions should be made at the “lowest” level possible – those in the trenches </li></ul></ul>Developing the Leader Within You – John C. Maxwell
    32. 36. When Change Doesn’t Work <ul><li>It’s a bad idea </li></ul><ul><li>It’s not accepted by the influencers </li></ul><ul><li>It’s not presented well </li></ul><ul><li>It’s self-serving to the leaders </li></ul><ul><li>Too much change is happening too quickly </li></ul>Developing the Leader Within You – John C. Maxwell
    33. 37. Errors of Change <ul><li>Making an error of change can have serious consequences: </li></ul><ul><ul><li>Creation of unnecessary resistance </li></ul></ul><ul><ul><li>Employee frustration </li></ul></ul><ul><ul><li>Poor implementations </li></ul></ul><ul><ul><ul><li>Too long and too expensive </li></ul></ul></ul><ul><ul><li>Failing to deliver and sustain expected results </li></ul></ul>Leading Change – John P. Kotter
    34. 38. Error: Allowing Too Much Complacency <ul><li>Failure to create sufficient urgency is fatal for a change process </li></ul><ul><li>Leaders underestimate how hard it is to drive people out of their comfort zones </li></ul>Leading Change – John P. Kotter
    35. 39. Error: Allowing Too Much Complacency <ul><li>Reasons for high complacency: </li></ul><ul><ul><li>Past success </li></ul></ul><ul><ul><li>Lack of a visible “crisis” </li></ul></ul><ul><ul><ul><li>“ Things aren’t that bad” </li></ul></ul></ul><ul><ul><li>Low performance standards </li></ul></ul>Leading Change – John P. Kotter
    36. 40. <ul><li>Leaders tend to: </li></ul><ul><ul><li>Skip creation of urgency due to lack of patience </li></ul></ul><ul><ul><li>Underestimate the power of the status quo </li></ul></ul><ul><ul><li>Confuse creating urgency with creating anxiety and make things worse </li></ul></ul>Error: Allowing Too Much Complacency Leading Change – John P. Kotter
    37. 41. Establish a Sense of Urgency <ul><li>“ Problem-Cast” – tell them why the current situation is bad </li></ul><ul><ul><li>Use hard data about your current clinical shortcomings – publicize the problems </li></ul></ul><ul><ul><li>ARRA HIT dollars and timelines are important, but don’t make it the central reason </li></ul></ul><ul><li>“ Vision-Cast” - bombard them with the great future, but tell them they can’t capitalize on it with the status quo </li></ul>
    38. 42. Is This Your Guiding Coalition?
    39. 43. Error: Failing to Create a Sufficiently Powerful Guiding Coalition <ul><li>Individuals and weak committees don’t have enough power to overcome the massive sources of inertia </li></ul><ul><li>They may get it off the ground, but it quickly fizzles away </li></ul>Leading Change – John P. Kotter
    40. 44. Error: Failing to Create a Sufficiently Powerful Guiding Coalition <ul><li>A weak committee will fail: </li></ul><ul><ul><li>Not enough credibility </li></ul></ul><ul><ul><li>Wrong composition </li></ul></ul><ul><ul><ul><li>Too many managers, not enough leaders </li></ul></ul></ul><ul><li>People “smell” lack of long term success and then disengage </li></ul>Leading Change – John P. Kotter
    41. 45. Error: Failing to Create a Sufficiently Powerful Guiding Coalition <ul><li>No one individual can: </li></ul><ul><ul><li>Develop the right vision </li></ul></ul><ul><ul><li>Communicate it broadly and effectively </li></ul></ul><ul><ul><li>Remove the key roadblocks </li></ul></ul><ul><ul><li>Generate short-term wins </li></ul></ul><ul><ul><li>Lead and manage all the sub-projects </li></ul></ul><ul><ul><li>Anchor changes in the culture </li></ul></ul>Leading Change – John P. Kotter
