Reflection Part 6 CSBI Course 6 Rel.docx

Reflection Part 6
CSBI Course 6: Relationship, Change
Management and Consulting skills
● Leading Change
● Finding Opportunity
● Communicating Within the Industry
● Proving Value
Leading Change
Consultants leverage knowledge,expertise and
communications competency to support
decision-makers in considering data and
information in ways that reveal robust
opportunities for
organizations. Some of these opportunities have
not previously been envisioned at an
operations level because meaningful information
has not been available or presented.
Exercising Influence and Stimulating Action
A well-considered and integrated use of
emotional intelligence, a variety of leadership
styles and
appropriate use of power will be valuable to
the BI/Analytics consultants as a change agent

in
times of turbulence. We will describe each
of these attributes and then discuss how their
integrated use creates strong leverage for
influence.
Much has been written over the past fifteen
years about the success of those who work
with
emotional intelligence(EI). High-EI people can
understand and read, in real time, their own
emotions while simultaneously understanding those
of others and subsequently advancing their
positions by interacting with greater skill and
influence than others. This capability is
present
even in the heat of the moment, when
most individuals would turn to more base-level
interpretations of and reactions to themselves,
others and a situation.
Daniel Goleman, a well-known author on EI,
finds that leadership performance is affected by
one’s ability to work within the two EI
competency sets- personal and social.
Specifically, one’s
ability to engage certain personal and social
competencies yields stronger leadership
performance and subsequent results as a
change agent.

Self Awareness
● Emotional awareness
● Accurate self-assessment
● Self confidence
Self Management
● Self control
● Trustworthiness
● Conscientiousness
● Adaptability
● Innovation
Motivation
● Achievement drive
● Commitment
● Initiative
● Optimism
Empathy
● Understand others
● Develop others
● Service orientation
● Leveraging diversity
● Political awareness
Social Skills
● Influence
● Communication
● Conflict management
● Leadership
● Change catalyst
● Building bonds
● Collaboration and cooperation
● Team capabilities

Exercise Influence and Stimulating Action
It can be surmised that building bonds
would be helpful in the complex healthcare
environment.
A key in building bonds is to develop
extensive informal networks where mutually
beneficial
relationships are carefully cultivated. The
networks are chosen based on expertise that
each
member brings to the table and willingness
to extend knowledge or expertise when needed.
Innovation is not seen as a necessary change
agent competency because the change agent
helps others unlock their ideas and work
through them.
Leadership styles and competencies
Goleman asserts that one can develop higher
EI competency through practice. Self tests are
available to see where one stands compared
to others. EI can be practiced by learning
to use
the six leadership styles listed. Practice of
each style sharpens one’s EI in specific
competencies. They should all be used at
points where such an effect is needed. Use
in
combination is appropriate.

The Power Bases
The social skill influence is an EI
competency that leaders leverage to get things
accomplished.
Influence is grounded in the power individuals
exercise, according to Kenneth W. Thomas,
PhD.
Thomas presents six power types along with
the influence effect each type produces.
The key aim for the BI/Analytics consultant
related to influence is to build commitment
to an
idea, an approach, a KPI or a new way
of looking at or making decisions.
Note the commitment effect is related to
personal power bases expertise and information,
which
the BI/Analytics consultant should have or can
build in abundance. Also needed is compliance
from those outside one’s direct control to
successfully conduct experiments and launch new
analytic approaches. Goodwill should also be
used to build commitment. Successful use of
these power bases relies on communication.
6 Power bases are:

1. Authority-one’s formal right to direct others
in certain matters and others’ obligation to
follow those directions.
2. Reward-one’s control over things others
desire.
3. Discipline-One’s formal right to punish others.
4. Information-Facts or reasoning that one
possesses and is able to share convincingly
with team members.
5. Expertise-One’s superior judgment or knowledge
in a specific area.
6. Goodwill-Feelings of support and respect that
one has built with others.
The influence effect that each power base
produces is presented here. Some sources of
power
base production are presented here. Some
sources of power are positional, while others
are
personal. Positional power bases often are not
available to the BI/Analytics consultant, as they
require one to be in position of direct
authority over another. Positional power bases
are not
needed to build commitment. However, ensuring
compliance is necessary, along with
occasionally overcoming resistance, and these do
not come from commitment alone.
Depending on the situation, one may be
available to wield positional power when acting
in
project management capacity, though this is

