1. What is your analysis and evaluation of the design of this intervention? What large-group intervention theories and models were applied in this case? Do you believe that the intervention made a difference in this organization?
this is the article
Selected Cases Large Group Interventions at Airbus’ Ict Organization
Airbus, an EADS company, is one of the leading aircraft manufacturers in the world. Its customer focus, commercial know-how, technological leadership, and manufacturing efficiency have propelled it to the forefront of the industry. With revenues of over €38 billion in 2012 and an industry record backlog of 4,682 aircraft valued at over €523 billion, Airbus today consistently captures about half of all commercial airliner orders.
Headquartered in Toulouse, France, Airbus is a truly global enterprise of some 55,000 employees, with fully owned subsidiaries in the United States, China, Japan, and the Middle East; spare parts centers in Hamburg, Frankfurt, Washington, Beijing, Dubai, and Singapore; training centers in Toulouse, Miami, Hamburg, Bangalore, and Beijing; and more than 150 field service offices around the world round out its physical footprint. Airbus also relies on industrial cooperation and partnerships with major companies all over the world, and a network of some 1,600 suppliers in 30 countries.
This case describes the launch of a transformation process that has taken root in Airbus’ Information and Communication Technology (ICT) function. ICT is a transnational group of around 1,300 information system professionals located wherever Airbus operates. ICT develops, maintains, and operates—24 hours a day, 365 days a year—every facet of the information systems that enable Airbus’ core business processes.
The Change Challenge
Guus Dekkers joined Airbus as Chief Information Officer in June 2008. The organization he inherited had been split, integrated, and split again in a series of reorganizations over the previous seven years. Not surprisingly, he faced a change-fatigued and cynical ICT workforce. Moreover, the reorganizations had not produced the results that Airbus top management was expecting with respect to time, cost, and quality objectives in projects or improved productivity in service delivery.
At the same time, the continuing global financial and economic crisis along with the intense competition in the aircraft manufacturing industry resulted in increasing budget pressures, growing business demands, changing business models, and increasingly disenchanted internal customers. The performance of his function needed to improve significantly and fast.
In his first year, Dekkers formed a new executive team with a mix of experienced internal managers, newcomers from outside Airbus, and others from outside the aviation industry. He worked with his new team and a core group of middle managers to define ICT’s new vision, mission, and customer-facing transnational organization (Figure 1). However, he knew that these changes were only the beginning. It could take months, or even years, to formulate and implement the necessary changes.
Figure 1 The New ICT Organization (~2009)
Details
Dekkers asked Susan Donnan to guide the implementation process as his internal change agent. She had the right background, education, and experience to facilitate large-scale change in organizations. She joined Dekker’s team in July 2009.
The Change Strategy
Working from her belief that high performance results when all parts of an organization’s design are aligned, Donnan searched for a change methodology that would simultaneously reconfigure design features and engage a critical mass of organizational members at all levels. She had studied large group interventions during her Masters of Science in Organization Development (MSOD) degree program at Pepperdine University. In addition, through her consulting work, she had experienced a variety of large group interactive events as a participant, a member of a design team, and a member of a logistics team that supported an event. She was convinced that such an intervention should be a central element of the change methodology. She considered a variety of these large group methods, including the Appreciative Inquiry Summit and Future Search, but was concerned that the current culture would not support such approaches.
In the end, she selected a process known as Whole Systems Transformation (WST), a process developed and refined by Roland Sullivan. Like other large group interventions, it is designed to help leaders engage a large, critical, and representative segment of the organization. It combines best practices in action research, small group dynamics, and large group dynamics. Unlike other large group interventions, it leads with alignment and transformation of the executive team, then transforms a critical mass of the organization, and follows up with efforts to sustain the transformation. In her experience, Donnan knew too well that an aligned leadership team was a critical success factor for transformation. She contracted with Sullivan to provide external consulting support.
Initiating Change at Ict
Phase 1: Contracting with the Leadership Team
Like most large organizations, Airbus had adopted a traditional change management approach—top management announced the change and facilitated it through extensive communication. To implement a change strategy that was clearly outside the organization’s norm, Donnan needed to convince Dekkers and his team that the traditional approach would be too slow and produce incremental change at best.
Her process began by securing executive commitment one-step-at-a-time while painting the picture for the whole journey. For example, Donnan presented a roadmap (Figure 2) that outlined the different milestones for the WST process.
Figure 2 ICT Transformation Roadmap
Details
She emphasized that transforming the executive team into a group with “one brain, one heart” would be a critical prerequisite for launching the “transform the ICT critical mass” phase. Committing ICT to such a radically different approach was a leap of faith and a courageous act for the executive team, especially for Dekkers. The executive team knew that they would need to learn and become different leaders to lead the transformation but they were willing to trust Donnan and Sullivan to guide them through the process.
She also recommended—because she knew from previous experience—that the organization needed to put an infrastructure in place to drive and support the transformation process. Figure 3 describes the ICT transformation infrastructure that was agreed to by the ICT executive team to support the change. Finally, she paid special attention to ICT’s Human Resource Business Partners. She was convinced that the HR organization needed to be fully on board if the change was to be successful.
Figure 3 Whole System Transformation Team Organization
Details
Phase 2: Transform the Leadership Team
ICT’s transformation process began with a two-and-a-half-day leadership retreat for the executive team in November 2009 that was jointly facilitated by Donnan and Sullivan. The retreat aimed to improve the effectiveness and alignment of the team and to develop “one brain and one heart” so that the team members could speak with “one voice.”
In preparation for the retreat, Donnan and Sullivan conducted ICT manager focus groups and executive team interviews. Executives were asked about the key issues in becoming a higher performing leadership team, helping ICT to become a higher performing function, thrilling internal customers, and deserving the role of a trusted business partner. The focus group and interview data were synthesized into data reports that were shared with the entire team prior to the retreat. Dekkers saw the data as reliable, valid, and rich, and it was used to ensure that the retreat addressed the right topics. Two members of the executive team worked with Donnan and Sullivan to co-design the event, acting as sounding board and providing valuable feedback.
Three important outcomes were achieved during the retreat:
Using the feedback in the data reports, the participants explored issues of trust within the team and worked on improving their relationship with Dekkers and each other. They exchanged appreciation for each other’s strengths, provided suggestions for improvements, and made requests and offers with each other. As a recently formed executive team, an important practical outcome of this conversation was new team norms and meeting ground rules. In addition, they developed a new annual calendar with dedicated meetings for operational reviews and strategic topics. Together, these deliverables had an important and positive impact on the team’s process effectiveness.
In addition to working on their relationships and team performance, the executive team visualized and described how ICT would look when its vision, mission, and strategy were fully achieved. They identified the priorities to be addressed to take ICT from where it was to where they wanted it to be: a trusted business partner delighting its internal customers. They agreed on actions and commitments that they would either personally or collectively perform to implement the ICT strategy. These included defining and refining the operating model, specifying ICT career paths, developing make or buy strategies with respect to ICT activities, building sourcing strategies for the ICT supply chain, and clearly articulating a convergence strategy to simplify the complex portfolio of business applications.
A final important outcome was the decision to hold the first two-and-a-half-day ICT summit in February 2010 with a clearly defined purpose and set of outcomes. Two members of the executive team volunteered to be sponsors for the summit. The summit participants would represent a carefully selected, diagonal crosssection or microcosm of ICT with all subfunctions, all locations, and all levels involved. The executive team nominated and empowered a design team of 13 members, representative of the summit participants, to design the event.
Phase 3: Transform a Critical Mass of ICT Members
Between November 2009 and February 2010, Donnan and Sullivan co-facilitated three two-and-a-half-day sessions with the design team to plan the summit. In the beginning, the consultants intentionally allowed the process to be ambiguous. At times, it was a messy and disruptive process, an emotional roller coaster for the team’s members. However, it was necessary to creating a safe environment where design team members could speak openly and directly about the organization’s challenges, their fears about the transformation’s success, and their hopes for the future. Several design team members were skeptical of the need for change and did not believe that they would be empowered. To address this issue, executive team members participated in the design sessions at different times, often in two’s or three’s, to show their support, to give their inputs, to answer questions, and to give feedback on the emerging summit design. The design team was surprised and impressed by the alignment in the executive team and how much they acted as one. Over the three-month period, this new group formed into a high-performing team. They were motivated and committed to creating an impactful, memorable, and transformative experience for the participants.
With Donnan and Sullivan’s guidance, the team used the following principles to guide the design of the summit:
The participants should represent a critical mass of the ICT organization, including believers and skeptics of change.
The design should create a safe place for people to speak openly and truthfully by ensuring that all small group discussions involved a maximum mix (“max-mix”) of people from different levels and sub-functions, and by ensuring no one in the group was from the same hierarchy or chain of command. All reportouts would come from the table as a whole so no individual would be exposed.
Table activities, breakout groups, and plenary sessions should engage each participant’s “whole brain,” both rational and emotional.
The purpose and outcomes for each activity should be defined clearly for participants.
Allow the large group to alternate between divergent and convergent activities and report-outs.
Diverse perspectives and the awareness of multiple realities should be generated through divergent activities, such as generating ideas, creating multiple views of today’s frustrations, or visioning tomorrow’s hopes and dreams.
Make effective, collective, and integrated decisions through convergent activities, such as “preferring” (e.g., a voting process) to identify priorities and expert panels to share views from customers or senior management.
Leverage Beckhard’s change formula to drive change activities in the summit: change is more likely to occur when the dissatisfaction with the status quo, multiplied by the vision of the future, multiplied by the clarification of first steps is greater than the resistance to change.
The design team worked long and hard to define the purpose and outcomes (Figure 4) for the summit. They debated and deliberated until everyone on the team was satisfied. Whenever the team could not agree, they referred back to the summit’s purpose and outcomes and used those as “tiebreakers.”
Figure 4 ICT Summit 2010 Purpose and Outcomes
Purpose:
The purpose of the summit is to accelerate the continued implementation of our ICT vision and mission by creating a single team with one mind and one voice, fully engaged and committed to change—enabling the success of Airbus.
Tangible Outcomes:
Identified improvement and concrete actions.
Personal commitment to change (measurable) things.
Communication and involvement plans to involve and engage the rest of the ICT organization.
Formal mechanisms to ensure execution/implementation and measurement of success.
Intangible Outcomes:
Clear understanding and buy-in of the Vision, Mission, and Strategy of ICT.
System wide understanding of operational activities and how we each contribute.
Increased respect and trust.
Change in attitude and mindset.
Commitment to being ICT ambassadors.
Eventually, the team designed the summit to take the participants through a process that mirrored the roller coaster they had experienced in the event design process. Figure 5 shows the high-level agenda.