    42. 46. Create the Guiding Coalition <ul><li>The coalition needs to be powerful: </li></ul><ul><ul><li>Reputations and relationships </li></ul></ul><ul><ul><li>Expertise </li></ul></ul><ul><ul><li>Titles </li></ul></ul><ul><ul><ul><li>Assuming those with the title are strong leaders </li></ul></ul></ul><ul><ul><li>Proven leadership capacity </li></ul></ul>Leading Change – John P. Kotter
    43. 47. Highly Recommended Reading Leading Change John P. Kotter Developing the Leader Within You John C. Maxwell
    44. 48. The Importance of Strategic Team Structures
    45. 50. Physician Leadership Team <ul><li>A group of 5 specialty-diverse physician leaders who were my “Guiding Coalition” </li></ul><ul><li>My “go-to” group for decisions that were too big for me to make alone; my trusted advisors </li></ul>
    46. 51. Physician Leadership Team <ul><li>I spent lots of time and asked a lot of advice from others before choosing and making the “pitch” to them </li></ul><ul><li>Our group: </li></ul><ul><ul><li>Emergency Department Physician– 0.3 FTE </li></ul></ul><ul><ul><li>General Medicine Section Chair – 0.1 FTE </li></ul></ul><ul><ul><li>Hospitalist/Assoc. Director of Residency – 0.1 FTE </li></ul></ul><ul><ul><li>OB/GYN Physician– 0.1 FTE </li></ul></ul><ul><ul><li>Myself (Internal Med/Vascular Med) 0.5 FTE </li></ul></ul>
    47. 52. Physician Leadership Team Develop Yourself As A Leader Lead Others Develop Other Leaders
    48. 53. Physician Leadership Team <ul><li>I poured lots of leadership development time and energy into them: </li></ul><ul><ul><li>Read several leadership books together </li></ul></ul><ul><ul><li>Discussed difficult leadership decisions </li></ul></ul><ul><ul><li>Discussed potential “fires” and how to handle them </li></ul></ul><ul><ul><li>Openly discussed our leadership strengths and weaknesses </li></ul></ul>
    49. 54. Recommended Reading Developing the Leaders Around You John C. Maxwell
    50. 55. Advisory Team <ul><li>Multidisciplinary group representing Physicians and Associate Providers in every inpatient specialty </li></ul><ul><li>At least one per specialty </li></ul><ul><li>Total of 35 people </li></ul>
    51. 56. Advisory Team <ul><li>My “go-to” group for decisions that were too big and far-reaching for the Physician Leadership Team: </li></ul><ul><ul><li>New Same Day Surgery flow </li></ul></ul><ul><ul><li>Navigator build </li></ul></ul><ul><ul><li>Smart Text content </li></ul></ul><ul><li>Most functioned as their department’s Super Users </li></ul>
    52. 57. Advisory Team <ul><li>They must be committed to the project’s success in relation to their department and the organization </li></ul><ul><li>They need to have your “back” and the project’s “back” when challenged </li></ul><ul><li>They will take a lot of hits for you, so be very appreciative! </li></ul>
    53. 58. Advisory Team <ul><li>We “funneled” all communication to and from their department through them </li></ul><ul><ul><li>Able to answer most questions in a way their department could best understand </li></ul></ul><ul><ul><li>MD Champion sanity: 35 people asking me questions instead of several hundred </li></ul></ul>
    54. 59. The slides that follow are some of what I presented to the Advisory Team at our first meeting . . .