difficult. Whennot in a positional power
position,
one can exercise personal power to reward
individuals that fosters compliance. Mechanisms
need to be in place to make this happen.
It is essential to have the ability to use
all power types
as appropriate to spur progress.
Source of Power Power Base Influence Effect
Position Authority Compliance
Discipline Resistance
Reward Compliance
Personal Information Commitment
Expertise Commitment
Goodwill Commitment
Fostering Commitment
Now one has a tool set for action.
However, conscious use of the tools must be
engaged. The
stakeholder provides insights into the interests
and needs of individuals involved at all
organizational levels. From this analysis, one
should have a keen appreciation of how to
engage EI social competencies. This strengthens
political awareness. Action steps, if
developed carefully in the stakeholder process,
can address political issues and act as power
mechanisms of reward and goodwill to foster
compliance and commitment. For example, set

up the plan for someone who wants a say
and participation, so they can participate and
talk.
They will feel rewarded. Enrolling them in
the process through participation because you
can(exercise goodwill) engage team capabilities.
In turn, those drawn in will now exhibit
goodwill
to others as it has been extended to them,
which leads to commitment.
Other Tools-Sponsorship
One of the other tools to engage in the
process is sponsorship. Sponsorship can be
defined as
fostering transparency and accountability in the
group process, again fitting with necessary EI
competencies of political awareness, initiative
and influence. Although one may not be
engaged
in a formal project management (PM) situation,
the PM tool of sponsorship ensures that
enough
organizational executive influence is available to
exert pressure against possible resistance.
Others Tools-Communication

Communication is another tool. It’s important
to understand one’s own communication style
and
preferences and be sensitive to the styles
and preferences of others. A number of self-
scoring
tools are available that can be used to
master interpersonal communication skills. Some
of
these are:
● DiSC profile-this tool illuminates one’s
communication preferences(dominant, influencer,
steadiness & conscientiousness). When these
preferences are known, one can work to
understand and interact with others in the
context of their preferred styles of
communication.
● Myers Briggs Temperament Index: This tool
helps individuals and groups understand
the basic differences in the ways they prefer
to use their perception and judgment.
● Kolbe Conative Index-this tool offers a
measure of how people are hardwired to take
action in one of four ways(fact finder,
follow through, quick start or implementer).
Exercising influence and Stimulating Action
Whether using these or other tools, it’s
helpful to understand communications preferences
and
styles in oneself and in team members. The

aim is to carefully build a team that is
balanced in
communication styles to achieve diversity of
thought and action. Then continue to hone
these
skills across the course of the work.
Is it this simple? No. Conscious action is
required along with careful and forward-looking
networking and preparation. There is no
substitute. There are those who might eschew
this
process as contrived and surreptitious. However,
goodwill-the most powerful of the power bases
due to the broad spectrum of activities and
methods. Goodwill is easily dissipated where
transparency and open action are not in
force.
Finding Opportunity
Focus on performance
Using the approaches discussed earlier for
working across the organization at all levels,
one
can uncover areas and issues of importance
that need to be addressed. Here the
organization
can see if attainment of the benchmark is
possible and what it might take to achieve
it based on
the what if findings. And the organization
can see what is possible today. So decision-
making
related to targets is in line with the 5

key power decision attributes-more targeted,
replicable,
expeditious and lower in cost.
Are Policies and rules in Place?
Also revealed in this type of analysis is
whether the organization has the policies in
place, and
whether actual practice and compliance are in
line with these policies, to perform at desired
levels. As the predictive analytic
experimentation process requires ia set of rules
by which to
make predictions(this is how the organization
wants or should operate), the set of rules
by which
the organization actually operates becomes clear.
Then the what if questions always prompt
the questions: “So what are you doing
now?” Often it
has been found that significant issues with
compliance exist and, frequently enough, policies
and rules do not exist. They must be
built.
So experimentation reveals 2 things:
● The data needed(ADT, clinical, financial, etc
or process performance)
● The policies and rules by which the
predictions and prescriptions must be developed
and

