Scaling Up and Rolling Out Change


Kaiser Permanent (KP) is the largest integrated healthcare system in United States, the facts as of 2014 are over 10 million members, 177,000 employees and with annual reporting revenue of $56.4 billion.

doctors

KP undertook few years ago a scaling journey to develop and implement electronic health record systems with the goal to make life better for patients and employees.

KP suffered a string of failed attempts to develop. The turning point came when its leaders realised that to scale up the record systems to all KP hospitals  needed to do things very differently.

Before the scaling effort, KP had endured a decade of failed efforts to implement electronic health records.

Between 2004 and 2010, KP scaled up KP HeatlhConnect. The scale up journey started by first being implemented in one of the smallest regions, Hawaii between 2004 and 2006, then rolled out the largest region, Southern California in 2008 and it deployed to LIVE in every region by 2010.

The leader of this initiative was Dr. Louise Liang and their team took a different approach to make this a success. They understood that the biggest obstacles to spreading the mindset across KP and rolling out the system was that hospitals operated under a paradigm of siloed regions with a weak relationship to shred functions. To succeed, KP required a lot more collaboration among regions.

However, understanding the history and culture of the local autonomy, the delivery team couldn’t insist that the exact same system be implemented in the exact way in each region, the team had to balance 3 constraints: commitment, creativity and customisation.

KP HealthConnect required local leaders to learn from and imitate other regions; Hawaii’s early success created challenges because, in the past, large regions like Southern California dictate and set the tone for changes across the entire organisation.

Starting in Hawaii was a great option, they were hungry for change, serve a smaller patience and medical audience and took less time; when the rollout was complete, initial fears and resistance vanished, and local doctors, nurses and patients reported that the system was making their lives easier.

Another reason why Hawaii succeeded was that in contrast to many other KP failures in the past, they didn’t implemented alone. The delivery team along with leaders from all other regions travelled to Hawaii to observe and help out, providing lessons and hands-on experience that guided and accelerated the roll out process.

The delivery team master a balance between standardisation and customisation, by specifying few critical constrains “non negotiables” for each region, this helped to ensure that each roll out was efficient, regions could learn from each other experience and users could learn faster to use a common system.

The non-negotaibles:

  1. the name: KP HealthConnect this reinforced the “one” solution mantra across all regions
  2. interoperability: no modifications could be made to the system that reduced the KP’s ability to maintain a single and integrated system, any software developed as a result of a customisation by a region, hospital or function had to work well with the rest of the system
  3. common data mode:  every local system had to use uniform data and definitions. This enable each region to generate consistent and comparable data so performance differences could be identified, problems spotted, improvements made and comprehensible reports generated.
  4. configuration no customisation: when Dr. Liang took charge, more than 300 contractor were working on customisations, this increased risk and maintenance costs. The delivery team understanding the need to provide fit to purpose solutions, allowed regions to select their own configuration, but they say no to programs that were built or designed differently from the system.

The operational model was also different, for instance when a new region went LIVE, teams from other regions that had already completed the implementation and deployment were “on loan” ready to support, guide and learn.

The learning in this case is:

Risk goes down and efficiency goes up when leaders and team complete a template that they can see and touch. It’s easier, faster and cheaper to imitate solutions that work elsewhere rather than to invent something from scratch every time.

Read more: Hayagreeva Rao and Robert I. Sutton. “Scaling up Excellence“. Random House Business.

What is Digital Disruption and How Companies can Embrace it?


Today the only source of competitive advantage and value delivering comes from seeing what customers need and delivering it.

Digital disruptors are changing complete industries, delivering value at a lower costs, with faster development times and with greater impact on customer experience.

Digital disruption

Digital disruption is simply a mindset that leads to a way of behaving; a mindset that bypasses traditional off-line obstacles, eliminating the gaps and boundaries that prevent people and companies from giving customers what they need in the moment that they want it.

Digital disruptors are obsessed with measuring results and rapid innovation cycles in which failure and mistakes are viewed as feedback.

Always evaluate your customer, benefits, business and product

  1. Customer: isolate the core target customers and make some smart guesses about what makes them tick. Ask yourself what your target customer really needs
  2. Benefits: what is the next thing that customer needs?, express the need in terms of what the customer will get out of the deal if you succeed.
  3. Business: what will we get out of it if we innovate?
  4. Product: the art of harmonising Customer, Benefits, Business and Product into a single approach

In other words, you need to focus on creating innovations that are most likely to give the consumers you want to reach the benefits they really desire while achieving strategic outcomes that are meaningful to the organisation.