    55. 60. Advisory Team Roles <ul><li>You must give us your input! </li></ul><ul><li>This is one of the high-risk areas of the project. </li></ul><ul><li>Represent your department . . . they are depending on you! </li></ul>Communicate with the Implementation Team
    56. 61. Advisory Team Roles <ul><li>You need to tell those around you how the project is going: </li></ul><ul><ul><li>Must keep abreast with what is happening </li></ul></ul><ul><ul><li>Plan an update at every department meeting </li></ul></ul><ul><ul><li>Ask us clarifying questions as they occur </li></ul></ul>Communicate with Those You Represent
    57. 62. <ul><li>Lead By Example </li></ul><ul><li>Maintain a positive attitude, even when things get rough . . . your colleagues are watching you closely </li></ul><ul><li>You will be asked to be in the first wave of training and be “Super Users” so you can dispel myths and fears of your colleagues </li></ul>Advisory Team Roles
    58. 63. Epic Super User Picture Yourself <ul><ul><ul><ul><li>                                                              </li></ul></ul></ul></ul><ul><ul><ul><ul><li>                                                              </li></ul></ul></ul></ul>
    59. 65. Executive Leadership <ul><li>It is critical to have Executive Leadership 110% behind the project </li></ul><ul><ul><li>Thankfully, ours was and still is </li></ul></ul><ul><li>In your interactions with them, remember a few important things . . . </li></ul>
    60. 66. Executive Leadership <ul><li>“ Don’t surprise us” </li></ul><ul><ul><li>Let them know of controversial decisions well in advance to avoid the hallway ambush </li></ul></ul><ul><li>Present likely scenarios in advance so they can process their responses </li></ul><ul><ul><li>What if “Dr. Jones” refuses to do XYZ? </li></ul></ul>
    61. 67. Executive Leadership <ul><li>Full disclosure </li></ul><ul><ul><li>Don’t even consider anything less than total honesty and transparency </li></ul></ul><ul><ul><li>Trust is a vital commodity </li></ul></ul><ul><ul><li>Your CEO should not lose sleep over your management of this project </li></ul></ul>
    62. 68. Executive Leadership <ul><li>Escalate issues appropriately </li></ul><ul><ul><li>Find your organization’s balance between “hands off” and “micromanagement” </li></ul></ul><ul><li>Allow them to help you </li></ul><ul><ul><li>Present issues in such as way to allow them to help you make the project succeed </li></ul></ul>
    63. 69. The slides that follow are some of what I presented to Executive Leadership when requesting Physician and Associate Staff time to be Super Users . . .
    64. 70. Things Unique to Physicians #1 <ul><li>Unlike other hospital employees, due to rotation schedules, some physicians may not set foot in the hospital for months </li></ul><ul><ul><li>Internal Medicine clinic-hospital docs </li></ul></ul><ul><ul><li>Rheumatologists </li></ul></ul><ul><ul><li>Dermatologists, etc </li></ul></ul>
    65. 71. Things Unique to Physicians #1 <ul><li>The 2 week Go-Live “Blast” of support when Epic is onsite, or even the lower level support intensity the month after Go-Live won’t help some of them </li></ul><ul><li>Therefore, they are at higher risk for troubles </li></ul>
    66. 72. Things Unique to Physicians #2 <ul><li>Most physicians and associate providers will use Epic only sporadically throughout the day, and in “bursts”, unlike nurses </li></ul><ul><ul><li>Morning rounds </li></ul></ul><ul><ul><li>Afternoon rounds </li></ul></ul><ul><li>The rest of the day they live in the clinic or operating room </li></ul>