Figure 5 ICT Summit 2010 High-Level Agenda
Day 1 Day 2 Day 3
Powerful opening
Purpose and outcomes
Building table teams
Achievements
Vision, Mission, and Strategy
Whole system working and not working
Customer view
Elephant questions generated
CIO reflections
Feedback from Day 1
Elephant questions answered
Articulation of success
Barry Oshry’s top/middle/bottom
Intergroup breakouts—(Exec/Mgrs/Non-mgrs)
Whole system action planning
Breakouts—Transversal action planning
Elephant questions answered
CIO reflections
Feedback from Day 2
Elephant questions answered
Breakouts—How to engage rest of ICT
System-wide communication
Appreciative feedback
Personal commitments
CIO inspirational sendoff
The first day of the summit began with a dramatic video that was edited just for this event, featuring the maiden flight of the A380 aircraft. Following the video, Fernando Alonso, who was the leader of the flight crew for the maiden voyage, spoke about the importance of trust. He talked passionately about the confidence he had in the A380 aircraft and its expected performance on that first flight. He described what it was like having the world’s attention on them but knowing that the flight crew would not decide to take off unless every team member was ready. He shared that ultimately his trust extended beyond the flight crew to the entire Airbus organization. No one, at any Airbus meeting, had ever spoken about emotions, like trust, as the key to success. Immediately, the participants knew that the summit was to be unlike any other meeting they had ever attended.
At the max-mix tables, participants reflected on the meaning and the implications of Alonso’s talk on trust. They reflected on and celebrated personal, team, and ICT achievements over the last 12 to 18 months. Then, after listening to ICT executive team members describe the vision, mission, and strategy, participants were encouraged to ask clarifying questions.
For the first time in their history, participants found themselves having deep and meaningful conversations sitting face-to-face with their colleagues, middle managers, and senior managers. The executive team, who were equally distributed among the tables, were coached by the design team to “trust the process.” They were encouraged to listen, be supportive of diverse ideas, and answer questions directly.Participants then discussed what was working well and what was not working well, focusing on ICT’s mission, operating model, customers, and people. These strengths and weaknesses were posted around the room and each participant was given green and red dots to identify his/her top three “working” and “not working” focus areas. The top issues for the group quickly emerged and “dotting” has since become a favorite means to arrive at consensus at ICT.
As the last activity of the day, participants were given the opportunity to pose “elephant” questions—something that they had always wanted to ask but were afraid to ask. Next, participants were invited to write down their feedback for the day. Finally, Dekkers closed the day with his reflections. He spontaneously asked participants to use their green “thumbs up” or red “thumbs down” signs to indicate how they felt the summit was going, and he was rewarded with a sea of green and a few red dots sprinkled around.
Participants continued to socialize and network in the evening over drinks and dinner with old friends and new colleagues. Because many of the participants came from around the world and worked virtually, the time for personal interaction was appreciated.
The second day of the summit began with the ICT executive team answering honestly some of the “elephant” questions developed by the participants the day before. The participants were both surprised and satisfied with the openness and willingness of the executives to answer in a spirit of vulnerability, honesty, and sensitivity.
Working at their tables, participants visualized what success would look like in five years’ time. The sharing of their creative presentations of the “future” was one of the high points of the summit. With vivid pictures of success and knowledge of the top issues, they identified actions needed from the individual, sub-function, and ICT levels to move ICT to where they would like it to be. This was breakthrough work. The day ended with Dekkers’ reflections and participants’ feedback, followed by social activities and more networking.
The third day of the summit also began with answering additional “elephant” questions from the first day. This was followed by activities to define ways to engage the rest of the ICT organization after the summit. The participants agreed on ways to communicate to the rest of the ICT community going forward. After rounds of appreciative feedback at the tables, the summit closed with the ICT executive team making personal commitments on stage in front of all, for which they received a standing ovation.
Phase 4: Implement and Sustain the Change
Immediately after the summit, the 300 participants returned to their offices and acted as ambassadors for change. At the top of the list was the wish to communicate the process and the results of the summit to the rest of the organization. Supported by communication kits and a web-based e-journal with photos and videos provided by Donnan, this occurred in all sub-functions and all locations.
In addition to communication, summit actions were translated into projects and personal objectives. Examples of projects included: harmonization and standardization of ICT activities using industry best practices; understanding these activities’ drivers and costs and measuring their performance; fighting bureaucracy and streamlining processes; working with its business partners to drive improvements on demand management and prioritization; and developing the competencies and careers of ICT employees.
ICT Executive Team members drove cross-functional or within function transformation in their respective groups. The design team volunteered to stay on as the transformation network. Together with Donnan, they monitored progress and supported the executives in driving implementation of summit actions in their respective functions. Donnan met monthly with the transformation network to share insights and best practices.
For the next 12 months, ICT Transformation remained a priority for the executive team.
Many of the transformation projects delivered bottom-line savings and enabled company objectives. The ICT organization got measurably better at delivering on its projects, services, and cost promises. Communication up, down, and across ICT improved appreciably.
Last but not least, the collaborative approach to change sent a clear message that transformation could not be successful without the engagement of ICT employees. Grass roots initiatives and volunteerism were actively encouraged. People at all levels felt greater empowerment. For example, in multiple locations, people chose to become local change agents and organized local transformation and social events, some of which continue today.
Maintaining the Change Momentum
Following the success of the first ICT summit, the
(1)
align and transform the executive team,
(2)
assess and plan the next cycle of change,
(3)
align and transform a critical mass of organization members, and
(4)
implement and sustain change process became institutionalized and has occurred every year since.
A new design team and a compelling focus from the leadership team underpins the annual cycle of the process.
For example, the focus for the 2010–2011 cycle was cross-unit or cross-functional breakthroughs involving the leadership population of about 200 ICT managers. The theme of the summit was “Leading as ONE.” The focus of the 2011–2012 cycle was creating an ICT environment that actively encourages agility, innovation, and leadership. Unlike previous summits, the third summit did not focus on what was not working or broken; rather it focused on a new way of thinking and working. Participants learned about design thinking through a simulated innovation project, explored psychological concepts that contribute to innovative thinking, and applied those concepts to four dynamics in the organization: agility and stability; anticipation and reaction; customization and standardization; and innovation and standardization.
During the months that followed the 2011–2012 summit, ICT dealt with a difficult business challenge using a collaborative approach that most people agreed would not have been possible three years earlier. It received, together with its customers, five 2012 Awards for Excellence, three of which were in the “Drive Improvement and Innovation” category and one of these won the Top Award of the Year.
In addition, ICT has made the greatest improvement in employee engagement in the company over a three-year period as measured by the Gallup Q12. Through productivity improvements, ICT also succeeded in handling 25 percent in volume growth while maintaining a flat budget in the same period.
ICT’s efforts have made important contributions to implementing its vision, mission, and strategy. It has achieved operational excellence, a critical foundation or prerequisite for becoming a trusted business partner. Going forward, the executive team would like to evolve ICT’s way of working: to be better immersed in the business strategy and business processes of its customers, to better anticipate their business needs, to focus sharply on value for Airbus, and to quickly propose and provide right-sized solutions. The journey continues.
Learning
Ever since her MSOD days at Pepperdine, Donnan had been searching for ways to facilitate system-wide alignment and to accelerate change. For her, the WST process has been the most effective methodology for achieving both. She reflected on her learning.
The importance of aligned leadership. Breakthroughs in the ICT executive team enabled breakthroughs in ICT as a whole. When leaders speak with one voice, provide a unified direction in vision and strategy, demonstrate a sense of urgency, and walk their talk, it gives organization members the confidence to act in alignment for the health of the whole. On the other hand, when leaders are not aligned and give conflicting directions, this causes conflicts and confusion that cascades all the way down the organization.
The critical roles of the event design team. The ICT case would not have been a success without the effective use of the event design team. In addition to bringing in data from across the ICT organization and mirroring the organization’s current state as part of the design process, the event design team members took an active role in facilitating different modules in the summit, listening to the participants during the summit, synthesizing the participants’ daily feedback, and refining the summit design based on their feedback. The teamwork within the team was critical for the smooth execution of the summit.
The real work of transformation occurs between large group interventions. While many people focus on how a large group event “releases the magic” of a paradigm shift, the real work of transformation occurs after the event or between events in the “implement and sustain change” phase. ICT is part of a global organization that has experienced and continues to experience tremendous growth and challenge. Managers are typically overloaded just running and delivering today’s business; requests to transform the business for the future are often overwhelming. Moreover, saying “no” to lesser priorities remains difficult for the organization. As a result, finding the resources and time for transformation remains a challenge. ICT’s experiments with a mix of structured and emergent approaches yielded two major lessons. First, do not launch more actions than the organization can handle, and second, focus more on cross-functional improvements that optimize overall results rather than local maximization.
The lead and lag indicators of success. Organization change is a journey that takes time and requires incredible patience. Following a large group interactive event, the lead indicators of success are team spirit, confidence, commitment, relationships, energy, trust, inclusiveness, transparency, and alignment. These are difficult to measure but can be felt, observed, and captured in anecdotal stories. Later, improvement projects lead to more tangible results, such as behavioral and engagement changes. However, only when the improvement projects are successfully implemented can improved business results be seen. These are the lag indicators of success. Executives and managers must understand that the easy-to-measure lag indicators of success will come if they recognize, support, and nurture the difficult-to-measure but equally valuable lead indicators of success. Many change initiatives fail because executives insist on instant results, give up too soon and move onto the next change.
Transforming how the organization deals with change. The ultimate measure of organization development is the degree to which the ability to change again is enhanced or diminished. Without any doubt, the WST process has helped people in ICT build a change capability. Realizing that transformation is a journey and not a destination, ICT people are no longer paralyzed by change and are more likely to embrace change as an opportunity rather than a threat. They have developed greater capacity and capability to act in aligned ways. In reflecting on the organization’s journey, Dekkers said, “Today, our ICT community is better mobilized and motivated to change.”
WST needs to be repeated regularly. In today’s complex, chaotic, and uncertain world, an organization’s ability to learn and innovate at the individual, team, and organizational levels allows the organization to adapt. Change is a constant and the days of returning to stability or business-as-usual are gone. To ensure a sustained long-term journey, the WST process must be repeated to regularly restore whole system alignment while adapting to internal and external drivers for change.
In conclusion, each year that the ICT has used the WST process, it has become more and more competent to self-direct and master its own change process. The organization is becoming better at doing what it says it will do, more respected by its customers, and more agile. ICT people is learning how to learn in real time as an entire function.
the second question is 1) Critique SHS’s visioning process.
2) What implications does the visioning process have for the intervention you want to implement? How can you take advantage of the process in your action plan?
and this is the article.
Selected Cases The Sullivan Hospital System
Part I
At the Sullivan Hospital System (SHS), CEO Ken Bonnet expressed concern over market share losses to other local hospitals over the past six to nine months and declines in patient satisfaction measures. To him and his senior administrators, the need to revise the SHS organization was clear. It was also clear that such a change would require the enthusiastic participation of all organizational members, including nurses, physicians, and managers.
At SHS, the senior team consisted of the top administrative teams from the two hospitals in the system. Bonnet, CEO of the system and president of the larger of the two hospitals, was joined by Sue Strasburg, president of the smaller hospital. Their two styles were considerably different. Whereas Bonnet was calm, confident, and mild-mannered, Strasburg was assertive, enthusiastic, and energetic. Despite these differences, both administrators demonstrated a willingness to lead the change effort. In addition, each of their direct reports was clearly excited about initiating a change process and was clearly taking whatever initiative Bonnet and Strasburg would allow or empower them to do.
