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Change and Cultural Transformation How to Make it Happen

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Change and Cultural Transformation
How to Make it Happen
Date or subtitle
Wednesday May 25, 2011
В© Wipfli LLP
В© Wipfli LLP
1
Objectives
z
Identify
y the root causes of change
g resistance
z
Recognize how to engage and influence change in your organization
z
Recognize the best practices to enact and sustain change
В© Wipfli LLP
2
Agenda
z
0900 to 10:30
z
10:30 to 10:40 – Break
z
10:40 to 12:00
z
12:00 to 12:30 Lunch
z
12:30 to 1:45
z
1:45 to 1:55 – Break
z
1:55 to 3:00
В© Wipfli LLP
3
Why is Change Needed?
z Cost
of Healthcare
z Supply Versus Resource Demand
• Need
z Health
the Ability to Do More with Less
Care Reform
• Reduce
Cost of Care
• Improve Quality of Care
• Implementing New Models of Care
z Meaningful
Use
• Implement
an EHR
• Coordinate Care with Other Care Partners
• Redesign Business Processes
• Develop
p Standard Work
В© Wipfli LLP
4
Health Care Current State
Cost of Healthcare
z
z
z
z
U.S. projected to spend over $2.5 trillion on health care in 2009
or $8,160 per resident
Health care spending is 4.3 times the amount spent on national
defense
January 2010, Gallop Poll estimates that 16.3% of Americans
are uninsured
Health care expenditure is 17.3% of the GDP in 2009
Sources – http://www.nchc.org/facts/cost.shtml and
http://www.kff.org/insurance/upload/7692_02.pdf
В© Wipfli LLP
Healthcare Current State
Supply and Demand
z U.S.
U S nursing shortage
в€’Expected
to intensify as baby boomers age and need grows
в€’Mass exodus of nurses is expected from 2011 and continue until
2020 (Average
(A
nurse age iis now 46 iin 2009)
в€’March 2009 greater than 116,000 nursing positions unfilled in
US hospitals and 100,000 in nursing homes
в€’Estimate 260,000 unfilled positions by 2025
z Increasing
• Elderly
y
demand for care
population
p p
increase by
y 40% between 2010 and 2030
z Increased
documentation to meet regulatory
requirements and reporting
Source: http://www.amnhealthcare.com/News.aspx?id=15444
В© Wipfli LLP
2010 Health Care Reform
Increase Healthcare “Value”
1.
A
Accountable
C
Care
Organizations
O
s
B
Bundled
Paym
ments
R
Reduce
Hospital
Acquired Cond
A
ditions
R
Reduce
Preve
entable
Readmissions
R
s
2.
V
Value-Based
Purchasing
P
Tactics
Reduce Costs
Improve Quality
The Goal
Interdependency
3.
Prerequisite
Electronic Health Records
Source: HFMA, 2009
В© Wipfli LLP
Health Care Reform – Outcomes Sought
Operational Improvement Opportunities: Outcomes and Cost
Source: “How to Create Accountable Care Organization, First Edition,
September 7, 2009; 2009 Center for Healthcare Quality and Payment Reform
В© Wipfli LLP
New Care Delivery Models - Potential Impact
Community
Ra n ge of P a rt ici p a n t s
Integrated System
Post Acute
Bundled
Payments
ACO
H it l
Hospital
Specialists
Medical Home
Primary Care
Low
High
Potential for Cost Savings
ww
w.wi
В© Wipfli LLP pfli.
com
Health Reform Primary Care Medical Home
В© Wipfli LLP
What Needs to Happen
•
•
•
•
•
•
•
•
Implement and integrate EHRs
Analyze of service lines
lines………value
value stream thinking
Redesign care delivery and workflow to drive efficiency, enhance
quality and safety
Remove waste, rework and redundancy in work processes
Provide decision support tools at the point of care
Leverage business intelligence tools to understand data regarding
care outcomes and financial impact
Implement sustainable managed processes with defined
accountability
Be action oriented and agile: respond quickly given the knowledge
obtained via information analysis
В© Wipfli LLP
Key Learning Points
z
Change management is like herding cats ‐ people start where they are,
not where we want them to be ‐ they bring their history
history, preferences and
fears. It’s messy!
z
Knowing change management principles is a start,
start but it’s
it s from hands on
experience that you learn what to do when things don’t go as planned.
This is the difference between practitioners and novices.
z
Understanding staff perceptions, abilities, motivators and then helping
them connect the dots are key to moving forward effectively.
