Luna Community College Massachusetts Healthcare Case Study Forum Q&A Discussion First Question: I would like for you all to discuss the case study on pag

Luna Community College Massachusetts Healthcare Case Study Forum Q&A Discussion First Question:

I would like for you all to discuss the case study on page 449 of your text. First, read the case study and answer questions 1 through 3 (and all the bulleted points) in the exercise. Please upload either a typed record of your responses or take a picture of your work and add it to the forum’s first question. For the first part of this discussion forum, please post replies to the following questions that are part of the exercise:

https://www.youtube.com/watch?v=bdraHSu08YY (Links to an external site.) (Links to an external site.)

https://www.youtube.com/watch?v=1zDLxr5UvH8 (Links to an external site.) (Links to an external site.)

How did Zane gain skills as a leader of change? To this, address the following, what skills was she missing and what skills did she have that you would like to have/exercise? Explain your response.

Question 2:

I hope you enjoyed the Ellen Zane video on negotiating.

Please post your thoughts to the bulleted items that were part of question 2 on Toolkit Exercise 8.1. In addition to posting your replies, what about Zane’s experience made an impression on you and explain why. The impression can be either positive or negative. Discuss at least one thing you took away from the video and your responses. END-OF-CHAPTER EXERCISES
TOOLKIT EXERCISE 8.1
Critical Thinking Questions
Please find the URLs for the videos listed below on the website at study.sagepub.
com/cawsey3e. Consider the questions that follow.
1. Please read Case 5 on page 449, “Ellen Zane-Leading Change at Tufts/NEMC”
and con- sider the following questions:
.Describe the health care environment in Massachusetts in the 1990s. What were
the driv- ing forces for change that were pushing the industry? What impact did these
forces have on Tufts/New England Medical Center?
What happens within Tufts/NEMC as the external environment gyrates with
change? What data in the case supports your claim?
What’s wrong with Tufts/NEMC as Zane takes over as CEO in January 2004?
How did Zane gain skills as a leader of change?
Which type of change would you prefer to lead? Why?
2. Ellen Zane on Negotiating-11: 13 minutes
What kind of power did Zane have when she was negotiating with insurers?
What did Zane do to prepare for this emergency?
How did Zane facilitate a solution?
3. Gene Deszca’s Talk: Leading Change-14: 59 minutes
Evaluate yourself on the core competencies mentioned in the video.
What do you think that you need to do to improve on your skills or create a
situation where you can be a successful change agent?
Chapter 8 – Becoming a Master Change Agent
Introduction
The focus of this chapter addresses what makes a change agent a GOOD change agent leader (change
leaders are people that get others to change by conveying to them an effective change vision and a
strategy to close the gap between where the organization is and where the organization needs to be).
What are the essential characteristics and behavioral practices that distinguish a good change agent
leader from a not-so-good change agent? Change teams are also examined in this chapter.
We are at the last stage of mobilization in The Change Path Model
People in organizations often question whether and what role they might take on relative to
organizational change. They question whether, given their current position in an organization, they can
initiate or play any part in change initiatives. These questions are important at the individual level and
should be addressed by looking perhaps at an individual’s social-psychological as well as organizational
maturity but contemporary formal organizations are looking for change agents, looking for people (at
senior and subordinate organizational levels) to take on “the roles of change agency: initiator,
implementer, facilitator, and/or task for team member. Leaders in organizations are asking people to
step forward and make a difference” (Cawsey, Deszca, and Ingols, 2016, p. 257).
Chapter 8 Notes – 1
The people who need to step forward may be leading change alone but it is also desirable for change
agents to come together in teams to lead change. Regardless of a “lone-wolf” or team approach, we
need to develop a greater understanding of how to be a great change agent.
Factors That Influence Change Agent Success
The Interplay of Personal Attributes, Situation, and Vision
Our authors take the position that change agent effectiveness is “a function of the person, his or her
vision, and the characteristics of the situation” (Cawsey, Deszca, and Ingols, 2016, p. 285).
What does this actually mean?
I think a clue to this question is found in the statement that “it was the person and it was more than the
person” (Cawsey, Deszca, and Ingols, 2016, p. 260). A change opportunity should be approached as a
situation created by internal and external environmental forces that requires a visionary or, perhaps a
paradigmatic shift in organizational perspective that, in many respects, coalesces around a change agent
leader/a person who will drive the change forward.