    67. 73. Things Unique to Physicians #3 <ul><li>Physicians will have questions not only when they are in the hospital, but also at their “home base” – usually in clinic </li></ul><ul><ul><li>This is a less chaotic environment to get more Epic support </li></ul></ul><ul><ul><li>A local knowledgeable person from their department/section is important </li></ul></ul>
    68. 74. Things Unique to Physicians #4 <ul><li>By far, physicians have been the group that struggles the most with change of this type </li></ul><ul><li>A struggling physician group trickles down to negatively impact others around them (Nurses, HUCs, etc) </li></ul>
    69. 75. Creative Use of Physician and Associate Staff Super Users <ul><li>So, support for physicians and associate providers needs to: </li></ul><ul><ul><li>Be available for a longer period of time </li></ul></ul><ul><ul><li>Be timed correctly for when they are using Epic (rounding) </li></ul></ul><ul><ul><li>Be locally available for questions when they are not in the hospital (in their clinic) </li></ul></ul>
    70. 76. Tips For the Physician Champion
    71. 77. Interactions with the Implementation Team <ul><li>You are the bridge/translator between the Implementation Team and end users </li></ul><ul><ul><li>You understand the clinical side already </li></ul></ul><ul><ul><li>You must also have an understanding of the technical side </li></ul></ul>
    72. 78. Interactions with the Implementation Team <ul><li>Consider taking full Clinical Documentation and Orders training </li></ul><ul><ul><li>Understand the build process </li></ul></ul><ul><ul><li>Feel their pain </li></ul></ul><ul><li>Be intimately involved with the build </li></ul><ul><ul><li>You will understand and see things the builders won’t and vice-versa </li></ul></ul>
    73. 79. Interactions with the Implementation Team <ul><li>Keep track of how the teams are doing to appropriately “time” your requests </li></ul><ul><li>Don’t overburden them </li></ul><ul><li>Give them what they can handle, when they can handle it </li></ul>
    74. 80. Interactions with the Implementation Team <ul><li>Review training materials in detail and attend several early sessions to ensure the wrinkles are ironed out </li></ul><ul><ul><li>Identify workflows that will be difficult </li></ul></ul><ul><li>Give the training team tips on how to handle difficult providers </li></ul><ul><ul><li>Setting ground rules for the classroom </li></ul></ul><ul><ul><li>How to relate with “Dr. Jones” </li></ul></ul>
    75. 81. Interactions with the Implementation Team <ul><li>Be a “thanking” machine! </li></ul><ul><ul><li>They are working like crazy and can’t hear it enough </li></ul></ul><ul><li>Publically praise them whenever you can </li></ul><ul><li>If a particular team is struggling, pour more into them </li></ul>
    76. 82. Interactions with the Implementation Team <ul><li>Protect your Implementation Team. Call out providers being unkind to them </li></ul><ul><li>Maintain an eternally positive attitude – there will be plenty negative thoughts and fears floating around </li></ul>
    77. 83. Implementation Team Develop Yourself As A Leader Lead Others Develop Other Leaders
    78. 84. Interactions with the Implementation Team <ul><li>You have a captive audience of leaders who are likely embarking on the biggest challenge of their lives </li></ul><ul><li>Use this opportunity to develop them as leaders: </li></ul><ul><ul><li>Leadership material recommendations </li></ul></ul><ul><ul><li>Large group teaching </li></ul></ul><ul><ul><li>One-on-one interactions </li></ul></ul>
    79. 85. Pure Gold Leadership Nuggets Illustrating Principles of Organizational Leadership through the Epic Project Jon Zlabek
    80. 86. Interactions with the Implementation Team <ul><li>Large Group Leadership Topics: </li></ul><ul><ul><li>Understanding organizational change </li></ul></ul><ul><ul><li>Basic and advanced conflict resolution </li></ul></ul><ul><ul><li>“ Your potential exceeds your expectations” </li></ul></ul><ul><ul><li>The approach to “critics” </li></ul></ul><ul><ul><li>Relating with difficult providers </li></ul></ul>