You were contacted by Bonnet to conduct a three-day retreat with the combined management teams and kick off the change process. Based on conversations with administrators from other hospitals and industry conferences, the team believed that the system needed a major overhaul of its Total Quality Management (TQM) process for two primary reasons. First, they believed that an improved patient care process would give physicians a good reason to use the hospital, thus improving market share. Second, although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) had enacted policies some time ago encouraging hospitals to adopt continuous improvement principles, SHS’s system was sorely behind the times. The team readily agreed that they lacked the adequate skills and knowledge associated with implementing a more sophisticated TQM process. This first meeting was to gather together to hear about how TQM, engagement, and other strategic change processes had advanced and the issues that would need to be addressed if more sophisticated processes were to be implemented. During the meeting, you guided them through several exercises to get the team to examine methods of decision making and how team-based problem solving
At&t Company
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Can you please put this into Blue Strands power point. I need at least 5 power point slides please. I included the document.
The slides need to focus on Opportunities, Threats, Strengths and Weaknesses.
Thank You
Boss to Coach Ch. 25-28
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Write a 250 word summary of chapters 25-28.
Combine the chapters for one summary, not a 250 word summary for each chapter.
Do not copy and paste, you must rewrite the book’s information into your own words.
Application of The IoT Smart City Technology In Transport Security Improvement In Sydney, Australia
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Application of The IoT Smart City Technology In Transport Security Improvement In Sydney, Australia. discussion should be upto 500-100 words.
Refer the document attached for any other information needed. Refer conceptualisation document for details.
MGT 404 assignment
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WORD format only
Times New Roman (size 12, double-spaced) font
Reference APA style
Read the instructions in the file and follow it.
Try to put more details on everything because the more words the better answers.
No plagiarism .
Information Systems; Cyber Security and Risk Management. 300+ words. APA style.
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Read Four(4) scholarly articles on Cyber Security and Risk Management.
(No Wikipedia)
1. Summarize all four (4) articles in 300+ words.
2. Discuss the relationship between cyber security and risk management.
APA style. Provide in-text citations when possible.
2-paragraph summary
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Write a 2-paragraph summary of what you have learned in the course.
Minimum of 400 Words.
I have attached the curse outline to be used as resource for what has been covered in this course
Short Response from watching a youtube video
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Eight limes of yoga
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Read the three articles that are listed below (scroll down after the questions) and answer the questions in paragraph form:
The Yamas and Niyamas by Emma-Louise Newman
Eight Limbs, Pantanjali’s eight-fold path by Mara Carrico
Pratyahara, Yoga’s Forgotten Limb by David Frawley
Which of the Yamas and Nyamas do you relate to and why?
What is the purpose and/or benefit of each of the eight limbs of Yoga and how you experience each limb on and/or off your mat?
How do the limbs relate to each other? Do you feel one is more important than the other and why?
The Yamas and Niyamas
by Emma-Louise Newlyn
The word ‘yoga’ is understood differently by many of us; for some it’s purely a physical exercise, a way to get stronger, healthier and more flexible; for others it’s meditating each day, and for others still, it might mean chanting mantras or worshipping a deity.
If there’s one thing to be sure of though, it’s that yoga meaning ‘unity’, offers us a way of life that can be much more transformational than a 60-minute yoga class once a week….
Beyond asana
While all the stretching, twisting, balancing and occasionally falling over (or a lot of falling over) is very beneficial, and certainly opens the gateways to a healthier, more vibrant and ‘alive’ sense of being, it is just one branch on a very big tree of yoga. Ancient texts such as the Hatha Yoga Pradipika and The Yoga Sutras focus very little on physical yoga postures (asana), and in fact when Patanjali speaks of ‘asana’ he is in no way at all referring to Headstand or Warrior II; he’s talking about the position you choose to sit in while meditating your ‘seat’. It’s the tantric traditions that focussed more on what the body could do, and these texts show more evidence of where the postures come from…
The Yoga Sutras
The Yamas and Niyamas originate from the very well known text ‘The Yoga Sutras of Patanjali’, which many yoga teachers or teachers-in-training will have attempted to decipher at some point. Patanjali is known as a sage, but it’s very unlikely that one man wrote these texts and far more likely that the texts are the
culmination of what a group of Patanjali’s disciples wrote over a period of time.
Without going into too much detail the Yoga Sutras are essentially less of a deep and philosophical book like many may think, and more like a guide or instruction manual on how to live in order to advance along a spiritual path towards enlightenment.
The Eight Limbs of Yoga
The Yoga Sutras contain a set of observances and practices referred to as “limbs”; each describing a different aspect of the yoga practice, and a different step on the ladder to realization. These are commonly known as the ‘Eight Limbs of Yoga’:
come to class for the physical benefits, but the reason so many of us stay is because there’s an inkling that there’s some other sort of magic at work here….
The Yamas and Niyamas are often seen as ‘moral codes’, or ways of ‘right living’. They really form the foundation of our whole practice, and honoring these ethics as we progress along ‘the path’ means we’re always being mindful of each action, and therefore cultivating a more present and aware state of being. It’s interesting to note that these five Yamas and five Niyamas resemble the ten commandments, and the ten virtues of Buddhism, so we’re all ‘different’ yet ‘united’ at the same time….
The idea of a yoga practice is really not just to focus and be aware and mindful and calm for the time that we’re on the mat, but to carry this state of being with us when we leave class
The Yamas
The word ‘yama’ is often translated as ‘restraint’, ‘moral discipline’ or ‘moral vow’, and Patanjali states that these vows are completely universal, no matter who you are or where you come from, your current situation or where you’re heading. To be ‘moral’ can be difficult at times, which is why this is considered a very important practice of yoga. Remember that the word ‘yoga’ means ‘unity’, ‘wholeness’ or ‘connectedness’; of course it’s important to be mindful, gentle and present in class, but if this doesn’t translate off the mat and connect into what we do in our day-to-day lives, we will never feel the real benefits of yoga.
The Yamas traditionally guide us towards practices concerned with the world around us, but often we can take them as a guide
of how to act towards ourselves too. There are five Yamas in total listed in Patanjali’s Sutras:
If we are to really benefit from a yoga practice, it has to expand beyond the mat and into life. When this happens, it’s not just our bodies that get stretched, expanded and strengthened, but our minds and hearts as well. From that state of being, we move ever closer towards wholeness, connectedness and unity, and start to not just ‘do’ yoga, but live and breathe it in each and every moment.
The Eight Limbs
Patanjali’s eight-fold path offers guidelines for a meaningful and purposeful life.
By Mara Carrico
In Patanjali’s Yoga Sutra, the eightfold path is called ashtanga, which literally means “eight limbs” (ashta=eight,anga=limb). These eight steps basically act as guidelines on how to live a meaningful and purposeful life. They serve as a prescription for moral and ethical conduct and self- discipline; they direct attention toward one’s health; and they help us to acknowledge the spiritual aspects of our nature.
1. Yama
The first limb, yama, deals with one’s ethical standards and sense of integrity, focusing on our behavior and how we conduct ourselves in life. Yamas are universal practices that relate best to what we know as the Golden Rule, “Do unto others as you would have them do unto you.”
2. Niyama
Niyama, the second limb, has to do with self-discipline and spiritual observances. Regularly attending temple or church services, saying grace before meals, developing your own personal meditation practices, or making a habit of taking contemplative walks alone are all examples of niyamas in practice.
3. Asana
Asanas, the postures practiced in yoga, comprise the third limb. In the yogic view, the body is a temple of spirit, the care of which is an important stage of our spiritual growth. Through the practice of asanas, we develop the habit of discipline and the ability to concentrate, both of which are necessary for meditation.
4. Pranayama
Generally translated as breath control, this fourth stage consists of
techniques designed to gain mastery over the respiratory process while recognizing the connection between the breath, the mind, and the emotions. As implied by the literal translation ofpranayama, “life force extension,” yogis believe that it not only rejuvenates the body but actually extends life itself. You can practice pranayama as an isolated technique
(i.e., simply sitting and performing a number of breathing exercises), or integrate it into your daily hatha yoga routine.
These first four stages of Patanjali’s ashtanga yoga concentrate on refining our personalities, gaining mastery over the body, and developing an energetic awareness of ourselves, all of which prepares us for the second half of this journey, which deals with the senses, the mind, and attaining a higher state of consciousness.
5. Pratyahara
Pratyahara, the fifth limb, means withdrawal or sensory transcendence. It is during this stage that we make the conscious effort to draw our awareness away from the external world and outside stimuli. Keenly aware of, yet cultivating a detachment from, our senses, we direct our attention internally. The practice of pratyahara provides us with an opportunity to step back and take a look at ourselves. This withdrawal allows us to objectively observe our cravings: habits that are perhaps detrimental to our health and which likely interfere with our inner growth.
6. Dharana
As each stage prepares us for the next, the practice of pratyahara creates the setting fordharana, or concentration. Having relieved ourselves of outside distractions, we can now deal with the distractions of the mind itself. No easy task! In the practice of concentration, which precedes meditation, we learn how to slow down the thinking process by concentrating on a single mental object: a specific energetic center in the body, an image of a deity, or the silent repetition of a sound. We, of course, have already begun to develop our powers of concentration in the previous three stages of posture, breath control, and withdrawal of the senses. In asana and pranayama, although we pay attention to our actions, our attention travels. Our focus constantly shifts as we fine-tune the many nuances of any particular posture or breathing technique. In pratyahara we become self-observant; now, in dharana, we focus our attention on a single point. Extended periods of concentration naturally lead to meditation.
7. Dhyana
Meditation or contemplation, the seventh stage of ashtanga, is the uninterrupted flow of concentration. Although concentration (dharana) and meditation (dhyana) may appear to be one and the same, a fine line of distinction exists between these two stages. Where dharana practices
one-pointed attention, dhyana is ultimately a state of being keenly aware without focus. At this stage, the mind has been quieted, and in the stillness it produces few or no thoughts at all. The strength and stamina it takes to reach this state of stillness is quite impressive. But don’t give up. While this may seem a difficult if not impossible task, remember that yoga is a process. Even though we may not attain the “picture perfect” pose, or the ideal state of consciousness, we benefit at every stage of our progress.
8. Samadhi
Patanjali describes this eighth and final stage of ashtanga, samadhi, as a state of ecstasy. At this stage, the meditator merges with his or her point of focus and transcends the Self altogether. The meditator comes to realize a profound connection to the Divine, an interconnectedness with all living things. With this realization comes the “peace that passeth all understanding”; the experience of bliss and being at one with the Universe. On the surface, this may seem to be a rather lofty, “holier than thou” kind of goal. However, if we pause to examine what we really want to get out of life, would not joy, fulfillment, and freedom somehow find their way onto our list of hopes, wishes, and desires? What Patanjali has described as the completion of the yogic path is what, deep down, all human beings aspire to: peace. We also might give some thought to the fact that this ultimate stage of yoga—enlightenment—can neither be bought nor possessed. It can only be experienced, the price of which is the continual devotion of the aspirant.
Pratyahara: Yoga’s Forgotten Limb
David Frawley
Pratyahara itself is termed as yoga, as it is the most important limb in yoga sadhana.
—Swami Sivananda
Yoga is a vast system of spiritual practices that provides tools for inner growth. It teaches us how to understand the different aspects of our nature and how to harmonize these with the greater universe within and around us. This wonderful inner science shows us how to realize our highest evolutionary potential.
How many people, even yoga teachers, can define pratyahara?