Let us accept for a moment that the person’s characteristics are important and that a vision is present.
What, about the situation, will affect change? The situation is important and needs to be examined.
Is the situation surrounding the need for change going to encourage or depress people? Is the situation
surrounding the change going to be perceived as advancing or threatening the organization’s life-cycle?
“Some situations invigorate and energize the change agent. Enthusiasm builds as coalitions form and
the proposed change gains momentum and seems likely to succeed. Other situations suck energy out of
the change agent and seem to lead to a never-ending series of meetings…and issues that
prevent…progress” (Cawsey, Deszca, and Ingols, 2016, p. 261).
Exothermic “describes a change situation when energy is liberated by actions”
Endothermic “describes a change program that consumes energy and arouses opposition, which then
requires more energy from the change agent” (Cawsey, Deszca, and Ingols, 2016, p. 285).
The above terms, not the most important in the world by any sense, do however reinforce the
importance of “situation” and the importance of trying to build an environment or context where the
specifics of the current “situation” are clearly seen, understood, and appropriately responded to.
Change Leaders and Their Essential Characteristics
I do not think there is a definitive discussion anywhere of the essential characteristics that successful
change leaders must possess as some characteristics might be more “essential” in some contexts versus
Chapter 8 Notes – 2
other contexts. That said, I think the following reflects an ideal-type (i.e. an ideal type is formed from
characteristics and elements of a given phenomenon. It is a model that stresses certain elements
common to most cases of the given phenomenon).
Our authors present the following ideal-type model of change leaders and their essential characteristics.
•
Commitment to Improvement – no explanation needed here but this: you had better have a
vision that you are committed to and can communicate to others. Without a vision, a change
leader is nothing.
•
Communication and Interpersonal Skills – a silver tongue is not enough. I advocate for the
following:
Walk with compassion – Treat others with intentional kindness, care and respect, knowing that
everyone is doing their best they can with the circumstances.
Listen more and talk less – What are people saying to you? When others have a chance to be
heard first, there is a much greater chance that you will be heard. An empathetic experience
when communicating with others lets them know that you understand where they are coming
from.
Find the common needs – Discover what you share in common with your stakeholders (e.g.,
efficiency in the use of financial and natural resources, or a shared caring that future
generations have the same opportunities as we have).
Rehearse and state your ideas and strategies clearly and concisely – If you question whether
your message is getting through to people, request that stakeholders restate your
points/message/vision.
Follow through with your stakeholders – One conversation does not necessarily make changes.
Approach your conversations so they include the potential for future conversations. Sometimes
the thing you want may require multiple conversations (http://cascadiaworkshops.com/5communication-guidelines-for-change-agents).
•
Determination – If you believe in the change, pursue it. Setbacks are inevitable…deal with it.
•
Eyes on the Prize and Flexibility – The prize or desired outcome of change is somewhere out
there and hopefully getting closer every hour. Stay focused on the change vision and keep the
stakeholders equally focused but recognize that, along the way, adjustments will need to be
made.
•
Experience and Networks – It is certainly ideal to have experience moving through a change
process as such can educate the change leader to identify others in the organization who can
help. Such a network must be based on “trustworthiness, credibility and interpersonal skills”
Chapter 8 Notes – 3
and the sense that those in the network see value in the change being pursued (Cawsey, Deszca,
and Ingols, 2016, p. 264).
•
Intelligence – Our authors unnecessarily complicated this discussion. Simply put, intelligence
involves the capacity to create knowledge and use it in a strategic manner to help the
organization adapt to necessary change forces.
At this point, please reflect on your readings and notes and complete Toolkit Exercise 8.2
Developmental Stages of Change Leaders
The following describes the developmental stages of a change agent (i.e., “vary from a novice stage to
an expert stage through successful experiences with increasingly complex, sophisticated change
situation” [Cawsey, Deszca, and Ingols, 2016, p. 286]). Much of this is learned but other elements of the
model are only acquired through experience.
The above makes a lot of sense but do you really want to use power and sanctions to lead and achieve
change?
Chapter 8 Notes – 4
How does this model affect your thinking of being a change leader?
Chapter 8 Notes – 5
Four Types of Change Leaders
Typologies are never complete/never perfect but they do help us think about concepts and issues with
improved clarity.
