Accelerating Implementation Methodology (AIM) : Society For Health Systems Forum Conference Presentation

Accelerating Implementation
Methodology (AIM)
Society for Health Systems Forum

Conference Presentation
Orlando, FL
February 21, 2003
Presented by: Byron G. Fiman, Ph.D, Principal

IMPLEMENTATION MANAGEMENT ASSOCIATES, INC.
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254

Session Goals
• Develop rationale that “soft” factors drive implementation

success
• Provide an overview of the Accelerating Implementation

Methodology (AIM) process
• Provide an opportunity to apply AIM tool, Sponsor

Assessment, to your project
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 1

AIM: What is it?
• Assessment of personal and cultural barriers

to organizational change
• Identification of work life disruptions that are the

consequences of strategic change
• Development of strategies and tactics to minimize

anticipated barriers and leverage key strengths to
increase readiness for change
• Process to accelerate the achievement of critical

strategic goals with less resources and fewer
human casualties
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254
AI047
2
AIM Benefits
Why Bother?
• Why does it take so long to get anything done

around here?
• Why do people resist changes even though the

payoff is so logical and obvious to me?
• Why did our project look so good to start with

and now . . . ?
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 AI049 3

Implementation of Process Change Has A
Poor Track Record
• Only 30% of change initiatives produced improvements in

bottom line results (1997)
• 70% of all major business change implementations have sub-
optimized results (1996)
• 70% of process changes in software fail (2002)
• Less than 10% of companies implementing Six Sigma get
results that affect the balance sheet (2003)
“All this is meaningless unless it

is supported by people.” (2003)
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 MP61 4
AIM: Requires Executives to be:
Proactive: Pay now or pay later
Systematic: No silver bullet
Flexible in Style: “Ungolden” rule

Lessons Learned: Life After the Appraisal*
Two Years After The Assessment
Developed Action Plans 94%

Established Action Teams 86%
Successful at Reassessment 31%
Generated Disillusionment 46%
Over Budget 59%
Exceeded Time Frame 76%
*SEI, 1995
Implementation Best Practices*
AIM Step
• Active Senior Management Monitoring 4
• Tight Link Between Change and Business Goals 3
• Clear Goals at All Levels 9
• Dedicated and Respected Staff Resources 7
• Involvement From Technical Community 5
• Focus on Project Management Processes 6
• Early Definition and Application of Metrics 1
*SEI, 1995

AI060
Change Strategy and Reengineering Outcomes*
Change Strategy Reengineering Outcomes
Direct Performance* *
Led by Top Management +++
Bottom-Up Strategy +
Based on Clear Business +++

Strategy
Based on Mission/Values +
Statement
Integrated Company Wide ++

Set of Unrelated Initiatives -
Same Approach Across 0

Countries
Based on 3 Year or More 0 **Cost, Cycle Time,
Plan Customer Satisfaction
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 * Survey of Fortune 1,000, 1999 AI299 8
Critical Factors In Accelerating Implementation
5.00
Very 4.76 4.71
Important 4.42 4.37 4.33
4.00
3.00
2.00
Very
Unimportant
1.00
Authorizing Reinforcing Clear Change Clear Business Good
Sponsor Sponsor Definition Rationale Communication
Commitment Commitment Strategy
*Identifying Best Practices: A Change Agent Survey (2002), n=156

Critical Factors In Inhibiting Implementation
5.00
Very
Important 4.38 4.37 4.18 4.15
4.00 4.01
3.00
2.00
Very
Unimportant
1.00
Low Low Distractions - Unclear Unclear
Authorizing Reinforcing Competing Expectations Business
Sponsor Sponsor Priorities Rationale
Commitment Commitment
*Identifying Best Practices: A Change Agent Survey (2002), n=156

Success Requires The Right Decision and
Managed Implementation
Decision
Wrong Right
Unmanaged Failure Failure

Implementation
Managed Failure Success

Change Flow Chart
YES Does the darn NO
thing work?
Don't mess Did you mess
with it YES with it?
You dumb
idiot NO
Does anyone Will you catch
know? YES YES hell?
You poor NO
NO
fool
NO Can you blame

someone else?
HIDE IT YES FORGET IT
NO PROBLEM

AI003
The Road Map Define the
Change
Prioritize
Assess the
Action
Climate
Build
Communication Plan
Plan Identify Change
Approach
Monitor Implement
Develop
Reinforcement Generate
Strategy Sponsorship
Build Agent
Capacity Develop Target
Readiness
Create
Cultural Fit