To this end, the classical yoga system (ashtanga yoga) incorporates eight limbs, each with its own place and function. Together they form a complete system for spiritual unfoldment. The eight limbs are: yama (observances), niyama (disciplines), asana (postures), pranayama (breath control), pratyahara (control of senses), dharana (concentration), dhyana (meditation), and samadhi (absorption). Of these, pratyahara is probably the least known. How many people, even yoga teachers, can define pratyahara? Have you ever taken a class in pratyahara? Have you ever seen a book on pratyahara? Can you think of several important pratyahara techniques? Do you perform pratyahara as part of your yogic practices? Yet unless we understand pratyahara we are missing an integral aspect of yoga. Without this aspect the system cannot work.
INNER AND OUTER ASPECTS OF YOGA
Yoga has an outer aspect, which consists of right living, right care of the body, and enhancement of vital energy. This is what yama, niyama, asana, and pranayama are all about. Yama and niyama build a foundation of right behavior through such values as nonviolence and truthfulness and such practices as cleanliness and contentment. Asana makes the body strong and flexible, and pranayama develops our vital energy.
Yoga also has an inner dimension—meditation or the development of higher consciousness. This is the real purpose of yoga, the focus of dharana, dhyana, and samadhi, which together form a single process—samyama, or meditation in the broadest sense.
As the fifth of the eight limbs, pratyahara occupies a central place. Some include it among the outer aspects of yoga, others with the inner aspects. Both classifications are correct, for pratyahara is the key to the relationship between the outer and inner aspects of yoga; it shows us how to move from one to the other.
It is not possible for most of us to move directly from asana to meditation. This requires jumping from the body to the mind, forgetting what lies between. To make this transition, the breath and senses, which link the body and mind, first need to be brought under control and developed properly. This is where pranayama and pratyahara come in. With pranayama we control our vital energies and impulses, and with pratyahara we gain mastery over the unruly senses—both prerequisites to successful meditation.
WHAT IS PRATYAHARA?
The term “pratyahara” is composed of two Sanskrit words, prati and ahara. “Ahara” means “food,” or “anything we take into ourselves from the outside.” “Prati” is a preposition meaning “against” or “away.” “Pratyahara” means literally “control of ahara,” or “gaining mastery over external influences.” It has been compared to a turtle withdrawing into its shell—the turtle’s shell is the mind and the turtle’s limbs are the senses. The term is usually translated as “withdrawal from the senses,” but much more is implied.
In yogic thought there are three levels of ahara, or food. The first is physical food that brings in the five elements necessary to nourish the body—earth, water, fire, air, and ether. The second is impressions, which bring in the subtle substances necessary to nourish the mind—the sensations of sound, touch, sight, taste, and smell that constitute the subtle elements: sound/ether, touch/air, sight/fire, taste/water, and smell/earth. The third level of ahara is our associations, the people we hold at heart level who serve to nourish the soul and affect us with the gunas of sattva, rajas, and tamas (the prime qualities of harmony, distraction, or inertia).
Pratyahara is twofold. It involves withdrawal from wrong food, wrong impressions, and wrong associations, while simultaneously opening up to right food, right impressions, and right associations. We cannot control our mental impressions without right diet and right relationships, but pratyahara’s primary importance lies in withdrawal from or control of sensory impressions, which frees the mind to move within.
By withdrawing our awareness from negative impressions, pratyahara strengthens the mind’s powers of immunity. Just as a healthy body resists toxins and pathogens, a healthy mind resists the negative sensory influences around it. If you are easily disturbed by the noise and turmoil of the environment around you, you need to practice pratyahara. Without it, you will not be able to meditate.
Just as a healthy body resists toxins and pathogens, a healthy mind resists the negative sensory influences around it.
There are four main forms of pratyahara: indriya-pratyahara—control of the senses; karma-pratyahara—control of action; prana-pratyahara—control of prana; and mano-pratyahara—withdrawal of mind from the senses. Each has its special methods.
CONTROL OF THE SENSES
Indriya-pratyahara, or control of the senses, is the most important form of pratyahara, although this is not something that we like to hear in our mass media-oriented culture. Most of us suffer from sensory overload, the result of constant bombardment from television, radio, computers, newspapers, magazines, books—you name it. Our commercial society functions by stimulating our interest through the senses. We are constantly confronted with bright colors, loud noises, and dramatic sensations. We have been raised on every sort of sensory indulgence—it is the main form of entertainment in our society.
The problem is that the senses, like untrained children, have their own will, largely instinctual in nature. They tell the mind what to do. If we don’t discipline them they dominate and disturb us with their endless demands. We are so accustomed to ongoing sensory activity that we don’t know how to keep our minds quiet—we have become hostages of the world of the senses and its allurements. We run after what is appealing to the senses and forget the higher goals of life. For this reason pratyahara is probably the most important limb of yoga for us today.
The old saying “the spirit is willing but the flesh is weak” applies to those of us who have not learned how to properly control our senses. Indriya-pratyahara gives us the tools to strengthen the spirit and reduce its dependency on the body. Such control is not suppression (which causes eventual revolt), but proper coordination and motivation.
THE RIGHT INTAKE OF IMPRESSIONS
Pratyahara is about the right intake of impressions. Most of us are careful about the food we eat and the company we keep, but we may not exercise the same discrimination about the impressions we take in from the senses. We accept impressions via the mass media that we would never allow in our personal lives. We let people into our houses through television and movies that we would never allow into our homes in real life!
What kind of impressions do we take in every day? Can we expect that they will not have an effect on us? Strong sensations dull the mind, and a dull mind lets us act in ways that are insensitive, careless, or even violent.
According to ayurveda, sensory impressions are the main food for the mind. The background of our mental field consists of predominant sensory impressions. We see this when our mind reverts to the impressions of the last song we heard or the last movie we saw. Just as junk food makes the body toxic, junk impressions make the mind toxic. Junk food requires a lot of salt, sugar, or spices to make it palatable because it is largely dead food; similarly, junk impressions require powerful dramatic impressions—sex and violence—to make us feel that they are real, because they are actually just colors projected on a screen.
We cannot ignore the role sensory impressions play in making us who we are, for they build up the subconscious and strengthen the tendencies latent within it. Trying to meditate without controlling our impressions pits our subconscious against us and prevents the development of inner peace and clarity.
SENSORY WITHDRAWAL
Fortunately we are not helpless before the barrage of sensory impressions. Pratyahara gives us many practical tools for managing them properly. Perhaps the simplest way to control our impressions is to cut them off, to spend some time apart from all sensory inputs. Just as the body benefits by fasting from food, so the mind benefits by fasting from impressions. This can be as simple as sitting to meditate with our eyes closed or taking a retreat somewhere free from the normal sensory bombardments—like a mountain cabin.
Yoni mudra (also known as shanmukhi-mudra) is one of the most important pratyahara techniques for closing the senses. It involves using the fingers to block the sensory openings in the head—the eyes, ears, nostrils, and mouth—allowing the attention and energy to move within. It is done for short periods of time when our prana is energized, such as immediately after practicing pranayama. (Naturally we should avoid closing the mouth and nose to the point at which we starve ourselves of oxygen.)
Another method of sense withdrawal is to keep our sense organs open but withdraw our attention from them. In this way we cease taking in impressions without actually closing off our sense organs. The most common method, shambhavi mudra, consists of sitting with the eyes open while directing the attention within, a technique used in several Buddhist systems of meditation. This redirection of the senses inward can be done with the other senses as well, particularly with the sense of hearing. It helps us control our mind even when the senses are functioning, as they are in the normal course of the day.
1. Focusing on Uniform Impressions
Another way to cleanse the mind and control the senses is to put our attention on a source of uniform impressions, such as gazing at the ocean or the blue sky. Just as the digestive system gets short-circuited by irregular eating habits and contrary food qualities, our ability to digest impressions can be deranged by jarring or excessive impressions. And just as improving our digestion may require going on a fast, followed by a mono-diet, like the ayurvedic use of rice and mung beans (khichari), so our mental digestion may require a period of fasting from impressions, followed by a diet of natural but homogeneous impressions.
2. Creating Positive Impressions
Another means of controlling the senses is to create positive, natural impressions. There are a number of ways to do this: meditating upon aspects of nature such as trees, flowers, or rocks, as well as visiting temples or other places of pilgrimage, which are repositories of positive impressions and thoughts. Positive impressions can also be created by using incense, flowers, ghee lamps, altars, statues, and other artifacts of devotional worship.
Another means of controlling the senses is to create positive, natural impressions.
3. Creating Inner Impressions
Another sensory withdrawal technique is to focus the mind on inner impressions, thus removing attention from external impressions. We can create our own inner impressions through the imagination or we can contact the subtle senses that come into play when the physical senses are quiet.
VISUALIZATION
Visualization is the simplest means of creating inner impressions. In fact, most yogic meditation practices begin with some type of visualization, such as a deity, a guru, or a beautiful setting in nature. More elaborate visualizations involve imagining deities and their worlds, or mentally performing rituals such as offering imaginary flowers or gems to imagined deities. The artist absorbed in an inner landscape or the musician creating music are also performing inner visualizations. These are all forms of pratyahara because they clear the mental field of external impressions and create a positive inner impression to serve as the foundation of meditation. Preliminary visualizations are helpful for most forms of meditation and can be integrated into other spiritual practices as well.
LAYA YOGA
Laya yoga is the yoga of the inner sound and light current, in which we focus on subtle senses to withdraw us from the gross senses. This withdrawal into inner sound and light is a means of transforming the mind and is another form of indriya-pratyahara.
CONTROL OF THE PRANA
Control of the senses requires the development and control of prana because the senses follow prana (our vital energy). Unless our prana is strong we will not have the power to control the senses. If our prana is scattered or disturbed, our senses will also be scattered and disturbed.
Pranayama is a preparation for pratyahara. Prana is gathered in pranayama and withdrawn in pratyahara. Yogic texts describe methods of withdrawing prana from different parts of the body, starting with the toes and ending wherever we wish to fix our attention—the top of the head, the third eye, the heart, or one of the other chakras.
Perhaps the best method of prana-pratyahara is to visualize the death process, in which the prana, or the life force, withdraws from the body, shutting off all the senses, from the feet to the head. Ramana Maharshi achieved Self-realization by doing this when he was a mere boy of 17. Before inquiring into the Self, he visualized his body as dead, withdrawing the prana into the mind and the mind into the heart. Without such complete and intense pratyahara, his meditative process would not have been successful.
CONTROL OF ACTION
In addition to sense organs (like the eyes and ears), we also possess motor organs (like the hands and tongue). We cannot control the sense organs without also controlling the motor organs. In fact the motor organs involve us directly in the external world. The impulses coming in through the senses get expressed through the motor organs, and this drives us to further sensory involvements. But because desire is endless, happiness consists not of getting what we want, but of no longer needing anything from the external world.
Just as right intake of impressions gives control of the sense organs, right work and right action gives control of the motor organs. This involves karma yoga—doing the actions necessary to life and avoiding those based on desire and self-gratification. Karma yoga has two parts: outer action or service (seva), and inner action, which consists of various forms of rituals (puja).
Karma-pratyahara can be performed by surrendering any thought of personal rewards for what we do, doing everything as service to God or to humanity. The Bhagavad Gita says, “Your duty is to act, not to seek a reward for what you do.” This is one kind of pratyahara. It also includes the practice of austerities that lead to control of the motor organs. For example, asana can be used to control the hands and feet, control which is needed when we sit quietly for extended periods of time.