    81. 87. Strong Relationships with End Users <ul><li>It’s culturally important to be a physician first </li></ul><ul><ul><li>Be in the trenches with them </li></ul></ul><ul><ul><li>Know the local culture and workflows </li></ul></ul><ul><li>You must know the personalities and how they will react to changes </li></ul><ul><ul><li>Communicate uniquely with each person </li></ul></ul>
    82. 88. Strong Relationships with End Users <ul><li>Listen before you react </li></ul><ul><ul><li>Even if you have the answer right away, they need to be heard </li></ul></ul><ul><li>Empathize with them </li></ul><ul><li>Have a contagious positive attitude </li></ul><ul><ul><li>Your attitude leads the way </li></ul></ul>
    83. 89. Strong Relationships with End Users Under-Promise and Over-Deliver
    84. 90. Communication <ul><li>Don’t rely on: </li></ul><ul><li>Cascading (trickle-down) communication </li></ul><ul><ul><li>Example – talking only at Department Chair Meetings </li></ul></ul><ul><li>Email </li></ul><ul><ul><li>While efficient, it isn’t enough </li></ul></ul>
    85. 91. Communication <ul><li>Get in front of them face-to-face in small groups at their department meetings </li></ul><ul><ul><li>We went to each department 5 times </li></ul></ul>
    86. 92. Communication <ul><li>Tell them the expected “Wins” early and often (every time you present) </li></ul><ul><li>Our big expected wins: </li></ul><ul><ul><li>Best Patient Care </li></ul></ul><ul><ul><ul><li>Safety, satisfaction, and quality </li></ul></ul></ul><ul><ul><li>High Employee Engagement </li></ul></ul><ul><ul><ul><li>Efficiency, recruitment, and retention </li></ul></ul></ul><ul><ul><li>Decreased Cost of Healthcare </li></ul></ul>
    87. 93. Communication <ul><li>Inform them early and often that this is an “all in” type of project – training and use. No one is exempt. </li></ul><ul><li>Proactively address every excuse! </li></ul><ul><ul><li>Computer skills training </li></ul></ul><ul><ul><li>Typing training </li></ul></ul><ul><ul><li>Tons of computers for access </li></ul></ul><ul><ul><li>“ Page me” if you get stuck – don’t struggle </li></ul></ul>
    88. 94. Communication <ul><li>After Go-Live, get in front of the departments again: </li></ul><ul><ul><li>Thank everyone for their help </li></ul></ul><ul><ul><li>Focus thanks on the Advisory Team member in front of their peers </li></ul></ul><ul><ul><li>Ask for optimization requests </li></ul></ul><ul><ul><li>Report on the pre/post metrics to anchor the change in the culture </li></ul></ul>
    89. 95. Anchoring Change in Culture <ul><li>“ Culture changes only after you have successfully altered people’s actions, after the new behavior produces some group benefit for a period of time, and after people see the connection between the new actions and the performance improvement. Thus, most cultural change happens [at the end, not at the beginning] .” </li></ul>Leading Change – John P. Kotter
    90. 96. How We “Connected” the Change to the Improvement <ul><li>Mortality </li></ul><ul><li>Length of Stay </li></ul><ul><li>ED Throughput </li></ul><ul><li>OR Start Time </li></ul><ul><li>Patient Satisfaction </li></ul><ul><li>Documentation Audits </li></ul><ul><li>Medication Events </li></ul><ul><li>Lab and Radiology Utilization </li></ul><ul><li>Professional Charges </li></ul><ul><li>Paper Savings </li></ul><ul><li>Transcription Savings </li></ul><ul><li>Implementation Savings </li></ul>Don’t forget the “Soft Wins”!
    91. 97. The slides that follow are some of what I presented to departments before Go-Live . . .
