From the Sponsor’s Desk: Missed Opportunities

Change is all around us, from those minor adjustments in our daily lives to world-shaping events. Excepting the whims of Mother Nature, in each change, someone is usually the catalyst, the driver.

If the change affects us directly, we can only hope that whoever the catalyst is, they have the greater good in mind. Unfortunately, that’s usually not the case. Most business decisions are made with the shareowners in mind. But one would expect not-for-profit organizations to take a somewhat more holistic view.

In this case, a not-for-profit organization, in response to competitive pressures, overlooked their primary reason for being in their rush to change. That oversight cost their clients, their staff and the community they served and threatened the very existence of the organization.

Related Article: Implementing Change – A 7-Phase Methodology

Thanks to L.D. for the details on this case.

The Situation

This not-for-profit home health care organization was facing a severe challenge. It provided nursing care, personal support workers, therapists and other health care providers for people in their homes, communities, and workplaces. A number of large for-profit companies had entered the market and were offering those same services for less, putting pressure on the organization’s long-term viability. Their response to the challenge was one of missed opportunities.

The senior management considered a number of options for reducing costs and increasing their competitiveness. The organization had a long history of quality service enabled by highly motivated and well-trained staff and fully supported by a forward-looking management group. Unfortunately, all of the options considered highlighted the need to reduce expenses. That translated into management cuts. The cuts would make their services more cost-competitive but reduce their future capability. It was a short term versus long term choice.

The senior management chose the alternative they believed offered the least long-term downside – implementation of self-managed teams. That would allow the elimination of the four district managers, the palliative care and mental health managers, and the best practice manager through the transfer of that work to local teams. All nursing care teams would report to the remaining senior service delivery manager.

The Goal

The goal for the organization was to implement self-managed teams throughout the organization to eliminate seven management positions. Accountability for staffing, nursing communications and training would reside with the senior service delivery manager. All other management duties would be transferred to the self-managed teams.

The Project

The Director of Operations announced the change to self-managed teams through a special newsletter to nursing care staff. The letter emphasized the benefits of self-managed teams, including increased job satisfaction, productivity, and quality of care. The staff was invited to one of three half-day self-managed team training sessions in the organization’s offices. Attendance was mandatory and unpaid.

The training sessions highlighted the rationale for the move, again emphasizing increased job satisfaction, productivity and quality of care, and the timeline and process for the implementation over the next month. The sessions covered the team structure – a team leader and two team members, responsibilities, the stages of team formation – forming, storming norming and performing and provided some tools to get the teams formed and up to speed. Teams would be geographically focused and be accountable for managing all clients in the assigned area, 24 hours a day, 365 days a year.

One of the key strategies for moving to the new organization was self-selection. Team members could approach the new team leaders (former district nurses and managers) to be on their teams. As well, team leaders could approach team members to join their groups. Some former managers and district nurses chose to leave or retire rather than fill a team leader role. Any gaps in the leader and member roles at the end of the matching process were filled by the senior service delivery manager. Team leaders were permanent, full-time employees on salary with benefits. The team members were part-time employees paid on an hourly basis, with no benefits.

During the month-long rollout, experience ranged from calm to chaos. A few teams formed quickly and began the process of exploring and shaping their new work world. A couple of teams formed and then disbanded due to unresolvable conflict. Most teams stuck closely to the former district nurse model where the district nurse called the shots and handed the team members their cases and times.

The Results

A few teams excelled. One, in particular, formed a very collaborative team culture with a team motto of “Duck, Bob, and Weave”. After the initial forming period, the team sent the following comments to the senior service delivery manager:

“It was an exciting and challenging transition. Our team was enthusiastic about SMT’S and went into it without any qualms. We did go through a major learning process and made many adjustments but found the process fascinating and rewarding. We learned and continue to learn from all our experiences and have been able to progress towards a fully functioning team.

Having one’s own clients and team definitely changes your outlook. It is more comfortable and rewarding and much better nursing practice to be involved with the same clients from beginning to end. Working as a team allows consistency and security for the clients which results in improved care.”