WITHDRAWAL OF THE MIND
The yogis tell us that mind is the sixth sense organ, and that it is responsible for coordinating all the other sense organs. We take in sensory impressions only where we place our mind’s attention. The mind also coordinates the sensory and motor organs, for example by linking what the eyes see with the movements of the hand when we pick up a cup from the table. In a way, we are always practicing pratyahara. The mind’s attention is limited, and we give attention to one sensory impression by withdrawing the mind from other impressions. Wherever we place our attention, we naturally overlook other things.
The yogis tell us that mind is the sixth sense organ, and that it is responsible for coordinating all the other sense organs.
We control our senses by withdrawing our mind’s attention from them. According to the Yoga Sutra, “When the senses do not conform with their own objects but imitate the nature of the mind, that is pratyahara.” More specifically, it is mano-pratyahara—withdrawing the senses from their objects and directing them inward to the nature of the mind, which is formless. Vyasa’s commentary on the Yoga Sutra notes that the mind is like the queen bee and the senses are like worker bees. Wherever the queen bee goes all the other bees must follow. Thus mano-pratyahara is less about controlling the senses than about controlling the mind, for when the mind is controlled, the senses are automatically controlled.
We can practice mano-pratyahara by consciously withdrawing our attention from unwholesome impressions whenever they arise. This is the highest form of pratyahara and the most difficult—if we have not gained proficiency in controlling the senses, motor organs, and pranas it is unlikely to work. Like wild animals, prana and the senses can easily overcome a weak mind, so it is usually better to start first with more practical methods of pratyahara.
PRATYAHARA AND THE OTHER LIMBS OF YOGA
Pratyahara is related to all the limbs of yoga. All of the other limbs—from asana to samadhi—contain aspects of pratyahara. For example, in the sitting poses, which are the most important aspect of asana, both the sensory and motor organs are controlled. Pranayama contains an element of pratyahara, as we draw our attention inward through the breath. Yama and niyama contain various principles and practices, like nonviolence and contentment, that help us control the senses. In other words, pratyahara provides
Case Airbus
/0 Comments/in Business & Finance /by bonniejecintaQUESTION
1. What is your analysis and evaluation of the design of this intervention? What large-group intervention theories and models were applied in this case? Do you believe that the intervention made a difference in this organization?
this is the article
Selected Cases Large Group Interventions at Airbus’ Ict Organization
Airbus, an EADS company, is one of the leading aircraft manufacturers in the world. Its customer focus, commercial know-how, technological leadership, and manufacturing efficiency have propelled it to the forefront of the industry. With revenues of over €38 billion in 2012 and an industry record backlog of 4,682 aircraft valued at over €523 billion, Airbus today consistently captures about half of all commercial airliner orders.
Headquartered in Toulouse, France, Airbus is a truly global enterprise of some 55,000 employees, with fully owned subsidiaries in the United States, China, Japan, and the Middle East; spare parts centers in Hamburg, Frankfurt, Washington, Beijing, Dubai, and Singapore; training centers in Toulouse, Miami, Hamburg, Bangalore, and Beijing; and more than 150 field service offices around the world round out its physical footprint. Airbus also relies on industrial cooperation and partnerships with major companies all over the world, and a network of some 1,600 suppliers in 30 countries.
This case describes the launch of a transformation process that has taken root in Airbus’ Information and Communication Technology (ICT) function. ICT is a transnational group of around 1,300 information system professionals located wherever Airbus operates. ICT develops, maintains, and operates—24 hours a day, 365 days a year—every facet of the information systems that enable Airbus’ core business processes.
The Change Challenge
Guus Dekkers joined Airbus as Chief Information Officer in June 2008. The organization he inherited had been split, integrated, and split again in a series of reorganizations over the previous seven years. Not surprisingly, he faced a change-fatigued and cynical ICT workforce. Moreover, the reorganizations had not produced the results that Airbus top management was expecting with respect to time, cost, and quality objectives in projects or improved productivity in service delivery.
At the same time, the continuing global financial and economic crisis along with the intense competition in the aircraft manufacturing industry resulted in increasing budget pressures, growing business demands, changing business models, and increasingly disenchanted internal customers. The performance of his function needed to improve significantly and fast.
In his first year, Dekkers formed a new executive team with a mix of experienced internal managers, newcomers from outside Airbus, and others from outside the aviation industry. He worked with his new team and a core group of middle managers to define ICT’s new vision, mission, and customer-facing transnational organization (Figure 1). However, he knew that these changes were only the beginning. It could take months, or even years, to formulate and implement the necessary changes.
Figure 1 The New ICT Organization (~2009)
Details
Dekkers asked Susan Donnan to guide the implementation process as his internal change agent. She had the right background, education, and experience to facilitate large-scale change in organizations. She joined Dekker’s team in July 2009.
The Change Strategy
Working from her belief that high performance results when all parts of an organization’s design are aligned, Donnan searched for a change methodology that would simultaneously reconfigure design features and engage a critical mass of organizational members at all levels. She had studied large group interventions during her Masters of Science in Organization Development (MSOD) degree program at Pepperdine University. In addition, through her consulting work, she had experienced a variety of large group interactive events as a participant, a member of a design team, and a member of a logistics team that supported an event. She was convinced that such an intervention should be a central element of the change methodology. She considered a variety of these large group methods, including the Appreciative Inquiry Summit and Future Search, but was concerned that the current culture would not support such approaches.
In the end, she selected a process known as Whole Systems Transformation (WST), a process developed and refined by Roland Sullivan. Like other large group interventions, it is designed to help leaders engage a large, critical, and representative segment of the organization. It combines best practices in action research, small group dynamics, and large group dynamics. Unlike other large group interventions, it leads with alignment and transformation of the executive team, then transforms a critical mass of the organization, and follows up with efforts to sustain the transformation. In her experience, Donnan knew too well that an aligned leadership team was a critical success factor for transformation. She contracted with Sullivan to provide external consulting support.
Initiating Change at Ict
Phase 1: Contracting with the Leadership Team
Like most large organizations, Airbus had adopted a traditional change management approach—top management announced the change and facilitated it through extensive communication. To implement a change strategy that was clearly outside the organization’s norm, Donnan needed to convince Dekkers and his team that the traditional approach would be too slow and produce incremental change at best.
Her process began by securing executive commitment one-step-at-a-time while painting the picture for the whole journey. For example, Donnan presented a roadmap (Figure 2) that outlined the different milestones for the WST process.
Figure 2 ICT Transformation Roadmap
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She emphasized that transforming the executive team into a group with “one brain, one heart” would be a critical prerequisite for launching the “transform the ICT critical mass” phase. Committing ICT to such a radically different approach was a leap of faith and a courageous act for the executive team, especially for Dekkers. The executive team knew that they would need to learn and become different leaders to lead the transformation but they were willing to trust Donnan and Sullivan to guide them through the process.
She also recommended—because she knew from previous experience—that the organization needed to put an infrastructure in place to drive and support the transformation process. Figure 3 describes the ICT transformation infrastructure that was agreed to by the ICT executive team to support the change. Finally, she paid special attention to ICT’s Human Resource Business Partners. She was convinced that the HR organization needed to be fully on board if the change was to be successful.
Figure 3 Whole System Transformation Team Organization
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Phase 2: Transform the Leadership Team
ICT’s transformation process began with a two-and-a-half-day leadership retreat for the executive team in November 2009 that was jointly facilitated by Donnan and Sullivan. The retreat aimed to improve the effectiveness and alignment of the team and to develop “one brain and one heart” so that the team members could speak with “one voice.”
In preparation for the retreat, Donnan and Sullivan conducted ICT manager focus groups and executive team interviews. Executives were asked about the key issues in becoming a higher performing leadership team, helping ICT to become a higher performing function, thrilling internal customers, and deserving the role of a trusted business partner. The focus group and interview data were synthesized into data reports that were shared with the entire team prior to the retreat. Dekkers saw the data as reliable, valid, and rich, and it was used to ensure that the retreat addressed the right topics. Two members of the executive team worked with Donnan and Sullivan to co-design the event, acting as sounding board and providing valuable feedback.
Three important outcomes were achieved during the retreat:
Using the feedback in the data reports, the participants explored issues of trust within the team and worked on improving their relationship with Dekkers and each other. They exchanged appreciation for each other’s strengths, provided suggestions for improvements, and made requests and offers with each other. As a recently formed executive team, an important practical outcome of this conversation was new team norms and meeting ground rules. In addition, they developed a new annual calendar with dedicated meetings for operational reviews and strategic topics. Together, these deliverables had an important and positive impact on the team’s process effectiveness.
In addition to working on their relationships and team performance, the executive team visualized and described how ICT would look when its vision, mission, and strategy were fully achieved. They identified the priorities to be addressed to take ICT from where it was to where they wanted it to be: a trusted business partner delighting its internal customers. They agreed on actions and commitments that they would either personally or collectively perform to implement the ICT strategy. These included defining and refining the operating model, specifying ICT career paths, developing make or buy strategies with respect to ICT activities, building sourcing strategies for the ICT supply chain, and clearly articulating a convergence strategy to simplify the complex portfolio of business applications.
A final important outcome was the decision to hold the first two-and-a-half-day ICT summit in February 2010 with a clearly defined purpose and set of outcomes. Two members of the executive team volunteered to be sponsors for the summit. The summit participants would represent a carefully selected, diagonal crosssection or microcosm of ICT with all subfunctions, all locations, and all levels involved. The executive team nominated and empowered a design team of 13 members, representative of the summit participants, to design the event.
Phase 3: Transform a Critical Mass of ICT Members
Between November 2009 and February 2010, Donnan and Sullivan co-facilitated three two-and-a-half-day sessions with the design team to plan the summit. In the beginning, the consultants intentionally allowed the process to be ambiguous. At times, it was a messy and disruptive process, an emotional roller coaster for the team’s members. However, it was necessary to creating a safe environment where design team members could speak openly and directly about the organization’s challenges, their fears about the transformation’s success, and their hopes for the future. Several design team members were skeptical of the need for change and did not believe that they would be empowered. To address this issue, executive team members participated in the design sessions at different times, often in two’s or three’s, to show their support, to give their inputs, to answer questions, and to give feedback on the emerging summit design. The design team was surprised and impressed by the alignment in the executive team and how much they acted as one. Over the three-month period, this new group formed into a high-performing team. They were motivated and committed to creating an impactful, memorable, and transformative experience for the participants.
With Donnan and Sullivan’s guidance, the team used the following principles to guide the design of the summit:
The participants should represent a critical mass of the ICT organization, including believers and skeptics of change.
The design should create a safe place for people to speak openly and truthfully by ensuring that all small group discussions involved a maximum mix (“max-mix”) of people from different levels and sub-functions, and by ensuring no one in the group was from the same hierarchy or chain of command. All reportouts would come from the table as a whole so no individual would be exposed.
Table activities, breakout groups, and plenary sessions should engage each participant’s “whole brain,” both rational and emotional.
The purpose and outcomes for each activity should be defined clearly for participants.
Allow the large group to alternate between divergent and convergent activities and report-outs.
Diverse perspectives and the awareness of multiple realities should be generated through divergent activities, such as generating ideas, creating multiple views of today’s frustrations, or visioning tomorrow’s hopes and dreams.