В© Wipfli LLP
12
Awareness of Habits
z
Are yyou a creature of habit?
z
Do the following………………
z
Why are we this way?
• Protective
• Helps
H l
z
us tto cope as adults
d lt
Neurobic Exercises Book – Keep Your Brain Alive by
Lawrence C
C. Katz PhD and Manning Rubin
Rubin, 2009 ISBN –
13:978-0-7611-1052-1
В© Wipfli LLP
13
“When one door closes another opens,
but sometimes it’s hell in the hallway.”
- unknown source
В© Wipfli LLP
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Change Can Be a Good Thing
В© Wipfli LLP
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Change Management Defined
z
z
z
z
z
Facilitates the human transition from current state to future state
Structured intentional process
Structured,
Deals directly with human factors
Focus on all initiative / project phases ‐ planning, implementation,
post change
post‐change
Delivers desired behavior change
Accelerate the speed at which people move through
the change process so that anticipated
benefits are achieved faster.
В© Wipfli LLP
16
Table Exercise
At your table, take 10 minutes to talk about your experiences with
change Document key points and prepare to share your findings with
change.
the larger group.
z
Discuss changes you have experienced that went well
well. What made
them successful?
z
Discuss changes you have experienced that did not go well
well. What
went wrong?
В© Wipfli LLP
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Organizational Self Assessment
zInitial
Diagnosis, where are you starting from?
zDimensions Typically Assessed:
Sponsorship
Leadership
Motivation
Direction
Measurement
Org.
g Context
Processes/
Functions
Benchmarking
g
Customer
Focus
R
Rewards
d
Org.
g
Structure
C
Communication
i ti
Change
Experience
Morale
Innovation
Decisionmaking
В© Wipfli LLP
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Organizational Self Assessment
Dimension Example:
Processes/Functions
• Major changes almost invariably require redesigning
business processes that cut across functions such as
admissions, nursing, lab, and accounts payable. If
functional executives are rigidly turf conscious, change will
be difficult.
• Give yourself more points the more willing they—and the
organization as a whole—are
whole are to change critical processes
and sacrifice perks or power for the good of the group.
В© Wipfli LLP
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Organizational Self Assessment
Dimension Example:
Measurements
z Three points if you already use performance measures
th t promote
that
t continuous
ti
improvement
i
t (nursing
(
i hours
h
per
patient day, LOS, etc.) and if these link to economics of the
organization
z Two points if some measures exist but compensation and
reward systems do not explicitly reinforce them
z If you don’t
don t have measures in place or don’t
don t know what
we’re talking about, one point.
*Measured on a scale of 1 to 3
В© Wipfli LLP
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E
N
C
EP
TA
N AC
C
ER
G
IN
PL
O
IN
G
EX
A
G
R
A
R
A
TI
O
B
B
MO
M
I
N
TIO
A
Z
ILI
N
A
Level off Observed Emotio
onal
Intensity
IMA Change Adaption
Accelerating Implementation Methodology (AIM) 2009: www.imaworldwide.com
www imaworldwide com
Implementation Mgmt Associates
В© Wipfli LLP
21
Satir Change Model
In many cases, initiatives are stopped or discontinued prematurely.
Initiatives that could otherwise succeed are viewed as failures
failures.
В© Wipfli LLP
Why Does Change Fail?
Many organizations do not realizing the anticipated return on
in estments and ne
investments
new initiati
initiatives
es
Kotter Common Errors:
• Allowing
too much complacency
• Failing to create a sufficiently powerful guiding coalition
• Underestimating the Power of vision
• Under communicating the vision by a factor of 10 or 100 or even 1000
• Permitting obstacles to block the new vision
• Failing to create short term wins
• Declaring
D l i victory
i
too soon
• Neglecting to anchor change firmly in the corporate culture
В© Wipfli LLP
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Change Resistance - Kotter
Point of View
Commonly Heard
1
It’s Not Important
“I don’t have time for this, I’ve got work to do.”
2
It Won’t Be Successful
“Are you kidding? The senior executives aren’t
backing this”
this
3
I Can’t Imagine Things
Differently
4
P
People
l Talk,
T lk But
B t Don’t
D ’t Do
D
“It’s a nice
“It’
i idea,
id
but
b t my manager won’t
’t allow
ll
me to
t
do things differently”
5
It’s Hard and it’s Too Much
Change
g
“No way we’re going to accomplish this.”
6
Our Processes and
Technology Won�t Change
7
g Ever Really
y Changes
g
Nothing
“We’ve always done things this way.”
