Building Change Management Capabilities For Massive Change.

Executive Summary

Dive into a compelling real-life example that showcases how to drive a large-scale transformation, simultaneously generating quick wins and setting the groundwork for deep-seated, sustainable change. Learn about the different layers of a balanced and holistic CM strategy. This case study provides timely insight into how one large medical organisation is transforming its (infra)structure, processes, and day-to-day operations to become a next-generation entity within its sector. 

Highlights:

How would you handle a large-scale transformation?

This project will impact 4500 people, with more than 150 projects rolled out over five years. The journey begins with no preexisting CM resources. Please keep in mind that this transformation is still ongoing. 

• NEXUM is building Change Management organisational capabilities from the ground up. We are taking it from ‘ground zero’ all the way up with a comprehensive strategy that focuses on establishing robust internal governance (Enterprise Change Management or ECM) while infusing CM skills and culture into every organisational level.
• NEXUM is taking a pragmatic and context-sensitive approach, with a cross-sectional action plan for managing saturation and co-creating the change with impacted populations. For a complete cultural transformation to occur, everyone in the organisation needs to have ownership of and commitment to the new values of the organisation (Awareness, Desire) before getting equipped to implement the changes (Knowledge, Ability).
• NEXUM is empowering the people. With NEXUM’s guidance, Change Managers, sponsors and middle managers are working together to ensure successful transformation - each playing a critical role in creating the right conditions for success.
• All CM actions and tools are available for you to explore! Keep reading and dig deeper by following the suggested links.

What the Grand Hôpital de Charleroi says: 

"The mission of the GHdC is to place the patient at the heart of everything we do. With Nexum's Change Management approach and our internal Change Managers, we are also emphasising how important our employees are to us by putting them at the centre of the GHdC. Furthermore, Nexum’s intervention has allowed for a structured integration between Change Management and Project Management - which plays an essential role in ensuring that this approach succeeds."

Alexandra Dupire, Change Management Officer of Grand Hôpital de Charleroi

Background: Building the healthcare facility of tomorrow

Sector: Medical

Dates: 2019-2024 (ONGOING)

Number of impacted people: 4500

Type of change: relocation and upgrading (see below)

Currently split across five different locations, the Grand Hôpital de Charleroi (GHdC) is looking to create a cutting-edge “Integrated, Innovative Healthcare Campus” by 2024. The redeployment of this Belgian Hospital will propel it towards pioneering status as a “next generation” facility with (1) the relocation of its premises and (2) the implementation of massive modernisation plans.

Type of change: Full-spectrum, high-impact

As a part of this strategic redeployment, four key initiatives were launched with a high to moderate impact on 10 out of PROSCI’s 10 domains of change and an immediate effect on 4500 people’s routines:

(1) Centralisation: Consolidating separate locations into a single cohesive unit and relocating teams accordingly (i.e. location)

(2) Integration: Establishing an overarching culture that is patient-centric (i.e. professional roles, critical behaviours, mindset and beliefs)

(3) Homogenisation and Optimisation: Unifying procedures and processes long split into geographic clusters (i.e. processes and systems)

(4) Upgrading and Optimisation: Introducing state-of-the-art technology (i.e tools)

The challenge: Driving massive change, preventing saturation

The sheer number of changes (150) enforced by this initiative, some of which requiring quick adoption from those impacted to be successful, means that it relies heavily on proficient Change and Project Management. The Covid-19 pandemic has left healthcare systems exposed and vulnerable, making it even more crucial to address the pressing risk of change saturation that comes with so many concurrent projects.

The initial assessment showed an absence of Change Management culture and structure, with uneven levels of progress from one project to another. In light of this situation, the GHdC’s steering committee decided to allocate substantial resources to managing the human side of the change. 