implemented with any analytics.
Who is responsible?
As part of moving along this path, one
will have performed a stakeholder analysis.
This analysis
will have revealed another important area of
information: Who is involved in the chain of
events
that makes up the item in question? Who
is ultimately responsible? Who executes the
item on
a daily basis? For example, staffing on
nursing floors, collection decisions or how the
marker
for high 30-day readmit risk is actually
addressed. Or regarding outpatient demand
management activity in Primary Care- to
manage identified chronic healthcare users with
diabetes. After building a new very expensive
construct dashboard with very detailed metrics
as requested-does the operating areas use it?
Do the metrics move?
One can easily surmise the highly sensitive
situation that begins to present itself. The
capability
and willingness of operating managers at
several levels may be called into question.
This is the
reason for advance engagement of the
stakeholders analysis and plan, EI building
bonds and
networking and sponsorship tools, along with

involving the operating managers in the
experiment development process.
However, this uncovers the need for
sponsorship and in some situations where
distributed
decision-making is required, this need is
absolute. This a model to ensure the aims
planned are
actually executed down the line.
In particular, the sponsorship tool calls for
finding a sponsor at the highest level who
can hold
accountable all actors involved in the work.
The CFO cannot hold the COO or CNO
accountable, therefore the CEO must be the
sponsor. If this is not possible, then the
initiative
should not be engaged.
Case study
Consider this real case regarding outpatient
demand management activity in Primary Care.
The
initiative’s aim is to manage identified chronic
condition healthcare users having diabetes. After
building an expensive dashboard with detailed
metrics(as requested) to support operating
managers(those responsible for execution) to
address the issue, does the outpatient primary
care office and clinic facilities use it? Do

metrics move? The senior leadership team is
asking
questions to validate the use of the tool to
address the issue as the metrics are not
moving
appreciably.
Case Study-Answer
CEO-Correct. No. Not necessarily intuitive, yet
the initiative involves clinical staff(medical &
nursing) along with the support of
administrative staff. All of these positions stop
with the CEO.
It might be considered below the CEO’s
work, yet as in the chart presented, the
sponsor must
have the authority to mobilize action. In
this case the clinical teams and administrative
team
must become and remain mobilized.
Chief Admin Officer-Incorrect. This position has
no leverage over the CMO, when push comes
to shove in organizational politics.
CNO-Incorrect. The CNO is the usual suspect
for clinical accountability. However, what about
the medical team? What about the necessary
support of the clinical staff by administrative

team? The CNO has no leverage here.
VP of Primary Office Admin: Incorrect. This
individual has no authority or leverage over
clinical
execution.
CFO: Incorrect. This individual has no
authority or leverage over clinical execution.
VP of Finance: Incorrect. This individual has
no authority or leverage over clinical execution.
Director of BI/A: Incorrect. This individual
has created a tool according to specs but
does not
have authority or leverage over clinical
execution.
Communicating within the organization
The BI/A consultant must present the results
data effectively in a general sense. In
addition,
however, he or she must present results in
terms to which others in the organization
will relate.
The typical return on investment(ROI) findings
leave many cold. Often the first thought is
that
ROI means loss of jobs. This can easily
be the case in clinical areas, since labor is
largely the
only visible expense. ROI to many is based
on cost reduction only. To mitigate this

tendency, it
is critical to involve not only the unit
director or manager when starting with the
experiment
design process. Stakeholders, specifically staff
members involved in the process should
participate. It is helpful to have staff
members who are vocal about the need for
change
because they have an invaluable ground-level
viewpoint that should be taken into
consideration.
Communicating of Analytic Process and
Information
This complement of participants provides the
base of information about how things are
done to
engage the foundational discovery work needed
at the start of designing the experiment, such
as process flowcharting, value stream mapping
and policy/operating practice identification. At
the same time, the BI/Analytics consultant can
teach participants about the work being done
and
its meaning.
The real payoff of involving this larger
group threefold:
● An outcome will be defined in advance in
terms the stakeholders understand(negotiating