Make effective, collective, and integrated decisions through convergent activities, such as “preferring” (e.g., a voting process) to identify priorities and expert panels to share views from customers or senior management.
Leverage Beckhard’s change formula to drive change activities in the summit: change is more likely to occur when the dissatisfaction with the status quo, multiplied by the vision of the future, multiplied by the clarification of first steps is greater than the resistance to change.
The design team worked long and hard to define the purpose and outcomes (Figure 4) for the summit. They debated and deliberated until everyone on the team was satisfied. Whenever the team could not agree, they referred back to the summit’s purpose and outcomes and used those as “tiebreakers.”
Figure 4 ICT Summit 2010 Purpose and Outcomes
Purpose:
The purpose of the summit is to accelerate the continued implementation of our ICT vision and mission by creating a single team with one mind and one voice, fully engaged and committed to change—enabling the success of Airbus.
Tangible Outcomes:
Identified improvement and concrete actions.
Personal commitment to change (measurable) things.
Communication and involvement plans to involve and engage the rest of the ICT organization.
Formal mechanisms to ensure execution/implementation and measurement of success.
Intangible Outcomes:
Clear understanding and buy-in of the Vision, Mission, and Strategy of ICT.
System wide understanding of operational activities and how we each contribute.
Increased respect and trust.
Change in attitude and mindset.
Commitment to being ICT ambassadors.
Eventually, the team designed the summit to take the participants through a process that mirrored the roller coaster they had experienced in the event design process. Figure 5 shows the high-level agenda.
Figure 5 ICT Summit 2010 High-Level Agenda
Day 1 Day 2 Day 3
Powerful opening
Purpose and outcomes
Building table teams
Achievements
Vision, Mission, and Strategy
Whole system working and not working
Customer view
Elephant questions generated
CIO reflections
Feedback from Day 1
Elephant questions answered
Articulation of success
Barry Oshry’s top/middle/bottom
Intergroup breakouts—(Exec/Mgrs/Non-mgrs)
Whole system action planning
Breakouts—Transversal action planning
Elephant questions answered
CIO reflections
Feedback from Day 2
Elephant questions answered
Breakouts—How to engage rest of ICT
System-wide communication
Appreciative feedback
Personal commitments
CIO inspirational sendoff
The first day of the summit began with a dramatic video that was edited just for this event, featuring the maiden flight of the A380 aircraft. Following the video, Fernando Alonso, who was the leader of the flight crew for the maiden voyage, spoke about the importance of trust. He talked passionately about the confidence he had in the A380 aircraft and its expected performance on that first flight. He described what it was like having the world’s attention on them but knowing that the flight crew would not decide to take off unless every team member was ready. He shared that ultimately his trust extended beyond the flight crew to the entire Airbus organization. No one, at any Airbus meeting, had ever spoken about emotions, like trust, as the key to success. Immediately, the participants knew that the summit was to be unlike any other meeting they had ever attended.
At the max-mix tables, participants reflected on the meaning and the implications of Alonso’s talk on trust. They reflected on and celebrated personal, team, and ICT achievements over the last 12 to 18 months. Then, after listening to ICT executive team members describe the vision, mission, and strategy, participants were encouraged to ask clarifying questions.
For the first time in their history, participants found themselves having deep and meaningful conversations sitting face-to-face with their colleagues, middle managers, and senior managers. The executive team, who were equally distributed among the tables, were coached by the design team to “trust the process.” They were encouraged to listen, be supportive of diverse ideas, and answer questions directly.Participants then discussed what was working well and what was not working well, focusing on ICT’s mission, operating model, customers, and people. These strengths and weaknesses were posted around the room and each participant was given green and red dots to identify his/her top three “working” and “not working” focus areas. The top issues for the group quickly emerged and “dotting” has since become a favorite means to arrive at consensus at ICT.
As the last activity of the day, participants were given the opportunity to pose “elephant” questions—something that they had always wanted to ask but were afraid to ask. Next, participants were invited to write down their feedback for the day. Finally, Dekkers closed the day with his reflections. He spontaneously asked participants to use their green “thumbs up” or red “thumbs down” signs to indicate how they felt the summit was going, and he was rewarded with a sea of green and a few red dots sprinkled around.
Participants continued to socialize and network in the evening over drinks and dinner with old friends and new colleagues. Because many of the participants came from around the world and worked virtually, the time for personal interaction was appreciated.
The second day of the summit began with the ICT executive team answering honestly some of the “elephant” questions developed by the participants the day before. The participants were both surprised and satisfied with the openness and willingness of the executives to answer in a spirit of vulnerability, honesty, and sensitivity.
Working at their tables, participants visualized what success would look like in five years’ time. The sharing of their creative presentations of the “future” was one of the high points of the summit. With vivid pictures of success and knowledge of the top issues, they identified actions needed from the individual, sub-function, and ICT levels to move ICT to where they would like it to be. This was breakthrough work. The day ended with Dekkers’ reflections and participants’ feedback, followed by social activities and more networking.
The third day of the summit also began with answering additional “elephant” questions from the first day. This was followed by activities to define ways to engage the rest of the ICT organization after the summit. The participants agreed on ways to communicate to the rest of the ICT community going forward. After rounds of appreciative feedback at the tables, the summit closed with the ICT executive team making personal commitments on stage in front of all, for which they received a standing ovation.
Phase 4: Implement and Sustain the Change
Immediately after the summit, the 300 participants returned to their offices and acted as ambassadors for change. At the top of the list was the wish to communicate the process and the results of the summit to the rest of the organization. Supported by communication kits and a web-based e-journal with photos and videos provided by Donnan, this occurred in all sub-functions and all locations.
In addition to communication, summit actions were translated into projects and personal objectives. Examples of projects included: harmonization and standardization of ICT activities using industry best practices; understanding these activities’ drivers and costs and measuring their performance; fighting bureaucracy and streamlining processes; working with its business partners to drive improvements on demand management and prioritization; and developing the competencies and careers of ICT employees.
ICT Executive Team members drove cross-functional or within function transformation in their respective groups. The design team volunteered to stay on as the transformation network. Together with Donnan, they monitored progress and supported the executives in driving implementation of summit actions in their respective functions. Donnan met monthly with the transformation network to share insights and best practices.
For the next 12 months, ICT Transformation remained a priority for the executive team.
Many of the transformation projects delivered bottom-line savings and enabled company objectives. The ICT organization got measurably better at delivering on its projects, services, and cost promises. Communication up, down, and across ICT improved appreciably.
Last but not least, the collaborative approach to change sent a clear message that transformation could not be successful without the engagement of ICT employees. Grass roots initiatives and volunteerism were actively encouraged. People at all levels felt greater empowerment. For example, in multiple locations, people chose to become local change agents and organized local transformation and social events, some of which continue today.
Maintaining the Change Momentum
Following the success of the first ICT summit, the
(1)
align and transform the executive team,
(2)
assess and plan the next cycle of change,
(3)
align and transform a critical mass of organization members, and
(4)
implement and sustain change process became institutionalized and has occurred every year since.
A new design team and a compelling focus from the leadership team underpins the annual cycle of the process.
For example, the focus for the 2010–2011 cycle was cross-unit or cross-functional breakthroughs involving the leadership population of about 200 ICT managers. The theme of the summit was “Leading as ONE.” The focus of the 2011–2012 cycle was creating an ICT environment that actively encourages agility, innovation, and leadership. Unlike previous summits, the third summit did not focus on what was not working or broken; rather it focused on a new way of thinking and working. Participants learned about design thinking through a simulated innovation project, explored psychological concepts that contribute to innovative thinking, and applied those concepts to four dynamics in the organization: agility and stability; anticipation and reaction; customization and standardization; and innovation and standardization.
During the months that followed the 2011–2012 summit, ICT dealt with a difficult business challenge using a collaborative approach that most people agreed would not have been possible three years earlier. It received, together with its customers, five 2012 Awards for Excellence, three of which were in the “Drive Improvement and Innovation” category and one of these won the Top Award of the Year.
In addition, ICT has made the greatest improvement in employee engagement in the company over a three-year period as measured by the Gallup Q12. Through productivity improvements, ICT also succeeded in handling 25 percent in volume growth while maintaining a flat budget in the same period.
ICT’s efforts have made important contributions to implementing its vision, mission, and strategy. It has achieved operational excellence, a critical foundation or prerequisite for becoming a trusted business partner. Going forward, the executive team would like to evolve ICT’s way of working: to be better immersed in the business strategy and business processes of its customers, to better anticipate their business needs, to focus sharply on value for Airbus, and to quickly propose and provide right-sized solutions. The journey continues.
Learning
Ever since her MSOD days at Pepperdine, Donnan had been searching for ways to facilitate system-wide alignment and to accelerate change. For her, the WST process has been the most effective methodology for achieving both. She reflected on her learning.
The importance of aligned leadership. Breakthroughs in the ICT executive team enabled breakthroughs in ICT as a whole. When leaders speak with one voice, provide a unified direction in vision and strategy, demonstrate a sense of urgency, and walk their talk, it gives organization members the confidence to act in alignment for the health of the whole. On the other hand, when leaders are not aligned and give conflicting directions, this causes conflicts and confusion that cascades all the way down the organization.
The critical roles of the event design team. The ICT case would not have been a success without the effective use of the event design team. In addition to bringing in data from across the ICT organization and mirroring the organization’s current state as part of the design process, the event design team members took an active role in facilitating different modules in the summit, listening to the participants during the summit, synthesizing the participants’ daily feedback, and refining the summit design based on their feedback. The teamwork within the team was critical for the smooth execution of the summit.
The real work of transformation occurs between large group interventions. While many people focus on how a large group event “releases the magic” of a paradigm shift, the real work of transformation occurs after the event or between events in the “implement and sustain change” phase. ICT is part of a global organization that has experienced and continues to experience tremendous growth and challenge. Managers are typically overloaded just running and delivering today’s business; requests to transform the business for the future are often overwhelming. Moreover, saying “no” to lesser priorities remains difficult for the organization. As a result, finding the resources and time for transformation remains a challenge. ICT’s experiments with a mix of structured and emergent approaches yielded two major lessons. First, do not launch more actions than the organization can handle, and second, focus more on cross-functional improvements that optimize overall results rather than local maximization.
The lead and lag indicators of success. Organization change is a journey that takes time and requires incredible patience. Following a large group interactive event, the lead indicators of success are team spirit, confidence, commitment, relationships, energy, trust, inclusiveness, transparency, and alignment. These are difficult to measure but can be felt, observed, and captured in anecdotal stories. Later, improvement projects lead to more tangible results, such as behavioral and engagement changes. However, only when the improvement projects are successfully implemented can improved business results be seen. These are the lag indicators of success. Executives and managers must understand that the easy-to-measure lag indicators of success will come if they recognize, support, and nurture the difficult-to-measure but equally valuable lead indicators of success. Many change initiatives fail because executives insist on instant results, give up too soon and move onto the next change.
Transforming how the organization deals with change. The ultimate measure of organization development is the degree to which the ability to change again is enhanced or diminished. Without any doubt, the WST process has helped people in ICT build a change capability. Realizing that transformation is a journey and not a destination, ICT people are no longer paralyzed by change and are more likely to embrace change as an opportunity rather than a threat. They have developed greater capacity and capability to act in aligned ways. In reflecting on the organization’s journey, Dekkers said, “Today, our ICT community is better mobilized and motivated to change.”