“Our systems don’t work now. What makes you
think this is better?”
g back to the way
y we
“As soon as this is over,, we’ll go
used to do things.”
В© Wipfli LLP
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McCarthy & Eastman - Organizational Fabric Model
1.
Sponsorship
2.
Stakeholder Mgmt
3.
Training
4
4.
Vision
5.
Communications
6.
Reinforcement
В© Wipfli LLP
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McCarthy & Eastman - Organizational Fabric Model
z Six
main threads of focus
z Strategy
z Snags
must consider inter‐relationship of threads
in the fabric result from loose adherence to bigger
picture
z One-off
approaches negatively impact end goal(s)
В© Wipfli LLP
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Understanding Resistance
Root Causes of Resistance
DecidesВ /В choosesВ notВ toВ change
Not
willing
illi
Not agreed
N t iinvolved
Not
l d
Not supported
N t able
Not
bl
Not knowing
DoesВ notВ agreeВ thatВ theВ changeВ isВ rightВ forВ theВ Does
not agree that the change is right for the
organizationВ orВ self
AВ senseВ orВ feelingВ thatВ oneВ isВ outВ ofВ controlВ createsВ strongerВ tiesВ toВ theВ oldВ wayВ ofВ working
LeadersВ orВ peersВ makeВ itВ difficultВ toВ change;В fearВ ofВ takingВ risksВ othersВ areВ not;В culture doesВ notВ encourageВ change
DoesВ notВ haveВ theВ rightВ skills;В unableВ toВ seeВ thingsВ differentlyВ (TRAINING,В inВ part)
UnclearВ aboutВ whatВ theВ changeВ is,В whatВ itВ meansВ forВ themВ andВ whatВ theyВ shouldВ do
В© Wipfli LLP
Ability Versus Motivation
z Must
understand the skill versus motivation challenge
z Adhere to change management strategy
z Well‐intentioned approaches don’t necessarily move
people from point A to point B
z Training is often times not the complete solution
High
Does
R
ea
di
ne
ss
Won’t
Ability
(Skill)
Won’t
Can’t
Low
Low
High
Motivation
(Will)
В© Wipfli LLP
28
Environment / Context
z All
change happens in the context of an environment
z The
environment either supports and reinforces the
change, or the status quo
z For
sustainable results, be thoughtful and deliberate
about creating an environment that supports your
change
• What are all the factors that support or hinder?
“Don’t send a changed person back into an
unchanged environment”
environment
В© Wipfli LLP
29
Six Sources of Influence
Six sources of influence are
id tifi d within
identified
ithi th
the areas off
motivation and ability
Set in the context of
•Personal (Self)
•Social
Social (Team)
•Structural (Organization)
Source: Influencer: The Power to Change Anything, by Kerry Patterson, Joseph Grenny, David Maxfield and Ron McMillan (Sep 13, 2007)
В© Wipfli LLP
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Six Sources of Influence – ED Software Use
Ability
Motivation
Personal
(Self)
• Process Knowledge
g – Do I know how to triage
g ppatients
well enough that I will not miss something?
• Advisory Capability – Do I have the capability to guide
patients to access other good care alternatives?
• Alignment
g
to Hospital
p Vision – Do I reallyy want to turn
away patients who come to our ED for care?
• Employment/Pay - If we do not have enough patients to
care for will I be asked to take a low census day?
• Perceived Safety/Support – Isn’t it better to treat the
patients versus taking the risk of potentially being wrong
in triaging them? If something bad happens to the
patient, will I be held liable? Will the hospital back up my
decision if there is litigation?
Social
(Team)
• Performance - What competencies are required to
ensure staff accurately triage patients
• Trust – Are we comfortable with the triage assessment
made byy others?
• Collaboration - What are the tools and protocols for
effectively handling the decision process?
• Availability - How can we ensure a qualified team
member is always available in the triage area?
• Employment - Will we be asked to float to other units?
Will someone lose his or her position?
• Parochialism – Do loyalties to our hospital location/ED
department/team
p
or ppreconceived notions around qqualityy
or safety prevent acceptance of distributing work to
another care location.
• Patient Readiness – Will our own perceptions of how
patients will receive this prevent us from embracing it?
Structural
(Organization)
• Compliance – Will this conflict with regulations such as
EMTALA?
• Governance - What are the processes and who are the
persons responsible to oversee and implement this
initiative?
• Infrastructure - Do we have the right technical skills and
procedures to address triage requirements? Do we
have providers to meet the care needs in an ambulatory
setting in a timely manner?