The solution: Holistic, multi-layered

NEXUM’s intervention at the Grand Hôpital de Charleroi is designed to provide a holistic and long-term approach to Change Management, addressing multiple levels of implementation in an integrated way: (1) empowering a portfolio of projects, with an overarching cultural transformation; (2) building an internal governance structure in charge of overseeing current and future changes; and (3) curbing saturation risks by prioritising activities based on their impact on stakeholders.

On top of the actions involving teams, middle managers and collaborators, NEXUM is implementing a comprehensive Enterprise Change Management (ECM) strategy to increase the Hospital’s agility and change readiness. As part of this effort, CM practices, processes and skills are becoming organic components embedded into GHdC’s identity- paving the way for the organisation to become entirely self-sufficient.

In practice, step by step

A.    ENTERPRISE CHANGE MANAGEMENT LEVEL

Creating a CMO and certifying Change Managers. 

NEXUM’s strategy for facilitating this large-scale transformation revolves around constructing a Change Management Office (CMO) and establishing an influential “Change” Community to address the human aspects of the change. This community is and will continue to be an invaluable resource for providing support during the implementation process and reinforcement down the line. 

By certifying roughly 25 members of the staff (nurses, logistics staff members, administrators) in PROSCI methodology, NEXUM constructed a base layer of CM skills throughout the organisation. Coaching these members through key projects also ensures that they can effectively utilise their newly acquired knowledge for successful outcomes.

Mapping out critical projects.

The more a project’s success depends on adoption and utilisation – meaning, its outcomes rely on transforming existing routines - the greater the value of Change Management. Identifying critical projects that require heavier intervention in terms of dealing with the human side of the change has enabled NEXUM to pinpoint priority areas of action and work streams.

Preparing CM key roles and crafting the story for change.

Forging a community of Change Managers is a pivotal aspect of nurturing a change-driven culture. But to ensure the successful implementation of projects, other key stakeholders, such as Sponsors and Managers, must be properly trained and informed on their expected roles. Sponsors – Executive Committee members and Chief Medical Officers alike – have been thoroughly coached on the ABC of sponsorship: being Active and visible; Building a coalition of sponsors; Communicating with employees effectively. Furthermore, all middle managers have received training on the essential CLARC roles they must assume to cascade the change (Communication, Liaison, Advocate, Resistance Management and Coaching).

Organising group workshops to collect feedback on the staff’s concerns and expectations regarding the transformation was critical in ensuring every voice was heard. These sessions helped provide bottom-up direction for further actions and contributed to crafting a compelling story of the change (collective narrative).

Establishing governance at the organisational and project level.

Establishing adequate governance at the organisation level and on a per-project basis is critical for success. PROSCI’s PCT Model (Project Change Triangle) provides the foundations to bring together three key actors in this process: Sponsor, Project Manager and Change Manager. This model facilitates decision-making while ensuring operational effectiveness throughout the organisation.

Catalysing the cultural transformation.

Uniting the 5 sites by location was only half the equation - they also needed to be brought together culturally. To ensure this happened, an overarching “cultural transformation” (stream culture) project was launched alongside a series of focused initiatives (see above). Working together with the Executive Committee, NEXUM has helped define the values and behaviours that should reflect GHdC’s new vision. This first high-level brainstorming session was quickly followed by an effort to co-create values. Every staff member was included in this process and asked to select 10 items from a Barrett’s survey which focused on personal values, current GHdC culture, and what they wanted the future GHdC culture to reflect.

The GHdC decided to embrace four core values that are now pivotal in guiding its rebranding efforts. To jumpstart the cultural transformation, NEXUM has designed a roadmap that showcases how these values can be reflected in individual behaviours. This blueprint will assist members in cascading and infusing this cultural transformation from top to bottom of the organisation.

B.   PROJECT LEVEL

Attached to various fields such as catering, pharmacy, logistics flows, computer park, operating room, medical practices (RAac), user journeys/mobility and quality accreditation - between 15 to 20 projects have been identified as top priorities. NEXUM’s intervention at the project level is structured in 6 different steps and incorporates several PROSCI methodology tools. Please keep in mind that this transformation is an ongoing process.