The team kept statistics by team member on number of clients, types of treatment, healing rates for wound care, complaints and compliments, hours worked, visits made, time per visit and the reasons for month to month variations (e.g. competitive pressures, training, vacation, case complexity, etc.). They reviewed their performance weekly and identified and captured improvement opportunities and best practices. They also produced a monthly report for themselves with a copy to the senior service delivery manager showing month by month progress, including the following charts:

The team registered three significant concerns: workload, unpaid time, and the need for continuing self-managed team support. The team found that:

• Providing full-time, round-the-clock coverage for their district with only the three team members was extremely challenging. Variability in service requests, the complexity of care, training for new procedures, vacation and sick time added to the stress.
• Unpaid time could account for up to 25% of their total time. They were paid by case, with a certain time established for each. Unapproved extra time on a case, travelling time, meetings with their team leader and manager, picking up supplies and calls to physicians and other healthcare professionals on behalf of their clients were not compensated.
• Additional support, tools, and training for self-managed team development was essential to maximize their performance potential. They wanted to share their findings with other teams and find out what was working and not working in those other teams. No training or support had been offered beyond the initial half-day session.

Unfortunately, other teams and staff weren’t nearly so positive. They viewed the change as something that was being done to them, without their input or involvement. There was significant resistance. Many of the former district nurses who had accepted team lead roles were overwhelmed with the additional leadership, planning, and coordination duties. Some simply continued to operate as district nurses and essentially ignored their supposed teammates. Others went on to other, less stressful jobs.

The organization’s management was generally not forthcoming with any solutions for the stress being experienced, the unpaid work or further self-managed team training. Turnover increased. Client service suffered. Recruiting became more difficult, with many new recruits departing after a few weeks because of the stress and lack of support. The sustainability of the organization is now in question.

How a Great Leader Could Have Changed the Result

1. Clearly articulate the burning platform

Management was not truthful about the challenges the organization was facing. It should have come clean and shared the burning platform, the competition from for-profits, with its staff. They needed to be involved in the search for solutions. The organization had talented, loyal, committed, long-serving staff. Unfortunately, they weren’t engaged to be part of the solution. A missed opportunity.

2. Present a compelling vision

The message from management focused on self-managed teams. Period. Instead, they could have focused on the need to improve competitiveness and productivity while sustaining and advancing their commitment to clients, community, and staff. They could have stressed the need for collaborative creativity, new work forms, structures and relationships to keep their organization performing at its peak. They didn’t. A missed opportunity.

3. Invest in the change

A change requires extra time, effort, and energy to be successful. It needs nourishment. It needs funding to realize a new way of performing. This organization’s management starting cutting as soon as the changes were announced. There was no transition support, no active measurement, and monitoring of progress being made, or not. There was no attempt to capture and disseminate the experiences of the teams, to share best practices. There were few additions or adjustments to address the concerns. A missed opportunity.

4. Leverage your strengths

The organization had a long-standing reputation for integrity and quality service to its clients. It had raised charitable donations for many years to fund its good works and had the ability to raise additional funds to support its mission, vision, and mandate going forward. Instead, senior management caved to the short-term pressure and focused solely on the expense side. A missed opportunity.

5. Measure

Management had very little information about how the change was progressing. They managed the financials, of course. They managed the number of full time and part time employees. They managed the number of clients and the services provided because that related directly to revenues. They tracked customer complaints. But, they didn’t know how the teams were functioning, how their staff was coping until it was too late. A missed opportunity.

6. Communicate

There was no overall communication plan for the change to self-managed teams, a major oversight. The communication that did happen was generally after the fact, one way, from managers to staff. One questionnaire was sent out after management realized the number of clients and levels of service were declining and turnover was increasing because of disintegrating teams. Unfortunately, there was limited remedial action taken. Very little was done on a team by team basis to solve individual challenges and share those remedies with other teams. A missed opportunity.

In his book The Wisdom of Crowds, James Surowiecki shows how large groups of people are almost invariably smarter than an elite few; “better at solving problems, fostering innovation, coming to wise decisions, even predicting the future”. Unfortunately, it seems no one on this organization’s management team read that book. Another missed opportunity.

So, if you find yourself in a similar situation, please put these points on your checklist of things to do in future endeavours so you too can be a Great Leader. And remember, use Project Pre-Check’s three building blocks covering the key stakeholder group, the decision management process and Decision Framework best practices right up front, so you don’t overlook these key success factors.

Finally, thanks to everyone who has willingly shared your experiences for presentation in this blog. Everyone benefits. First-time contributors get a copy of one of my books. Readers get insights they can apply to their own unique circumstances. So, if you have a project experience, good, bad and everything in between, send me the details, and we’ll chat. I’ll write it up and, when you’re happy with the results, Project Times will post it so others can learn from your insights. Thanks