• Performance Metrics - What measures are regarded as
most important by leadership? How does this initiative
relate to departmental and individual performance
evaluation?
• Rewards - How will this impact compensation for our
contracted ED physicians?
• Revenue - Will this allow the organization to attain a
greater number of inpatient admissions?
В© Wipfli LLP
31
Strategies for Change Resistance
Source
Strategies
Source 1 – Personal Motivation
Strategy: Consciously connect to values
Source 2 – Personal Ability
Strategy: Demand Deliberate Practice
Source 3 – Social Motivation
Strategy 1: Pave the Way.
Strategy 2: Enlist the power of those who motivate.
Strategy 3: Seek the support of those who enable.
Source 4 – Social Ability
Strategy
gy 1: Pave the Way.
y
Strategy 2: Enlist the power of those who motivate.
Strategy 3: Seek the support of those who enable.
Source 5 – Structural Motivation
Strategy 1: Link rewards third and in moderation.
Strategy 2: Link rewards to vital behaviors
behaviors.
Strategy 3: Use rewards that reward.
Source 6 – Structural Ability
Strategy 1: Use the power of space.
Strategy 2: Use the power of data and cues.
Strategy 3: Use the power of tools.
tools
В© Wipfli LLP
Establish a Foundation for Change
Process
Change
Management
People
Technology
В© Wipfli LLP
33
McCarthy & Eastman - Organizational Fabric Model
1.
Vision
2.
Communications
3.
Sponsorship
4
4.
Stakeholder Mgmt
5.
Training
6.
Reinforcement
В© Wipfli LLP
34
Vision
z Vision
• Start
with the end in mind - Covey
• Reach common agreement on the issues ‐ don’t jump to
solutions
• Build a picture for people to step into ‐ make it behavioral
• Be careful how you define success
• Agree on critical success factors and behaviors up front
• Simplify and clarify
В© Wipfli LLP
35
Communication
z Communication
• Communicate,
communicate, communicate!
• Be transparent, tell the truth
• Know
o you
your aud
audiences,
e ces, their
e frames
a es o
of reference
e e e ce a
and
d what’s
a s in it
for them (WIIFM)
• Clear, concise, consistent, compelling messages stick!
• Provide feed back loops
• Use multiple media
• Gather lessons learned for continuous improvement
В© Wipfli LLP
36
Communication Plan
z Things
to consider with plan development
• Audiences
• Timing
• Content
Co e
• Format
z Intent
of the communication
• Inform
• Influence
• Educate
z Keep
it simple
В© Wipfli LLP
37
Communication Plan Template
Message
Purpose
Vehicle
Audience
Subject
Matter
Content
Developer
Distribution
Due Date(s) /
Timeframe
p
Status Updates
Weekly Project
Status
To report weekly status Status
Report
Monthly Project
Status
To provide status &
information
Project Team
Project
Milestones
Manager
achieved, not
achieved,
changes to
project plan, plan
for next week,
open issues
Beginning of
each week
Power point Steering Team;
and e-mail Wipfli Executives
summary
Project status
and next steps
Project
Manager
Monthly on or
around the end
of each month
Executive Committee To provide status &
Update
information
E-mail
summary
Project status
and next steps
Project
Manager
Quarterly
Field Partner Update To provide relevant
project status
E-mail
summary
Field Partners
Project status,
next steps, and
relevant impact
Project
Manager
Following
completion of
key milestones
To provide relevant
project status
E-mail
summary;
newsletter
Appropriate Users Project status,
next steps, and
relevant impact
Project
Manager
As needed
To notify team of
important items
SharePoint
Site; e-mail
Project Team
Miscellaneous
Project Team As needed
To notify project team
of scheduling conflicts
E-Mail
Project Team
Out of office
schedule
Project Team As needed
Ad hoc
Communications to
Users
Executive Team
General
Communication
Project
Announcements
Holiday / Vacation
Calendar
В© Wipfli LLP
38
Sponsorship
The most critical success
factor in any change effort
В© Wipfli LLP
39
Effective Sponsorship
Sponsors communicate volumes through what they…
• Say
(Written/verbal)
Do
• Do
(Behavior)
• Value
(Reinforcement)
Say
Value
В© Wipfli LLP
40
Effective Sponsorship (cont.)
z Verbal
and Written Communication
• Least
impactful, most utilized
• Own the business case for change ‐ explain “why”
why and
“what”
• Be clear about non‐negotiable
• Make it personal ‐ incorporate own experiences / words
• Invite feedback‐ make it safe
• Share goals and expectations
В© Wipfli LLP
41
Effective Sponsorship (cont.)