Accelerating Implementation Cycle:
Road Map & Tools • Project
Overview
• Implementation Plan Define the • Organizational Change

Change Stress Test
• Implementation
• Implementation
Planning Summary History Assessment
Prioritize Assess the • Implementation Risk
Action Climate Forecast
• Communication
Audit Build Communication
Plan Identify Change
Plan Approach
Monitor Implement
• Targeted Develop Reinforcement Generate

Strategy • Sponsor
Reinforcement Sponsorship
Assessment
Index
Build Agent
Capacity Develop Target
Readiness
• Change Agent • Individual
Assessment Readiness
Create Cultural Assessment
Fit
• Culture
Assessment
Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 HO170 14

IHA A Company Implementation History Profile
Profile #1 Composite 487 Respondents - September, 2003
100%
Percentage of Respondents
80%
60%
46%
40%
40%
20%
12%
0%
2%
Very Low
Low
Moderate
High
Probability of Implementation Success

IHA A Company
Composite
Implementation History Profile
487 Respondents - September, 2003
Profile #1 70
Moderate
Average Score
Probability of Implementation
59.5
60
Low
50
40
1 2 3 4 5
6
7
8
9
10
·
Sections
Section 1: Structure 1 64.4

Section 2: Stress 2 55.3
Section 3: History 3 61.1
Section 4: Sponsorship 4 59.6
Section 5: Target Ready 5 59.5
Section 6: Cultural Fit 6 56.3
Section 7: Agent Capacity 7 65.1
Section 8: Reinforcement 8 57.7
Section 9: Communication 9 59.7
Section 10: Involvement 10 55.0
• Belief · 68.3

IHA A Company
Composite
Implementation History Profile
487 Respondents - September, 2003
Profile #1 1.
1
Very Low
2
Low
3
Moderate
4
High
5
2.9 1. Structure is conducive

Structure 2. 3.1 2. Organizational layers
3. 3.4 3. Responsibility defined
4. 3.4 4. Authority defined
5. 2.8 5. Changes prioritized
6. 2.5 6. Number of changes
Stress 7. 2.7 7. Rewards aligned
8. 2.7 8. Maintain focus
9. 3.1 9. Related to vision
10. 3.2 10. Expect to be successful
11. 2.9 11. Implement on time
History 12. 3.0 12. Implement within budget
13. 3.4 13. Business objectives
14. 2.7 14. Human objectives
15. 2.9 15. Establish commitment
16. 3.1 16. Demonstrate commitment
Sponsorship 17. 2.9 17. "Walk their talk"
18. 3.1 18. Managerial discipline
19. 2.9 19. Understand impact
20. 3.2 20. Anticipate resistance
21. 3.0 21. Surface resistance
Readiness 22. 2.8 22. Manage the resistance
23. 3.0 23. Concerns are valued
24. 2.8 24. Understand FOR
25. 3.1 25. Vision modeled
26. 2.9 26. Vision reinforced
Cultural Fit 27. 2.6 27. Non-political
28. 3.2 28. Organization vs department
29. 2.3 29. Turf guarding is rare
30. 3.3 30. Agents previous success
31. 3.1 31. Business/human aspects
Agent Capacity 32. 3.3 32. Line management vs staff
33. 3.2 33. High trust and credibility
34. 3.5 34. Understand FORS
35. 2.5 35. Rewards risk taking
36. 2.7 36. Adequate resources
Reinforcement 37. 3.2 37. Errors seen as learning
38. 3.1 38. Clear rewards
39. 2.9 39. Negative consequences
40. 3.1 40. Objectives are clear
41. 3.1 41. Understanding of purpose
Communication 42. 2.8 42. Defined at all levels
43. 2.9 43. Communicate expectations
44. 3.1 44. Clear vision and strategy
45. 2.4 45. Involved in decisions
46. 2.6 46. Involved in design
Involvement 47. 2.7 47. Involved in implementation
48. 3.1 48. More than "lip service"
49. 3.0 49. Support involvement
Belief 50. 3.4 50. Implementation success