How to deal with digital disruption inside a large company?

  • Create small innovation teams
  • Identify silos and break down the boundaries between them
  • Get senior executives to commit their support
  • Insist on short development time frames

Digital disruptors constantly seek for the adjacent possible:

  • Asking a simple question “what is the next thing my customer needs?
  • Iterating so quickly from one adjacent to the next
  • Giving the customer the next logical thing, or things

Digital disruptors keep the scope of their innovations small. Rather than creating a five-year innovation plan, digital disruptors proceed from adjacent possibility to adjacent possibility, occasionally failing, but failing so quickly and so cheaply that recovery can be nearly immediate.

Read more: James McQuivey. “Digital Disruption: Unleashing the Next Wave of Innovation“. Amazon Publishing.

Program Management Governance in Few Words


The first thing the program must do is establish program governance by planning how it will monitor and control the constituent projects.

Program Governance

Effective governance ensures strategic alignment, the realisation of promised service and benefits, stakeholders are communicated with and kept aware of progress and issues; appropriate tools and processes are used in the program; decisions are made rationally and with justification; and the responsibilities and accountabilities are clearly defined and applied. All of this is done within the policies and standards of the partner organisations and is measured to ensure compliance. Program Governance is intended to provide:

  1. A framework for efficient and effective decision-making
  2. Consistent delivery management with a focus on achieving program goals
  3. An appropriate mechanism to address risks and stakeholder requirements

Governance is about structured decision-making on investments in projects as has been summarised as the four areas:

  1. Are we doing the right projects?
  2. Are we doing them the right way?
  3. Are we getting them done well?
  4. Are we getting the benefits?

What criteria to use to select the right programs?

There are 5 selection criteria for organisations to evaluate what programs to start, being the strategic fit and benefits analysis the most important ones.

  1. Strategic fit: how well the program fits with the business strategy of the organisation
  2. Benefits analysis: what the benefits to the business are and how they will be achieved
  3. Budget: the preliminary budget estimate for the program
  4. Resources: the human and other resources required for the program and their availability
  5. Risks: analysis of the potential risks to the program

What are the Responsibilities of a Program Manager?


We know that programs are longer-term collections of related projects and other activities that will be managed in a coordinated way.

Program manegement

A Program manager goal is not about managing the details of each individual project, but rather about managing the big picture, in order to achieve the strategic objectives and realise the benefits for which the program is designed.

What are the Program Manager tasks:

Program Manager is responsible for leading and managing the program from its initial set up, through the delivery of new capabilities and realisation of benefits to program closure. The program manager has primary responsibility for successful delivery of the new capabilities and establishing program governance.

  1. Managing the inter-dependencies between the individual projects in the program
  2. Prioritising issues that arise from different projects
  3. Making sure the strategic goals and objectives of the organisation for which the projects are being executed
  4. Realisation of benefits from the program
  5. Management of stakeholders
  6. Management of program risks
  7. Oversee the projects in the program and provide high level guidance to the project managers

Management Skills of a Program Manager:

  1. Change: not only expect change but actively encourage it in order to maximise the strategic benefits of the program
  2. Leadership Style: focus on managing relationships, conflict resolution and the political aspects of stakeholder management
  3. Management skills: need to provide overall vision and leadership
  4. People Management: manage the project managers
  5. Planning: responsible for performing high level planning and providing guidance to project managers for their detailed project planning
  6. Success: measured in terms of return on investment (ROI), benefit realisation and new operational capabilities delivered by the program

How Leaders Create Conditions for Change


Leaders can not dictate the culture, but they can nurture it. they can create the right conditions for change, creativity and innovation. Leader can multiply the effect of a team. Liz Wiseman interviewed more than 150 leaders to research her book Multipliers: How the best leaders make everyone smarter.

Leading a team

Leaders who are multipliers can double the output of a team or a company and improve morale in the process, here is how you can become a multiplier:

  1. be a talent magnet, who attracts and retains the best people and help them to reach their highest potential
  2. find a worthy challenge or mission that motivate people to stretch their thinking
  3. encourage debate that allows different views to be expressed and considered
  4. give team members ownership of results

Basic group dynamics

  • great groups believe they are on a mission beyond mere financial success, they believe they will make the world a better place
  • they are more optimistic than realistic
  • they ship
  • belonging to a strong creative group can be one of the most rewarding aspects of working life

In Agile, How to Handle New Client Requirements?


