Speaker 1: Organizational Culture and Change Management Basics After completing this module, participants will be able to define change management, describe organizational culture, and recognize how organizational culture impacts change management. Change management is a broad discipline, but let's narrow it down by starting with a practical definition of what it encompasses. Change management is a structured approach to transitioning individuals, teams, and organizations from a current state to a desired future state. It is an organizational process to empower employees to help design and embrace changes in their current environment. In the QI Basics Introduction to Quality Improvement module, we defined quality improvement as bridging the gap between what we know and what we do. Here, we'll take that a step further. As it relates to change management, quality improvement is the path through change, adapting to new ways of looking at and accomplishing work. Organizational culture is defined as the values and behaviors that contribute to an organization's unique social and psychological environment. In other words, organizational culture is how we do our work and behave and interact with each other. An organization's culture reflects the shared values, patterns of belief, and expectations that guide the behaviors of the individuals that make up the organization. For example, some organizations get things done by using face-to-face communication, more in-person meetings as part of their cultural preference, and in other organizations, electronic communication is the cultural norm. Large organizations have an overarching culture and are made up of many cultures in each facility or department, and even further differences among those. Think day shift compared to night shift, for example. The ability to manage change, and therefore improve quality, is dependent on organizational culture. In this way, change and culture are related, but unique concepts. Keep in mind that change brings both anticipation and nervousness, along with new opportunities. Process, policy, and procedural changes need to be assimilated at several levels where individuals are impacted and asked to alter what may be routine and standard for them. As organization development expert Peter Drucker so succinctly put it, culture eats strategy for breakfast. The idea here is that despite the best laid plans and strategies to make change happen, the culture of our environment will dominate. If your culture is very resistant to change, quality improvement efforts will likely be harder to implement. A culture or environment that is open and welcoming to change is a key ingredient for successful quality improvement initiatives, as processes will be modified and individuals will be required to work in different ways. In assessing your organization's readiness for change, think about how your policies, systems, and environment define your culture and adaptability to change. A few things to keep in mind regarding the process of change. Staff involvement and ongoing communication and feedback loops are essential to supporting change. Sometimes, the only way to change culture is to change key people. Individuals in leadership positions need to be on board, otherwise the old ways of doing things will reassert themselves. New approaches sink in after success has been proven. People need to see results. Finally, know that culture change comes last. Most alterations in norms and shared values come at the end of the transformation process. William Bridges, the author of Managing Transitions, provides a simple insight that is key to understanding the challenge of creating, adapting to, and making change successful within our organizations. There can be any number of changes, but unless there are transitions, nothing will be different when the dust settles. Change is a process and a means to get from where we are, our current state, to the desired or future state. The path to achieving the desired change is made up of steps necessary to get there or, as Bridges describes, the transitions. When we implement quality improvement, we need to focus on the process of getting to the desired goal or future state, and change management is a collection of tools that help us navigate that transition process. Factors in change management that can help us achieve our desired goals, or pillars that hold up the bridges of transitions, include leadership commitment. The leadership role is key and there must be commitment for the long haul. A shared focus on goals and understanding of the why behind change efforts. Being attentive to both the technical and personal aspects of change. There are the mechanics of change that we need to make change happen, but always keep the person or individual as a primary variable in the change equation. And recognizing how each person adapts to change and working to make that happen, including for yourself. Again, keep the people aspect of change at the forefront. For example, individuals need information to help them understand and navigate their own way through change. Each person will deal with and adapt to change differently. While quality improvement is a discipline that demands change, it's important to validate that resistance and apprehension to change is a normal human phenomenon, and something that we need to recognize when promoting change. We are creatures of habit and change can make us feel out of control, uncertain, and fearful of losing command over our work and processes. John Kenneth Galbraith, a Canadian-born economist, public official, and diplomat who wrote bestsellers on economics from the 1950s through the 2000s, poignantly said, Faced with the choice between changing one's mind and proving that there is no need to do so, almost everybody gets busy on the proof. The idea, of course, is that we default to the status quo and are generally resistant to change. Let's take another view of our ability to adapt to change. Here are five categories that fit under the distribution model included in Everett Rogers' Diffusion of Innovations book. Think about where you might fit in, and do you feel that you will always fall into the same category, or does that shift depending on what type of change you are contemplating or confronted with? Within the distribution, innovators or enthusiasts are on the cutting edge of change, but account for only 2.5% of change adopters. Early adopters, or visionaries, follow the innovators in adoption, making up 13.5% of the bell curve. Pragmatists and conservatives, referred to by Rogers as the early and late majority, account for 34% each, and together make up roughly two-thirds of the change adopters. Finally, skeptics, referred to by Rogers as laggards, make up the final 16% of the distribution. Depending on how you self-identify, the terms and descriptions of each category may suggest certain value judgments. It's important to note that none of these categories are inherently good or bad. Innovators may bring forward new and exciting approaches to improvement, or must have their enthusiasm tampered to a pace of change that works for the organization. Skeptics may have important questions and be wary of change for the sake of change, or they may need extra support in getting on board with an initiative. We encourage you to think about what value each group can bring to the table when considering a change effort, and in future modules we'll talk about ways to strategize involving folks across the continuum. As you reflect on this model, think about where you might categorize yourself, where your quality improvement team members fit, and your organization as a whole. While the category you, your quality improvement team, and your organization fit in is not definitive, it does help paint the landscape and understand readiness and enthusiasm for undertaking quality improvement projects that will lead to change, and how the changes we desire to implement from our quality improvement work will be accepted and viewed by your team and your organization. This distribution model helps us once again think about the ocean we swim in, or what is the culture of our organization when it comes to adapting to change. In summary, effective change management, a structured approach to transitioning individuals, teams, and organizations from a current state to a desired future state, is directly affected by organizational culture, the shared values, patterns of belief, and expectations that guide the behaviors of individuals in an organization. Remember, culture eats strategy for breakfast. If the culture isn't ready for and doesn't support change, even the best-laid change management plans will fail. And organizations will have better change management outcomes if they assess readiness, demonstrate leadership commitment, have a shared understanding of why, and recognize individual approaches to change.

Speaker 2: Stratis Health is a nonprofit organization that leads collaboration and innovation in healthcare quality and safety and serves as a trusted expert in facilitating improvement for people and communities.