Describe what you learned from the Course Describe how you may apply the information in your current or future career. Reflectionpart6.pdf

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

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