z Behavior
• More
M
iimpactful
tf l th
thatt verbal/written,
b l/ itt
used
d lless
• Actions speak louder than words! Lead by example
• Visibly and consistently engage in the process
• Make the hard calls
• Allocate necessary resources
• Walk the talk
• Stay the course
“What
What you do speaks so loudly I can
can’tt hear what you’re
you re saying”
saying
В© Wipfli LLP
42
Effective Sponsorship (cont.)
z Reinforcement
• Most
M t
impactful,
i
tf l but
b t mostt underutilized
d tili d success ffactor!
t !
• Reinforcement = rewards and consequences
• Reward what you want to see
• Align incentives
• Use both tangible and intangible reinforcement
• Tailor rewards for g
greatest impact
p
‐ know y
your p
people!
p
Reward what y
you want to see
В© Wipfli LLP
43
Lessons Learned
z Sponsorship
• Develop
D
l
a clear
l
role
l map off organization
i ti tto d
define
fi sponsor cascade
d
– Positional authority does not necessarily reflect power / influence
• Ensure sponsors understand and can fulfill sponsor role
• Sponsors must focus the organization‐ prioritize, limit distractions
• Lack of agreement among multiple sponsors big stumbling block
• Define g
governance up
p front
• Real power in aligning all three‐ SAY, DO, VALUE
N t a passive
Not
i role
l ‐ “launch
“l
h and
d leave”
l
” is
i nott
sponsorship!
В© Wipfli LLP
44
Table Exercise
At your table, take 10 minutes to talk about your experiences with
sponsorship Document key points and be prepared to share your findings
sponsorship.
with the larger group.
z
When did a project go well because of strong sponsorship? What were
the elements of strong sponsorship?
z
When did a project go poorly due to weak sponsorship? What are the
risks of weak sponsorship?
В© Wipfli LLP
45
Building Commitment
Process
Change
Management
People
Technology
В© Wipfli LLP
46
Organizational Readiness Team
Training
Communication
Operations
Change
Management Plan
Workforce
Planning
Human
Resources
В© Wipfli LLP
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Stakeholder Analysis
Identify
Engage
Manage
В© Wipfli LLP
48
Key
y Learning
g Points
z
Get front line supervisors and middle managers
in ol ed earl
involved
early
z
If unionized, get unions at table as soon as possible
z
Resistance is normal and inevitable, embrace it and
understand its meaning throughout the life cycle of
the change
В© Wipfli LLP
49
Key Learning Points
z Ensure
the right people are at the table for effective
decision making
z Don
Don’tt
assume you know how others will react
• Fundamental
z Credibility
z Create
Attribution Error – will react like you think
is difficult to earn, even harder when it is lost
cross
cross‐functional
functional teams with ad hoc members
В© Wipfli LLP
50
Change Readiness
Process
Change
Management
People
Technology
В© Wipfli LLP
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Connect the Dots
Connecting the Dots to the Organization
Present
Case for
Change
Share
Goals and
Expectations
Define
Incentives and
Recognition
Connecting the Dots to the Team
Enlist Those
Who
Motivate
Support
Those Whose
Motivate
Pave
the
Way
Connecting the Dots to the Individual
Know
What
Motivates
Teach
Requisite
Skills
Allow
Practice of
New Skills
В© Wipfli LLP
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Forest and Trees
z Overview
of why change is
being implemented
z Future state vision
z How change fits into overall
strategy of organization
z Benefits and opportunities
z Anticipated returns on
investment
z Things that may be difficult
z Project
details, overview
z Implementation schedule
z Support model
z Sources for additional
information
z Readiness plan and logistics
z Sponsorship endorsement
z What will stay the same,
what will change
В© Wipfli LLP
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User Readiness
Ready
y for Change
g
Self/Individual
Practice
Skills
Personalized Content
Team
Workflows/Policies & Procedures
Roles and Responsibilities
Goals and Expectations
Organization
Vision
В© Wipfli LLP
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Change Management
z Effective
change strategies include life beyond the change
implementation
• Sustaining
procedures
• Standard work defined
z Focus
on developing critical thinkers, becoming change
experts
z Sustaining
g
p
procedures and reinforce end g
goal(s)
( )
В© Wipfli LLP
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Change Training / Support Risk Factors
z
Be careful not to reinforcing
g dependent
p
users
z
Blanket approach to skill gaps
z
Reactionary responses to demand
z
Overlooking front line leader role in team development
z
O b d i iinternal
Overburdening
t
l resources or early
l adopters
d t
as llocall
champions
z
Not leveraging informal leaders
z
Not establishing an appropriate learning context up front
В© Wipfli LLP
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Bottom Line - Summary
Can’t realize benefits when tools and technology are not
used
d appropriately
i t l
z Can’t monitor performance or progress if success measures
aren’t defined and tracked
z Can’t transform delivery of care if stuck at change
implementation
z Technology does not solve human inefficiencies or a poor
processes
z Active, effective sponsorship is critical
z Peer
P
t peer supportt is
to
i key
k
z
В© Wipfli LLP
57
Kotter - Organizational Change - Success
Kotter – Eight Characteristics of Effective Change Efforts
1
Establish A Sense Of
Urgency
Examining market and competitive realities;
Identifying and discussing crisises, potential crisis,
or major opportunities.