WST needs to be repeated regularly. In today’s complex, chaotic, and uncertain world, an organization’s ability to learn and innovate at the individual, team, and organizational levels allows the organization to adapt. Change is a constant and the days of returning to stability or business-as-usual are gone. To ensure a sustained long-term journey, the WST process must be repeated to regularly restore whole system alignment while adapting to internal and external drivers for change.
In conclusion, each year that the ICT has used the WST process, it has become more and more competent to self-direct and master its own change process. The organization is becoming better at doing what it says it will do, more respected by its customers, and more agile. ICT people is learning how to learn in real time as an entire function.
the second question is 1) Critique SHS’s visioning process.
2) What implications does the visioning process have for the intervention you want to implement? How can you take advantage of the process in your action plan?
and this is the article.
Selected Cases The Sullivan Hospital System
Part I
At the Sullivan Hospital System (SHS), CEO Ken Bonnet expressed concern over market share losses to other local hospitals over the past six to nine months and declines in patient satisfaction measures. To him and his senior administrators, the need to revise the SHS organization was clear. It was also clear that such a change would require the enthusiastic participation of all organizational members, including nurses, physicians, and managers.
At SHS, the senior team consisted of the top administrative teams from the two hospitals in the system. Bonnet, CEO of the system and president of the larger of the two hospitals, was joined by Sue Strasburg, president of the smaller hospital. Their two styles were considerably different. Whereas Bonnet was calm, confident, and mild-mannered, Strasburg was assertive, enthusiastic, and energetic. Despite these differences, both administrators demonstrated a willingness to lead the change effort. In addition, each of their direct reports was clearly excited about initiating a change process and was clearly taking whatever initiative Bonnet and Strasburg would allow or empower them to do.
You were contacted by Bonnet to conduct a three-day retreat with the combined management teams and kick off the change process. Based on conversations with administrators from other hospitals and industry conferences, the team believed that the system needed a major overhaul of its Total Quality Management (TQM) process for two primary reasons. First, they believed that an improved patient care process would give physicians a good reason to use the hospital, thus improving market share. Second, although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) had enacted policies some time ago encouraging hospitals to adopt continuous improvement principles, SHS’s system was sorely behind the times. The team readily agreed that they lacked the adequate skills and knowledge associated with implementing a more sophisticated TQM process. This first meeting was to gather together to hear about how TQM, engagement, and other strategic change processes had advanced and the issues that would need to be addressed if more sophisticated processes were to be implemented. During the meeting, you guided them through several exercises to get the team to examine methods of decision making and how team-based problem solving
Nursing Question
/0 Comments/in Health Medical /by bonniejecintaQUESTION
Write a quality improvement proposal, 5-7 pages in length, that provides your recommendations for expanding a hospital’s HIT to include quality metrics that will help the organization qualify as an accountable care organization.
Introduction
Health care has undergone a transformation since the release of the Institute of Medicine’s 2000 report To Err Is Human: Building a Safer Health System. The report highlighted medical errors as a contributing factor leading to poor patient outcomes. The Institute of Medicine challenged organizations to implement evidence-based performance improvement strategies in order to improve patient quality and safety. Multiple governmental and regulatory agencies, such as the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Quality and Research (AHRQ), vowed to strengthen and improve incentives for participation, safety, quality, and efficiency in accountable care organizations (ACOs).
Health information technology (HIT) performs an essential role in improving health outcomes of individuals, the community, and populations. Health organizations, consumer advocacy groups, and regulatory committees have made a commitment to explore current and future opportunities that HIT offers to continue momentum to meet the Institute of Medicine’s goal of improving safety and quality.
Understanding HIT is important to improving individual, community, and population access to health care and health information. HIT enables quick and easy access to information for both patients and providers. Accessible information has been shown to improve the patient care experience and reduce redundancies, thereby reducing health care costs.
This assessment provides an opportunity for you to make recommendations for expanding a hospital’s HIT in ways that will help the hospital qualify as an ACO.
Preparation
In this assessment, you will again assume the role of case manager at Sacred Heart Hospital. This time, you are asked to develop a strategy for tracking quality metrics to help facilitate the hospital’s qualification for ACO status.
Before drafting your proposal, complete the following simulation exercise:
Challenge Details
You continue your work as a newly hired case manager at Valley City Regional Hospital, located in Valley City, North Dakota. As you know, VCRH was recently acquired by Vila Health, a large health care system that operates hospitals and clinics in several Midwestern states.
Vila Health wants all of its hospitals to be Accountable Care Organizations. However, as a small rural hospital, VCRH will have to make many improvements in order to qualify for ACO status. In order to develop a strategy for making these improvements, the first step will be to track quality metrics better so that the hospital will have data to work with to measure problems and to track improvements. You, the new case manager, will be asked to develop a strategy for tracking quality metrics to help facilitate the hospital’s qualification for ACO status.
From: Karen Dellington
To: Inna Marisse Caing
Hello! Thank you so much for all your hard work in helping VCRH to develop a strategy for achieving Triple Aim Outcomes. The hospital has another, similar project, and we need your help to complete it.
As you know, VCRH was recently acquired by Vila Health. Vila Health wants all of its hospitals to become Accountable Care Organizations (ACOs). However, in order to qualify to become an ACO, VCRH will have to make a number of quality improvements.The Center for Medicaid and Medicare Services says that an organization has to show quality improvements in the following areas in order to become an ACO:
Patient experience.
Care coordination/patient safety.
Preventative health.
So, here’s what I’d like for you to do:
First, I’d like for you to meet with a patient named Caroline McGlade, who has recently been diagnosed with breast cancer. Mrs. McGlade is a typical example of one of our patients who hasn’t gotten enough preventative care. I’d also like for you to look at her EHR—which, as you’ll see, isn’t very thorough. As you think about this case, ask yourself this: how could we be tracking data in cases like this one better to help us to make the improvements we need to qualify for ACO status?
Second, I’d like for you to interview a series of stakeholders who can provide you with information about changes that need to be made in our HIT.
After completing these tasks, I need you to write recommendations for how we can expand our HIT to better include quality metrics—with the ultimate goal of qualifying for ACO status.
This is a challenging assignment, but I know that you’re up to it! Best of luck.
Karen
Patient ID:
DOB:
Gender:
Phone:
Address:
Insurance:
Primary Care Provider: Dr. Brown
Contact Permissions: Mike McGlade, husband
History – 04/24/19
H&P: Mrs. McGlade is a 61-year-old woman with a PMH of breast cancer.
Family Hx Mother:
Father: Alive.
Sister:
Meds on Adm:
Neuro:
Cardio: EKG Normal.
Respiratory:
GU: Menses have ceased.
GI:
POC:
Allergies & Medication – 04/24/19
Allergies: NA.
Medication: Estrogen
Lab – 04/23/19
CBC:
RBC: 5.1
HCT: 38.8
HGB: 14.7
WBC: 11.1
MCV: 81
MCH: 31
PLT: 301
BMP:
Glucose: 399
BUN: 15
CR: 1.1
Sodium: 138
Potassium: 4.2Chloride: 106
Chloride: 106
Co2: 23
Calcium: 11
Protein: 7.9
CA-125-1700 U
Primary Care Notes – 04/24/19
04/21/19: Mrs. McGlade is a 61-year-old woman with a lump that may be breast cancer. DX: Dr. McCall, suspected breast cancer
Called Dr. Brown-GYN ONC. Consult expected for tomorrow. Suggested CA-124, HCG, AFP prior to consult.
04/23/19:
04/24/19: MRI negative for spinal cord or brain lesions.
Plan of care: Breast oncology consult.
CBC, BMP, CA-125, HCG, AFP, Paracentesis, in am. PT, SW, CM consult.
GYN/ONC Note – 04/24/19
61-year-old woman with a possible PMH of breast cancer.
Her initial exam revealed an enlarged mass in right breast. GYN/ONC physical exam. Based on physical presentation, blood work and radiology studies, breast cancer is confirmed. Discuss with pt. treatment options such as surgery and/or chemotherapy and radiation.
Accountable Care Organizations: What Providers Need to Know
The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health & Human Services (HHS), finalized regulations under the Affordable Care Act to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program (Shared Savings Program) will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. Provider participation in an ACO is purely voluntary.
In developing the program regulations, CMS worked closely with agencies across the Federal government to ensure a coordinated and aligned inter- and intra-agency effort to facilitate implementation of the Shared Savings Program.
CMS encourages all interested providers and suppliers to review this program’s regulations and consider participating in the Shared Savings Program.
This fact sheet provides an overview of ACOs.
It’s time to meet Caroline McGlade, a 60-year-old patient who has breast cancer. Remember, you’ve been asked to talk with this patient because she’s a typical example of someone who hasn’t been getting preventative care—a factor that makes it difficult for the hospital to qualify for ACO status. Be sure to refer back to her EHR, and think about ways the EHR could be modified to better collect qualify metrics for patients like this one.
Mrs. McGlade, how are you feeling?
Caroline: I feel just fine. A little scared, I guess. But it’s hard to believe I have cancer. I mean, I don’t feel sick at all. I guess I’ll start feeling sick once they start giving me that chemo. I’m not looking forward to that, believe me!
Can you tell me a little bit about yourself?
Caroline: I guess you could say I’m a pretty typical lady from Valley City—not very exciting! I’ve lived in this county all my life. I grew up on a farm near Tower City. Then I got married to my high school sweetheart and we live on a big plot of land about 45 minutes from here. I wouldn’t want to live anywhere else. Sometimes I wish we had more neighbors, but Mike and I like living in the middle of nowhere! I guess you could say we’re independent spirits? That’s how we were raised—we don’t like to be dependent on other people. We have four kids—our son lives in Valley City and our three girls live in the Fargo-Moorhead area. Nine grandkids so far.
How did you discover the cancer?
Caroline: I felt a lump. It wasn’t big and at first I didn’t think it was anything to worry about. I don’t like running to the doctor every time something feels weird in my body—I mean, that’s just part of getting old, right? But my daughter finally convinced me to get checked. And I guess I’m glad I did. Stage 3 breast cancer—that’s pretty serious.
Have you ever gotten a mammogram?
Caroline: Yeah. I think twice? Maybe three times? It’s been a long time though. I don’t know…I guess they could’ve caught the cancer earlier if I went more often. But I’ve heard that mammograms aren’t all that important. You can find a lump pretty easy by checking your breasts, right? And I do that once a month or so.
Do you regularly see a gynecologist?
Caroline: Well, I did when I was pregnant—but that was a long time ago. My youngest daughter is 30 years old. And when I needed birth control pills—then I used to go. But there’s no reason for me to go at my age, right? It’s not like I need birth control pills anymore—I mean, I finished with menopause when I was 47! I don’t know—I guess maybe I should have gone more often. But I really hate … you know, putting my legs in those icky metal things? I just don’t like having doctors poking around my private parts. Maybe if there were a woman doctor around here I might have gone more often, but around here there’s not a lot of choice who you see. All the gynecologists I’ve ever been to, they’re old guys who are kind of creepy.
Do you regularly see a primary care physician?