with key stakeholders and managing expectations)
● Policies and practices, whether they are
good, absent or lacking in performance, will
become transparent and can be appropriately
addressed
● The group will have a greater level of
understanding and analytics sophistication
An additional benefit of this process is the
advisory role one can develop with the team
over the
time of the working relationship. The
transparency of the process called for the
assistance of
analytics in developing solutions.
This process leverages EI competencies,
leadership styles and robustly leverages power
bases. It is also well known as part of
the Total Quality Management process, lean
processes
and similar implementations used over the last
20 years.
Proving Value
ROI
“Because everyone else is'' is, of course, not
a reasonable statement for winning approval.
The
question regularly asked is how does one
show ROI? Consider, first, that ROI means
many

things. Straight dollar costs or revenues, care
quality and process improvement cover the
major functional concerns.
Regarding costs, consider the following:
● First, look at performance against known
benchmarks. Organizations normally track a
number. Tracking against benchmarks is fraught
with disagreement as to
appropriateness and applicability, often depending
on who is speaking and how the
benchmark makes their area appear. Remember
that with cost being the predominant
indicator of performance, defending a position
often revolves around how “thethings
driving cost in our business look nothing
like the others in the benchmark cohort.”
And it
is best not to spend a great deal of time
arguing about this. The benchmark is not an
absolute, it is a relative position with all
other things being equal. Benchmarks provide
needed directional information( i.e., is the
organization on the right highway?).
For example, let’s look at the biggest
organizational expense, labor. Suppose one finds
labor cost related to revenues to be in
excess of benchmarks determined by a cohort
of
best-practice organizations, or even the
benchmark overall, by upwards of 10%. Are
there differences in a host of operating
conditions?

Yes, maybe. Do they account for a
difference of 10%? One may be a different
road
altogether. More importantly, one has a
tremendous opportunity for return even with a
few points improvement, as the dollar amounts
are so large. Careful simultaneous use
of analytics across all three types discussed(
descriptive, predictive & prescriptive) will
unlock this potential.
Similarly, related to supply expense, best-practice
organizations run these costs in the
very low 20% range. Calculate what these
mean for your organization in excess dollars
spent.
Quality and return
The relationship between clinical quality and
return is becoming obvious when one
considers the cost savings of fewer re-
hospitalizations, lower numbers of MRSA cases
and earlier detection of high blood pressure,
for example. These are not necessary soft
costs. The challenge will be for the
BI/Analytics consultant to set up straw-man
experiments using predictive models that look

at the possibilities in advance and obtain
agreement on the range of outcomes. Then
compare these to a cost table. Again, likely
the 3-year return will show clearly.
The question is, how does one monetize
some aspects of performance that need to be
considered, such as clinician coverage or
process redesign? Again, careful
experimentation is called for. As part of the
experiment, one will first need to flowchart,
measure the value and stream map the
processes involved, looking carefully at the
time
needed for performing tasks(resource consumption),
timing of tasks and the time
wasted between tasks. This gives a
comparison baseline to see if any clinical
changes(
such as length of stay), result from
processes of coverage change. And what
changes
are likely to be related to improvements in
healthcare user condition?
Working with clinical informaticists can lead
to much richer experimentation and
analysis, such as investigation of particular
clinical factors, interventions, processes,
outcomes, etc. related to operational aspects(
such as unit coverage, timing of shifts,
availability of supplies,etc.,).
If there are no clinical informaticists in your
organization to work with you will have to
develop some organizational capacity that

incorporates the thinking of this discipline into
your analytics work. Unfortunately, the path
for doing this is beyond the scope of this
course.
Measuring Performance Gains
If significance was found in fewer SL 1P
cases after opening the urgent care center,
one
adjusts processes to ensure more SL 1P
cases go to the urgent care center(which
could
be monetized and studied and might lead to
staffing the ED differently). The new ED
staffing might be focused on fewer RNs but
may require RNs with greater experience
and competency to handle the now higher
severity mix. The cost for RN labor could
be
measured, as it should be. And since one
performed value stream mapping prior to
making changes, it could be conducted again
to measure performance gains in task
time(cost). All of these would be looked at
in relation to ED practice information that is
available on throughout and outcome
improvements.
The key here is engaging advance planning
of experiments to include process and value
stream mapping, with input from staff,
conducting the experiment and analyzing
significance. Improvements of significance-those
that can be scaled up-can be taken to

the bank. Use of all analytic types ensures
that one’s experiment covers all the
questions discussed.
Conclusion

Reflection Part 6 CSBI Course 6 Rel.docx

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