Before we address the types of change leaders, let us reinforce some essential points:
•
•
•
•
Being a change leader requires some level of intuition or the ability to anticipate that change is
coming.
Anticipating change stems from data and “deep study of a field or industry” (Cawsey, Deszca,
and Ingols, 2016, p. 269).
Change comes in different forms (recall the discussion of incremental/continuous change and
discontinuous/radical change [see p. 23 of our text]). The type of change leader needed for
incremental/continuous change is one that can make sense of new forces in the internal and/or
external environment and get the organization to redirect. The type of change leader needed
for discontinuous/radical change is one that can take charge, craft a new vision, and direct
people.
Change can involve pulling (leading in such a way that draws people to the change and you)
versus pushing (leading in a such a way that use of rewards/punishment and/or one’s position
get people to engage in or embrace change).
Our authors present the following as types of change leaders:
1. The Emotional Champion – “has clear and power vision of what the organization needs and uses that
vision to capture the hearts and motivations of the organization’s members”.
If the change is likely significant/dramatic, the emotional champion aims to give hope by reinforcing the
vision, and clearly pointing out the gap between where the organization is and where it is going.
As our text noted (see p. 271), the emotional champion:
•
•
•
•
is comfortable with ambiguity and risk;
thinks tangentially and challenges accepted ways of doing things;
has strong intuitive abilities; and
relies on feelings and emotions to influence others.
2. The Developmental Strategist – “applies rational analysis to understanding the competitive logic of
the organization and how it no longer fits with the organization’s existing strategy”.
Logic applied to a critique of where the organization is and what new structures and processes are
needed to take the organization to a new status/place characterizes the developmental strategist.
The developmental strategist:
•
•
engages in big-picture thinking about strategic change and the fit between the environment and
the organization;
sees organizations in terms of systems and structures fitting into logical, integrated components
that fit (or don’t) with environmental demands; and
Chapter 8 Notes – 6
•
is comfortable with assessing risk and taking significant chances based on a thorough
assessment of the situation.
3. The Intuitive Adapter – “has the clear vision for the organization and uses that vision to reinforce a
culture of learning and adaptation”/continuous improvement.
The intuitive adapter:
•
•
•
•
embraces moderate risks;
engages in a limited search for solutions;
is comfortable with the current direction that the vision offers; and
relies on intuition and emotion to persuade others to propel the organization forward through
incremental changes.
4. The Continuous Improver – “analyzes micro environments and seeks changes such as re-engineering
systems and processes”.
The continuous improver is generally going to thrive in an environment that is, more so than not,
working well and aligned with its environment. Thus, drastic/radical change is not on the radar.
The continuous improver:
•
•
•
thinks logically and carefully about detailed processes and how they can be improved;
aims for possible gains and small wins rather than great leaps; and
is systematic in his or her thinking while making careful gains (Cawsey, Deszca, and Ingols, 2016,
pp. 270-272).
Chapter 8 Notes – 7
Change Teams
Change teams refer to a “group of employees, usually from a cross-section of the organization, that is
charged with a change task” (Cawsey, Deszca, and Ingols, 2016, p. 286). It is argued that we need to
employ change teams because the volume of work associated with a substantive/strategic will be heavy
and perhaps more than one person can effectively handle.
Change teams, particularly when you build the team from the inside, with insiders, can be
advantageous, as the insiders will learn new skills, practice their communication skills, and likely become
more committed to the change process.
Further, internal change agents (i.e., employees that know the organization very well and are ready to
embrace change) are present within organizations and can be selected to help steer the change
initiative. They can be a valuable addition to a change team as they know the organization from the
inside. They may be a more valuable asset to the change teams that brining in an external change agent
(i.e., people from outside the organization, such as consultants, that will help steer the change).
Let us stop for a moment and complete Toolkit Exercise 8.5
Chapter 8 Notes – 8
Rules of Thumb for Change Agents
Chapter 8 Notes – 9
Case Study 5
Ellen Zane-Leading Change at Tufts/NEMC
Cynthia Ingols
Lisa Brem
Simmons College School of Management
Boston
It was a difficult decision to take
this job. But there was something
about the history of Tufts-NEMC
and its importance to so many
stakeholders that really grabbed
me as the epitome of what one
could do in one’s career. I’d also
learned not to be adverse to risks.
You have to take risks, not stupid
.
risks, but you have to take risks.