Winning Triangle number 1.

During the inaugural PCT session, all critical stakeholders—the Project Manager, Sponsor and Change Manager— come together to ensure a shared vision for successful project completion and change implementation.

Coaching Change Managers through the preparatory phase.

NEXUM guides newly certified Change Managers through the initial preparation stage of PROSCI’s 3-phase process (Prepare Approach, Manage Change, Sustain Outcomes) to ensure a complete understanding of how changes will affect team members’ workloads and working routines.

Designing « Ad hoc » plans.

NEXUM encourages a needs-based approach to every project and works with Change Managers to develop plans tailored according to the impact analyses conducted during the preparatory phase.

Winning Triangle number 2.

To validate the analysis and plans proposed, a new “PCT Triangle” session is organised. This serves as both an opportunity for decision-making and collective reflection to feed into the story of the change (as it relates to this project), providing sponsors and managers with a robust communication framework.

Integrating Change Management and Project Management.

The validation phase is quickly followed by establishing ‘change’ milestones and integrating them with the ‘project’ ones for an effective, integrated execution of CM/PM plans. 

Implementing Change plans.

Managing the human side of each change project requires implementing specific change plans (e.g. communication plan, sponsorship plan, training and coaching programs, and resistance management plan). The story of the change is cascaded from the sponsor to its coalition; managers are equipped with a clear understanding of their CLARC roles (see above); any fears or hopes for team members are collated to provide timely responses that will drive engagement.

C.    MITIGATION OF CHANGE SATURATION RISKS

Understanding the impact of change projects on the people is essential to reduce the risk of saturation and interference with daily operations. Mapping out projects helps identify potential sources of blockage, making it easier to adjust actions and prioritise in terms of Change Management or Project Management

D.    TRACKING PROGRESSES

By leveraging the power of three research-based models, it is possible to create meaningful metrics and performance indicators (KPIs) that enable more effective follow-up work. The PROSCI Change Triangle (PCT) model is an invaluable resource for any project at any stage, providing clarity on change objectives, aligning stakeholders and pinpointing the actions needed to remain on track and keep the momentum going. The ADKAR model provides a framework that measures each member’s progress on the change continuum (Awareness, Desire, Knowledge, Ability, Reinforcement). Heat maps are the main visualisation and analysis tool for saturation. The combination of these tools creates a complete dashboard to track progress and course correct.

Main takeaways

• Meeting the challenges of today and tomorrow with the ECM approach. NEXUM is creating an internal Change Management governance structure as part of GHdC’s relocation project. Integrating Change Management into the organisation’s DNA will increase its agility and overall change-readiness.
• The “fast-track” to long-term results: Change Management culture and skills for all. Building a CM culture at all organisational levels is crucial for long-term success. Targeted actions include Change Manager certification programs, PCT triangles, Sponsor(s)/Manager(s) training sessions, and support at the project level.
• Making change happen with sponsors and managers. Sponsors and Managers can make or break the change. By fully understanding the magnitude of their role in managing the human side of the change, sponsors bring an identity to each project that strengthens team cohesion and guarantees sustainability. As managers are positioned close to the field, they serve as indispensable catalysts for change. Through training, managers can now effectively cascade the change within their respective teams, gather feedback from firsthand experiences and ensure a quick yet lasting adjustment of working routines.
• When CM becomes PM’s best ally. Change Management has developed into a strategic internal entity that encourages project leaders to set milestones, KPIs, and goals. More than an add-on to Project Management, CM becomes a driving force.
• New values come to life. Geographical relocation spells cultural transformation. Through a collaborative bottom-up approach to defining the core values of the future organisation, Nexum and the GHdC have made it simpler for everyone to adopt and integrate new behaviours into their daily routines.
• Measurable change, tangible change! Performance indicators have been established at the organisational, team, and individual levels to gauge success. By actively tracking these metrics throughout the project lifecycle, we can ensure that the change is effectively managed and delivers on its promises.