When your customer discovers what they really want in their project, ask them how they would like to handle it. You can push out the release date or add more resources (which is like saying we are going to need more money), or you can drop some of the less important stories from the to-do list (preferred).

Managing change requests

Don’t get emotional when you have this conversation. It is not your call to make. You are simply communicating.

Your responsibility is to:

  1. make them aware of the impact of their decisions and
  2. give them the information they need to make an informed decision.

If your client really wants it all, create a nice-to-have list and tell them that if there is time at the end of the project, these are the first stories you will do.

But make it clear, the nice-to-haves are currently off the table and are not going to be part of the core plan.

Change Management and Communication


Communication problems are regularly cited as a main issue for delays in change, misunderstanding, lack of coordination, etc. However basic information about the change program is relatively easy to provide.

Those involved in change usually have many questions and concerns, but they also have very good ideas about how to make the change work. Communication should be an ongoing two-way process. This process is about understanding issues and needs. Effective communication ensures that those leading and executing the change are aware of issues, questions and concerns, and that their answers are provided on time, with consistency and in the right context.

  1. Is clear, timely and complete information available to the key audience involved and affected by the change?
  2. Do this audience have access to information and also can provide timely input and feedback?

5 tactics to follow to improve communication in change programs

  1. Develop a clear summary document – to read more on this see change management with clarity
  2. Emphasise listening through formal and informal surveys, meetings, discussions, forums
  3. Continually update and revise the resources (e.g. FAQs, summary document, guides, blog)
  4. Create a system to capture feedback (e.g. a wiki)
  5. Deploy social media to maintain and keep an updated flow on information

Change Management with Leadership


Employees who are involved in change but not leading it often complaint that they have to change and promote change while leaders continue behaving in the old way.

From some initiatives, new leadership may be needed to ensure success. Examples of new behaviours include promoting cross functional cooperation, focusing on customer experience,  digital transformation. etc.

The change initiative will achieve success if an executive sponsor is both committed and involved. The leader will help with prioritisation, protect the program from conflicting initiatives or corporate politics, guide on problem solving by removing any problems that could impede the success of the program and finally with the promotion of the change initiative, championing the benefits.

  1. Are leaders at al levels of the organisation involved and committed to the change?
  2. do leaders follow-up on issues, provide guidance and manage the process?

Support from leaders is important during change initiatives

  1. Ensure the executive sponsor is accessible and consistently driving the change
  2. Engage leaders on planing and executing
  3. Implement activities to maintain leaders engaged, e.g. weekly conference calls, newsletters, blogs, twitter, forums, etc.
  4. Address concerns and questions leaders may have about their responsibilities during and after the change
  5. Use key influencers to spread the message and motive the teams across the organisation – consider snowball sampling to tapping the power of hidden influencers

Change Management with Alignement


Alignment is about ensuring that business systems and processes collaborate to move the change ahead. To successfully execute change, it may be necessary to modify rewards, controls, communication, training, IT applications, sales, etc.

For example, a re-organisation of the sales force may involve the implementation and training on a new Customer Relationship Management (CRM) system, changes in rewards and incentives, accounting processes, major changes in one location, division or account. There will lots of questions about these changes and a plan must be in place to address all these issues.

  1. Do systems and processes support the change?
  2. Have required changes to these systems been identified, developed and deployed?

How to align business and change

  1. Assess key process to ensure and support the change
  2. Add training and developed programs as required
  3. Review communications processes to be consistent and support changes
  4. Share information about the changes across the organisation and not just the areas affected, customers should also be aware of what is happening
  5. Continually seek input from stakeholders on systems and processes that may be impeding change and that require adjustment to ensure better alignment with the new objectives and direction

Change Management and Resources


Many change efforts fail because the required resources are not in place. Significant time is needed to put change into effect. For example, new organisation structures may need to be developed; training is required;  people need to be selected to take on new leadership roles; new tools and software need to be deployed, etc.

Managing change is a complex process that involves analysis, planning, communication and execution. Managers need to recognise that some projects may need to be deferred if the change is to move forward.

  1. Are required resources (financial, people, technical) in place and available?
  2. Is an effective team in place and ready to guide the change process and motivate employees?
  3. Acknowledge the additional workload created by change efforts, if required engage additional resources (e.g. outsourcing)
  4. Facilitate adjustment of priorities (day-to-day operation vs. change), provide guidance to employees to address the issues
  5. Identify and acquire required skills and resources
  6. Make appropriate budget provision to ensure resources can be sustained
  7. Communicate these costs as a continuous process in the change management