    92. 98. Deep Thoughts by JON ZLABEK
    93. 99. Go-Live Expectations <ul><li>The Go-Live process will be a HUGE thing </li></ul><ul><ul><li>Get ready for a wild ride, baby </li></ul></ul><ul><li>All of the benefits from this project WILL NOT be seen in the first few weeks-months </li></ul>
    94. 100. Go-Live Expectations <ul><li>There will be bugs to work out </li></ul><ul><li>Believe it or not, we’re not going to catch everything in the thousands and thousands of decisions we have to make </li></ul><ul><li>Please be patient! </li></ul>
    95. 101. We Are ALL Leaders . . . <ul><li>Leading By Example </li></ul><ul><li>Maintain a positive attitude, even when things get rough </li></ul><ul><ul><li>Go-Lives of this magnitude can get “bumpy” . . . expect some difficulty </li></ul></ul><ul><ul><li>Medical and non-medical staff are watching you closely and taking cues from your reactions to change </li></ul></ul><ul><ul><li>Whether you like it or not, you are a role-model </li></ul></ul>
    96. 102. We Are ALL Leaders . . . <ul><li>Communication is KEY! </li></ul><ul><li>Please read and keep abreast with what is happening </li></ul><ul><ul><li>Department meeting updates </li></ul></ul><ul><ul><li>Talking with your Advisory Team Rep </li></ul></ul><ul><ul><li>Bridges (our weekly newspaper) </li></ul></ul><ul><ul><li>Medical and Associate Staff E-Newsletter </li></ul></ul><ul><ul><li>GLadiator Link (our intranet) </li></ul></ul><ul><li>Ask us clarifying questions as they occur </li></ul>
    97. 103. A Normal Part of Big Change <ul><li>People tend to experience different emotions at this stage of change in a big project like this . . . </li></ul><ul><ul><li>Excitement </li></ul></ul><ul><ul><li>Concern, worry, fear . . . </li></ul></ul><ul><li>These are normal! </li></ul>
    98. 104. Keep Perspective . . . <ul><li>Thousands of organizations are using electronic health systems </li></ul><ul><li>Hundreds of organizations are using Epic </li></ul><ul><li>They succeeded. </li></ul><ul><li>Some of the reasons we’re in great shape . . . </li></ul>
    99. 105. Keep Perspective . . . <ul><li>Epic’s inpatient system has been consistently rated #1 by customers </li></ul><ul><ul><li>Many other hospitals are working with lesser-rated vendors </li></ul></ul><ul><li>The Epic Inpatient 2008 version has many new features to streamline care and make our lives better </li></ul><ul><ul><li>Other hospitals using Epic have paved the way for improvement to our benefit </li></ul></ul>
    100. 106. Keep Perspective . . . <ul><li>We will be the first hospital to Go-Live with “partial dictation” </li></ul><ul><ul><li>Other hospital’s MD/PA/NPs need to type a lot, or else dictate all the notes </li></ul></ul><ul><li>We have been using an electronic medical record for over 10 years in the clinic </li></ul><ul><ul><li>A lot of other places were still on paper when their hospitals went live </li></ul></ul>
    101. 107. We Will Prevail <ul><li>There is absolutely no doubt in our minds that we will have overwhelming success during Go-Live </li></ul>
    102. 108. We Will Prevail <ul><li>However, we need to stay on track and work together: </li></ul><ul><ul><li>You will need to be focused during training </li></ul></ul><ul><ul><li>There will be a learning curve </li></ul></ul><ul><ul><li>There will be tweaks to make along the way </li></ul></ul><ul><ul><li>Patience please . . . </li></ul></ul>
    103. 109. Engaging Everyone <ul><li>Everyone who “touches” hospital and Emergency Department patients must participate for success </li></ul><ul><li>Administration is 100% behind the policy of everyone being engaged </li></ul>