– Ellen Zane, CEO, Tufts-NEMC
Medical Center (Tufts-NEMC). It was the sum-
mer of 2006 and it had been an incredibly rough
two-and-a-half years since she accepted the
CEO position at the ailing Boston hospital. Since
then the hospital had survived the worst of its
financial troubles—they were meeting efficiency
goals and for the first time in years, more doc-
tors joined the hospital than left it. Tufts-NEMC
posted an $18 million gain in 2005, after losing
nearly $60 million since 2001 (see Exhibit 1 for
financial statements). People were smiling and
thanking Zane in the corridors.
But that was a piece of the problem. This was
the tricky part, she thought, in one of her rare
moments of quiet as the predawn light slowly
infused the room. Zane realized that she was still
deeply worried about the future:
–
E
llen Zane brought a cup of coffee into her
home office. It was 4:30 a.m. and she was,
las usual, starting the day early. She fired
off a few e-mails to her senior staff and looked
over the Women’s Business magazine on her
desk. Her photograph was on the cover, high-
lighting the article on the turnaround she was
attempting to execute at Tufts-New England
This place was just so fragile and I still
consider it fragile. It’s one month forward
and one month back. This market is
unforgiving and tough-I swim with the
Source:From Linda E. Swayne, W. Jack Duncan & Peter M. Ginter. Strategic Management of Health Care Organizations.
sos
lossey-Bass. 2008.
450
ORGANIZATIONAL CHANGE
sharks and nobody glad-hands us. I tell
the staff all the time—not a minute do we
take our foot off the gas.
an
Institutes of Health (NIH) research grant money
second only to California. Massachusetts hospi
tals employed 12.2% of the total labor pool, and
ta
accounted for a whopping 11.7% of the
state product. Health care expenditures
fc
gross
per
S
t
t
care
1
capita were between 27% and 29% higher than
(see Exhibits 2-9 for Massachusetts health
the national average from 1990 to 2000
statistics). Consumers, health plans, and
governing bodies tended to accept that heath
care in Boston costs more in accordance with
the high quality and cutting-edge services
the region provided.
Zane struggled with how to maintain the
solidarity that the financial crisis had created
among Tufts-NEMC’s 5,000 employees. She
knew from her 30 years of experience in hospital
management that sustaining change in Boston’s
cutthroat medical industry was the hardest part
of any turnaround. She had been successful
before with Quincy Hospital, but Quincy had
been a much smaller player. Tufts-NEMC was
a 450-bed Academic Medical Center (AMC)
that was the primary teaching site for Tufts
University School of Medicine, and conducted
over $50 million in research each year. It had
17,000 admissions in 2005 and generated $600
million in revenue. Unfortunately, while
Boston’s other AMCs merged, built networks,
and grew stronger, Tufts-NEMC had for years
floundered directionless in Boston’s rough seas.
As Zane headed to her office overlooking
Boston’s Chinatown she wondered: How could
she create and sustain true and lasting change
for Tufts-NEMC?
Vrofil
be
The Health Care
Industry in Boston
Nationally, however, years of underfunding
by federal and state governments and rising
enrollment left Medicare and Medicaid
ments lagging behind surging medical costs.
pay-
Hospitals in Massachusetts and the rest of the
nation amassed significant debt in the 1970s and
1980s as they refurbished older facilities,
expanded services, and purchased expensive
new technologies. While reimbursements fell
behind rising costs, hospital discharges declined
sharply in the 1980s, as did the average length of
stay. In Massachusetts, a decrease in hospital
births and nonresident discharges led to an
overall decline of 24% in total hospital dis-
charges from 1991 to 1996. The increase in out-
patient surgeries also affected hospitalizations.
Throughout the 1990s, Massachusetts health
care insurance plans followed nationwide trends
when they merged into three large competitors:
Harvard Pilgrim Health Care, Blue Cross/Blue
Shield of Massachusetts, and Tufts Health Plan.
These “big three’ plans wielded increasing
“Health care, together with education and
computer technology, is what Massachusetts
is known for throughout the world.”
power in the marketplace, and their movement
to managed health (HMO) plans resulted in
lower payments to providers and more over-
Home to several high-profile Academic
Medical Centers, the Boston area was a world-
renowned destination for health care services.
Massachusetts General Hospital (MGH),
Brigham and Women’s Hospital (BWH), and
Beth Israel/Deaconess Medical Center were
affiliated with Harvard Medical School, Boston
University Medical Center with Boston
University, and Tufts-New England Medical
Center with Tufts. These large AMCs led the
way in capturing $2.3 billion in National
sight on costs and medical services. All three
expanded regionally, to entice large regional and
national companies to offer their plans to
employees. HMOs used capitated payments,
meaning they reimbursed providers based on
the number of covered lives” in the provider
system. Thus, providers of health care services
such as hospitals and doctors believed volume

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