2
Build A Powerful
Guiding Coalition
Assembling a group with enough power to lead the
change effort. Encouraging the group to work
together as a team
team.
3
Create A Vision
Creating a vision to help direct the transformation
effort. Developing strategies for achieving that
vision
vision.
4
Communicate The
Vision
Using every vehicle possible to communicate the
new vision and strategies. Teaching new behaviors
by the example of the guiding coalition
coalition.
В© Wipfli LLP
Kotter - Organizational Change - Success
5
6
7
8
Empower Others To
A t on the
Act
th Vision
Vi i
Getting rid of obstacles to change. Changing
processes systems or structures that seriously
processes,
undermine the vision. Encouraging risk taking and
nontraditional ideas, activities, and actions.
Plan for and Create
Short Term Wins
Planning
g for visible p
performance improvements.
p
Creating those improvements. Recognizing and
rewarding employees involved in the improvements.
Consolidate
Improvements and
Produce Still More
Change
Using increased credibility to change systems,
structures, process, and policies that don’t fit the vision.
Hiring, promoting, and developing employees who can
implement the vision. Reinvigorating the process with
new projects, themes, and change agents
Institutionalize New
Approaches
Articulating the connections between the new
behaviors and corporate success. Developing the
means to ensure leadership development and
succession
В© Wipfli LLP
The Handwriting on the Wall
z
Change Happens: They Keep Moving the Cheese
z
Anticipate Change: Get Ready for the Cheese to Move
z
Monitor Change: Smell the Cheese Often So You Know When It is
Getting Old
z
Adapt to Change Quickly: The Quicker You Let Go of Old Cheese,
The Sooner You Can Enjoy the New Cheese
z
Change: Move with the Cheese
z
E j Ch
Enjoy
Change: Savor
S
the Adventure and the Taste off New Cheese
C
z
Be Ready to Quickly Change Again & Again : They Keep
Moving the Cheese
Excerpted from Who Moved My Cheese? В© 1998 Spencer Johnson, M.D.
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The Journey
Process
Change
Management
People
Technology
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Go alone to go fast,
Go together to go farther.
- African proverb
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Change Management Resources
z
z
z
z
z
z
z
Change Anything, Kerry Patterson, Joseph Grenny, David Maxfield,
Ron McMillan and Al S
Switzler,
it ler 2011
2011, VitalSmarts
VitalSmarts, LLC
Change Management Strategies for an Effective EMR
Implementation, Claire McCarthy, MA and Doug Eastman, PhD,
HIMSS 2010
HIMSS,
Neurobic Exercises Book – Keep Your Brain Alive by Lawrence C.
Katz PhD and Manning Rubin, 2009 ISBN – 13:978-0-7611-1052-1
Influencer The Power to Change Anything
Influencer,
Anything, Kerry Patterson,
Patterson
Joseph Grenny, David Maxfield, Ron McMillan and Al Switzler,
2007, VitalSmarts, LLC
Harvard Business Review on Change
Change, 1998
Who Moved My Cheese? Spencer Johnson, M.D. 1998
Leading Change, John P. Kotter, Harvard Business School Press,
1996
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Questions
?
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Contact Information
Janice Ahlstrom,, CPHIMS,, FHIMSS,, RN,, BSN
Partner, Health Care
Wipfli LLP
414 431 9352
414.431.9352
jahlstrom@wipfli.com
Jeff
ff Wulff
Sr. Manager, PPT Consulting Practice
Wipfli
p LLP
Phone: 608-270-2938
jwulf@wipfli.com
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