    104. 110. Training <ul><li>Training details: </li></ul><ul><ul><li>Please arrive on time and be free of patient care duties (ideally “pager off”) </li></ul></ul><ul><ul><li>Training is not the time to question or challenge workflows </li></ul></ul><ul><ul><ul><li>Write down your questions and ask me after class </li></ul></ul></ul><ul><ul><li>Please be respectful to your trainers! </li></ul></ul>
    105. 111. Physician Champion Tips At Go-Live
    106. 112. Physician Champion Tips At Go-Live <ul><li>Lots and lots of caffeine </li></ul><ul><li>Lots and lots of sugar </li></ul><ul><ul><li>You should easily burn off more than you can ever consume! </li></ul></ul><ul><li>Have a fresh pager battery at all times! </li></ul>
    107. 113. Physician Champion Tips At Go-Live <ul><li>Be on the go and in the trenches </li></ul><ul><li>Put out fires immediately </li></ul><ul><li>Go to the command center only: </li></ul><ul><ul><li>For food </li></ul></ul><ul><ul><li>To resolve burning issues </li></ul></ul><ul><ul><li>To check on the Implementation Team </li></ul></ul>
    108. 114. Physician Champion Tips At Go-Live <ul><li>Carry candy – the cure for many a stressed-out end user </li></ul><ul><li>Carry relevant tip sheets and other support material with you to hand out </li></ul>
    109. 115. How I Addressed Resistance <ul><li>First of all, do your best to prevent resistance: </li></ul><ul><ul><li>Strong, clear vision communicated repeatedly </li></ul></ul><ul><ul><li>Administration that is solidly behind you </li></ul></ul><ul><ul><li>“ Nip it in the bud” when you first hear about it – Have great spies </li></ul></ul>
    110. 116. How I Addressed Resistance <ul><li>Second, LISTEN PATIENTLY </li></ul><ul><ul><li>Let them fully vent </li></ul></ul><ul><ul><li>NEVER strike back at this time </li></ul></ul><ul><ul><li>Top quote from a surgeon: </li></ul></ul><ul><ul><ul><li>“ His/her behavior stinks, but that’s how a surgeon asks for help” </li></ul></ul></ul>
    111. 117. How I Addressed Resistance <ul><li>Third, remember your role (protect your sanity) </li></ul><ul><ul><li>“ Going electronic was a board decision – I’m just the implementer” </li></ul></ul><ul><ul><li>“ I didn’t invent Epic” </li></ul></ul><ul><ul><li>“ I am not the Epic police – I can’t punish anyone for bad behavior” </li></ul></ul>
    112. 118. How I Addressed Resistance <ul><li>Third, remember your role (protect your sanity) </li></ul><ul><ul><li>“ There is a defined escalation pathway in place for your concerns. I’ll be happy to guide you if you wish” </li></ul></ul><ul><ul><li>Second best quote of the project: </li></ul></ul><ul><ul><ul><li>“ Epic isn’t meant for the older docs who are ready to retire, it’s for the next generation of physicians” </li></ul></ul></ul>
    113. 119. How I Addressed Resistance <ul><li>Lastly, work your butt off to teach them and fix things </li></ul><ul><ul><li>Offer help immediately – this resolves most lower level resistance right away </li></ul></ul><ul><ul><li>“ Under-Promise” and “Over-Deliver” </li></ul></ul><ul><ul><li>Follow up with them to let them know you are still working on a solution and/or what the resolution is </li></ul></ul>
    114. 120. The Importance of YOUR Leadership Development
    115. 121. The Leadership Pyramid Develop Yourself As A Leader Lead Others Develop Other Leaders
    116. 122. <ul><li>Success in current and future environments depends on your competitive drive and lifelong learning </li></ul><ul><li>You must intentionally and continually develop yourself as a leader </li></ul><ul><ul><li>Don’t even consider “winging it” </li></ul></ul>Leadership and Lifelong Learning Leading Change – John P. Kotter
    117. 123. Who’s Gonna Pay? <ul><li>If you are not willing to pay the price of developing yourself as a leader, your people will pay the price of your poor leadership </li></ul><ul><li>Who is gonna pay the price? </li></ul>The Way of the Shepherd – Leman & Pentak
    118. 124. Who is ultimately responsible for YOUR leadership development?