Caroline: No, not anymore. When Dr. Tucker was alive my husband and I used to go… but he died about seven, eight years ago? And we’ve never bothered finding a new doctor. Like I said, there aren’t a lot of doctors around here, and we’d have to drive 45 minutes to get to one. Gas is expensive, so we don’t like to go on trips that aren’t necessary. And I don’t want to go to someone I don’t know. Dr. Tucker, he was my doctor since I was a teenager. I guess we ought to find a new doctor, but we just don’t get sick very often. A few times we’ve gone to Urgent Care, but we don’t like to go running to the doctor every time we have some aches and pains. We can’t stand people who do that.
Have you ever gotten a colonoscopy?
Caroline: NO! No no no. Nobody’s sticking a camera up in there, or whatever it is they do. My husband’s never gotten one either–I’m pretty sure he’d rather die! Besides, those tests costs a fortune.
How do you feel about preventative care?
Caroline: You mean, like shots and such? We got all the immunizations for our kids. Oh, do you mean, like preventative care for adults? Like getting your cholesterol checked and all that? I don’t know. I guess I kind of feel like that’s a waste of time. And it’s expensive too. We just try to eat healthy and get some exercise. Neither one of us is overweight, so it’s not like we’re going to get diabetes or anything like that.
Why haven’t you gotten more preventative care?
Caroline: Well, why would we? Like I said, we’re pretty healthy and we don’t like to run to the doctor for every little thing. If there were a doctor around who I trusted, I guess I would go more often. Plus going to the doctor is expensive. It didn’t used to be so bad when we were younger, but now going to the doctor costs a fortune. My husband and I are doing okay, but we definitely don’ t have money for extras.
Have you always had health insurance?
Caroline: No, we’ve almost never had health insurance. Just during this one period when my husband was working in town for a factory that closed down. But we have health insurance now, thanks to that Obama! We don’t have a choice anymore, do we? Although much as I hate to admit it, maybe it’s a good thing we have insurance. Otherwise I don’t know how we’d pay for cancer treatments.
Do you think your views about health care and preventative care are typical for people in this area?
Caroline: Yeah. I don’t know anyone who goes to the doctor a lot. Most of the people I know, they have even less money than we do. And like I said, people are independent around here. People don’t like to ask for help unless we really need it. So going to the doctor a lot… I guess that’s not something people like to do around here.
From: Karen Dellington
To: Inna Marisse Caing
I see you’ve spoken with Caroline McGlade! I wanted you to meet with her because her case is typical of so many that we see around here. We need to address the types of issues you encountered with this patient—especially regarding preventative care—if we’re going to become an ACO. And before we can do that, we need to gather data on these issues.
I’ve arranged for you to meet with a panel of four people at VCRH so you can ask them some questions about the strategies we need to develop in order to better track quality metrics. The panel will consist of:
Todd Chester, Director of Quality Assurance.
Mary Loudsinger, a social worker.
Pete Wade, Director of Information Technology.
Trish Walstrom, the Care Coordination Manager.
Thanks again for your hard work!
–Karen
EHR Meeting
What is your opinion of the hospital’s EHR?
Trish: Um, well…
Pete: It’s okay, Trish. You don’t have to hold your tongue around me. I know the hospital’s EHR has a lot of problems.
Todd: In all fairness, Pete, it’s not worse than EHRs you’d find at many small-town rural hospitals. We simply haven’t had the budget to improve it.
Pete: That’s for sure. I don’t have the budget to do much of anything.
Todd: We just haven’t made the EHR much of a priority. The wish list of things we need at this hospital is pretty large, and that’s always lower on the list than things like new equipment. But now that there’s this push to become an ACO, we’re going to have to find the funds to upgrade the EHR. Otherwise, we’re never going to be able to track the metrics we need to make improvements.
Trish: And that’s the problem with the EHR, in my opinion. It’s not set up to track much of anything. Patients come in here multiple times, and we have to ask them the same questions over and over again because the EHR just isn’t comprehensive enough. And if the EHR isn’t comprehensive enough to help patients on an everyday basis, it sure isn’t comprehensive enough to be used for data collection purposes.
How would you recommend updating the hospital’s EHR?
Mary: Well, in my opinion, one of the biggest problems is that there simply aren’t enough categories to enter information. I wish there was a social work tab so that I could keep track of visits with patients. If we had that tab, we could record things like patient barriers to care, and other important information that might impact their treatment.
Trish: Oh, I totally agree, Mary. There’s just not a lot of places to add non-medical information.
Pete: I’m not sure what to do about that. it would be great if we could add more categories, but that’s not easy. We’d have to work with the vendor, and that could be expensive.
Todd: Oh, I know, Pete. But if we’re ever going to become an ACO, we might need to find a way to make this investment.
Trish: So, here’s a suggestion for you, since you’re the one coming up with a strategy for tracking metrics. Why don’t you take a good look at our EHR and think about places where we could add more categories? And other updates too.
Are there changes that need to be made in how the EHR is used?
Trish: I’ll say! The system takes a long time to navigate. It’s not the least bit intuitive. And that means that nurses and case managers sometimes don’t enter information as thoroughly as they need to.
Pete: Aren’t they required to fill it out in detail?
Trish: Well, yes. But this hospital is understaffed. Sometimes the EHR isn’t filled out as completely as it ought to be.
Pete: What? Now that sounds like a serious problem. How are we ever going to use the EHR to track quality metrics if people aren’t even using it correctly?
Todd: I’m really glad you brought that up, Trish. We should discuss this further. I know that part of the problem is technical; we’re going to need to spend some money to make the system more user-friendly. But it sounds like we’re going to need a change management strategy as well. We need it to be the norm for people to use the system correctly.
Trish: I’m fine with that. But are you going to address the reasons why people aren’t filling the EHR out completely? It’s not because anyone is lazy. It’s because they’re busy.
Todd: I understand that. And we do need to be cognizant of people’s schedules as we develop our change management strategy.
How can we better track issues related to preventative care?
Todd: Well, like we’ve already discussed, we need to include more fields on the EHR so we can track more kinds of information. Other than that, well, that’s something we’re really going to need to discuss. I don’t have all the answers. But I can’t emphasize enough what an important issue this is. People are not getting the preventative care they need in this county, and that’s driving up costs and driving down quality of care.
Pete: But how do we measure that?
Todd: Well, we do have data from Barnes County that measures some statistics. For example, the data shows that women aren’t getting Pap smears and mammograms, and that people aren’t getting enough colonoscopies. That’s a start. But I think we need more nuanced data.
Trish: I agree. For example, the county data doesn’t track what percentage of women are seeing gynecologists, or how often they’re going. There’s data about how many people don’t have a primary physician, but there’s not data about how many women see a gynecologist. And I’d like to see more nuanced data in relation to mammograms. The only stat they provide is how many women over 40 have had a mammogram in the past two years. I’d like to know how often they get mammograms, and how many women have never had one.
Mary: And in addition to these numbers, I’d like to know why. Are women not getting mammograms because of cost? Or because there aren’t enough providers around here? Or because they just don’t think it’s important? I mean, based on my experience, I can tell you why I think women aren’t getting mammograms.
Pete: But we need nuanced data to back that up.
Mary: Exactly!
Trish:And I think that’s true for a lot of the county data. There’s good surface information in there, but we need more nuanced data on a lot of different things. I recommend that you take the time to read through the data carefully, and come up with some ideas for areas where we need to do more nuanced research.
Are there social factors that the hospital could be tracking better?
Mary: Yes! Where do I ever start?
Trish: You could start with barriers to care. As a care coordinator, I see every day that there are barriers to care that make it difficult for people to get the care they need.
Mary: Absolutely. Poverty, lack of transportation, lack of access to providers and specialists in this region—those are the big barriers to care that we see all the time.
Trish: And there are other issues too, like our large population of vets with PTSD—some of them don’t want to go into town and see a health provider.
Mary: Plus there’s just the general attitude of distrust that a lot of people around here have in regard to the health care system.
Pete: But how do you measure that in terms of quality metrics?
Mary: That’s a good question, Pete. I don’t know how to measure that attitude, but I know from experience that it serves as a very real barrier to care.
Pete: I don’t mean to be a downer here, but I’m confused. I know it’s important for you all to track social factors so you can treat patients better. But what does that have to do with tracking quality metrics that would help us to become an ACO?
Todd: Good question, Pete. The thing is, we need to track problems that are making it difficult for us to give the best health care experience we can. And a lot of those problems are directly related to social issues, like poverty and other barriers to care. If we can figure out how to measure these problems more effectively as they relate to health care, we could come up with effective strategies for improving people’s health care experiences.
Are there special population needs we could be tracking better?
Mary: And we’re not tracking other things either, like home care needs for disabled vets.
Pete: For starters, we could add a demographic box for veterans on the EHR.
Mary: Great idea. And I hate to bring this up repeatedly, but if there were a field in the EHR to enter information about social work concerns, we could enter that information there as well.
Trish: Are there other special populations we need to be tracking?
Mary: Of course. This county may be over 90 percent white, but that doesn’t mean there aren’t people of color around here. We need to do a better job tracking the needs of everyone in this county.
Are there partnerships that the hospital could form with other organizations to track metrics better?
Mary: I think teaming up with the public health department would be a good start, don’t you? They’re already collecting data that we can use. Maybe we could work with them to collect more nuanced data, or different kinds of data.
Todd: That’s a very good idea, Mary. In addition, one thing I think we really need to do is link our EHR with some of the clinics in the area.
Pete: And like I said, that could be expensive.
Todd: I know. But we have to prioritize this.
Trish: I think we could do more than just linking the EHR. We could work with clinics in the area to help us collect data about things like barriers to care and other patient information.
Conclusion
You have completed the Vila Health: Quality Metrics Tracking challenge. Based on this information, you should now be able to make recommendations for strategies that Valley City Regional Hospital can use to track quality metrics better—with the ultimate goal for becoming an ACO.
Investigate strategies for expanding the health information technology (HIT) at a small rural hospital to better track quality metrics.
Recommend strategies for improving the tracking of quality metrics at a small rural hospital so that this hospital can qualify to become an ACO
Develop a proposal to expand Sacred Heart Hospital’s HIT to better include quality metrics—with the ultimate goal of qualifying for ACO status. Use the following template for your proposal:Writing the Proposal
The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your proposal addresses each point, at a minimum. You may also want to read the Quality Improvement Proposal Scoring Guide to better understand how each criterion will be assessed.
Recommend ways to expand the hospital’s HIT to include quality metrics.
How will you collect information and solve the problem of coordinating care for patients who are not getting diagnostic tests, such as mammograms or colonoscopies?
What can you do to track health information from the community or the target population to make necessary improvements?
How can you most effectively and efficiently show the role of informatics in nursing care coordination?
What evidence supports your recommendations?
Describe the main focus of information gathering in health care and how it contributes to guiding the development of organizational practice.
Provide examples to support your QUESTION.
Identify potential problems that can arise with data gathering systems and output.
What suggestions can you make for avoiding those problems?
Write clearly and concisely, using correct grammar and mechanics.
Express your main points and conclusions coherently.
Proofread your writing to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your proposal.
Support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
Is your supporting evidence clear and explicit?
How or why does particular evidence support a claim?
Will your audience see the connection
Format your proposal using APA style:
Use the APA Style Paper Template [DOCX] provided. Be sure to include:
A title page and references page. An abstract is not required.
A running head on all pages.
Appropriate section headings
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