    119. 125. Foundation of Leadership - Trust <ul><li>1. Integrity </li></ul><ul><ul><li>Honesty </li></ul></ul><ul><ul><li>Congruence – walk the talk </li></ul></ul><ul><ul><li>Humility - quick to apologize & forgive </li></ul></ul><ul><li>2. Intent </li></ul><ul><ul><li>Pure motives </li></ul></ul><ul><ul><li>Mutually beneficial agenda </li></ul></ul><ul><ul><li>Act in the best interest of others </li></ul></ul>The Speed of Trust – Stephen M.R. Covey
    120. 126. Foundation of Leadership - Trust <ul><li>3. Capabilities </li></ul><ul><ul><li>Know and use your talents and skills </li></ul></ul><ul><ul><li>Keep up to date </li></ul></ul><ul><li>4. Results </li></ul><ul><ul><li>Take responsibility for results, not just for “trying” </li></ul></ul><ul><ul><li>Communicate the results </li></ul></ul><ul><ul><li>“ Beginners are many; finishers are few” </li></ul></ul>The Speed of Trust – Stephen M.R. Covey
    121. 127. Recommended Reading The Speed of Trust Stephen M.R. Covey speedoftrust.com
    122. 128. A Leadership Development Plan <ul><li>Form solid trusting relationships with those around you, then: </li></ul><ul><ul><li>Lead something </li></ul></ul><ul><ul><li>Read everything you can on leadership – leaders are readers </li></ul></ul><ul><ul><li>Attend leadership courses/conferences </li></ul></ul><ul><ul><li>Learn from leaders better than you – get a leadership mentor </li></ul></ul>
    123. 129. Highly Recommended Reading The 21 Irrefutable Laws of Leadership John C. Maxwell
    124. 130. Epic – Home Life Balance <ul><li>Awesome wife and kids! </li></ul>
    125. 131. Epic – Home Life Balance Your career is a 30+ year marathon, not a sprint Take a step back and look at the big picture . . . What matters most? Leave work at work Family comes first
    126. 132. Epic – Home Life Balance <ul><ul><li>Movie recommendation about this issue: </li></ul></ul><ul><ul><ul><li>“ Click” with Adam Sandler – stresses the importance of “Family Comes First” </li></ul></ul></ul><ul><ul><ul><li>The modern day movie version of the song “Cats in the Cradle” </li></ul></ul></ul>
    127. 133. Epic – Home Life Balance <ul><li>I did my very best to avoid taking work home, and when I was getting crushed, tried to do it early AM or late PM </li></ul><ul><ul><li>Worked very hard to compartmentalize my two worlds </li></ul></ul><ul><ul><li>Personal policy: “Taking work home will be uncommon” </li></ul></ul>
    128. 134. Epic – Home Life Balance <ul><li>Took strategic blocks of time off: </li></ul><ul><ul><li>After big bursts of project intensity </li></ul></ul><ul><ul><li>Times that the Implementation Team needed me less </li></ul></ul><ul><ul><li>Took more than a day off at a time </li></ul></ul><ul><ul><li>Pager free – pushed every work thought out of my mind </li></ul></ul>
    129. 135. Epic – Home Life Balance <ul><li>I actually grew in other critical areas of my life that helped keep me going: </li></ul><ul><ul><li>Improved my spiritual life </li></ul></ul><ul><ul><ul><li>One tends to experience the need for divine intervention more in projects like this </li></ul></ul></ul><ul><ul><li>Improved my physical conditioning with a few triathlons last year and now in training for a marathon </li></ul></ul>
    130. 136. My Top Leadership Lessons <ul><li>Your career is a 30+ year marathon, not a sprint; Leave work at work – family comes first </li></ul><ul><li>Never rely on cascading communication </li></ul><ul><li>“ Under-Promise” and “Over-Deliver” </li></ul><ul><li>Your guiding coalition and initial structure set-up are critical – take your time and get it right </li></ul><ul><li>Your leadership development is the key to your success – be a “student” of leadership </li></ul>
    131. 137. “ It ain’t an easy job, but when you bring a couple thousand Gundersen Lutheran employees through implementation, and you ain’t lost a one of them . . . Ain’t a feeling like it in the world.”

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