Reinforcement Management Tactics
Tangible Salary increase Control Exemption from policies
Good wages Personal control over time
Awards Job security
Bonuses, commissions Relief from threat of dismissal
Prizes (trips, etc.) Reduction in supervision
Stock/profit sharing Recognition Public, positive
Perks Public, negative
Tasks Assignment of new duties/roles Private, positive
Relief from unpleasant duties Private, negative
Relief from repetition Personal Increase benefits
Varied duties Cafeteria style benefits
Preferred equipment Longer breaks
Development Access to training Increase vacation
Increased visibility Time off with/without pay
Project control Intrinsic Challenge of a difficult task
Professional recognition Interesting work
Responsibilities Increased input Being part of a team
Influence over goals/tasks Doing your very best
Access to information Appreciation
Supervise more people Solving an important problem
High level input
Larger interdepartmental role
Unfreezing Communication
PRESENT
STATE
1. Explain the objectives

2. Explain the rationale
3. Explain the time frame
4. Utilize the language of the Target
5. Utilize the Frame of Reference (FOR) of the Target
6. Emphasize the cost of not changing
7. Focus on external drivers for change, not internal deficiencies (“not your
fault”)
8. Describe why you personally believe in the change
9. Be specific about what is and is not changing for each Target group
10. Communicate where to go for more information
11. Repeat communication and check for understanding

Menu of Communication Vehicles And Characteristics
Characteristics
Co
In
m
fo
D
FO
ur
r
C
m
itm
ab
os
R
Tr
Vehicles
at
t
-F
ili
io
en
us
ty
it
n
t
t
Newsletter M L M L L H
E - Mail L L L L L M
V-Mail L M H L L H
Town Hall M M M L M M
Small Group H H H H H H
Memo L L L L L H
Video Tapes M L L L L H
Web Page H M L M L H
E - BBoard M L L L L H
One-on-One H H H H H H
Cast Of Characters
C Champions ` Individuals who want the change and attempt to obtain

commitment and resources for it, but lack sponsorship.
Implementation can be accelerated when the other three
roles are also Champions.
A Agents ` Implement change. Plan and execute implementation

architecture. At least part, if not all of their
performance is evaluated on success of the
implementation.
S Sponsors ` Authorize, legitimize and demonstrate ownership for

the change: possess sufficient organizational power
and/or influence to either initiate resource commitment
(Authorizing Sponsor) or reinforce the change at the
local level (Reinforcing Sponsor).
T Targets ` Change behavior, emotions, knowledge, etc.
Overall Goal:
The right Sponsors doing the right things, cascaded
down and across the organization.
Unsuccessful Sponsor Strategy
Authorizing
Sponsor CEO SA
VP VP
BLACK HOLE
Mgr. Mgr. Mgr. Mgr.
Target
Supr. T Supr. T T T T T T T


Successful Sponsor Strategy
Authorizing 1 CEO S
A
Sponsor
Target/Reinforcing 2 VP T1S VP T1S

Sponsor
R R
Target/Agent 3 Mgr. T2AS Mgr. T2AS Mgr. T2AS Mgr. T2AS

Reinforcing Sponsor
R R R R
Target Supr. T3 Supr. T3 T3 T3 T3 T3 T3 T3
Legend ` S Sponsor
A Authorizing
R Reinforcing
A Agent
T Target
1,2,3 Target Sequence
` Cascading sponsorship must occur at each level between the Authorizing Sponsor
(SA) and the final Targets (T3).
` There must be Reinforcing Sponsors (SR) at each level between the Authorizing
Sponsor (SA) and the final Targets (T3).
Sponsorship Paradox
You can’t expect to sustain top executive

support without producing consistent
bottom-line results…yet consistent
results are unlikely without sustained top
executive support.

High Leverage (ROI) Sponsor Behaviors to
Demonstrate Commitment
Expressed
Modeled
Reinforced

Next Steps to Accelerate Successful Implementation
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Accelerating Implementation

Society for Health Systems Forum

Presented by: Byron G. Fiman, Ph.D, Principal

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254

• Develop rationale that “soft” factors drive implementation

• Provide an overview of the Accelerating Implementation

• Provide an opportunity to apply AIM tool, Sponsor

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 1

• Assessment of personal and cultural barriers

• Identification of work life disruptions that are the

• Development of strategies and tactics to minimize

• Process to accelerate the achievement of critical

• Why does it take so long to get anything done

• Why do people resist changes even though the

• Why did our project look so good to start with

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 AI049 3

• Only 30% of change initiatives produced improvements in

“All this is meaningless unless it

Proactive: Pay now or pay later

Systematic: No silver bullet

Flexible in Style: “Ungolden” rule

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 AI048 5

Developed Action Plans 94%

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 7

Based on Clear Business +++

Integrated Company Wide ++

Same Approach Across 0

*Identifying Best Practices: A Change Agent Survey (2002), n=156

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 AI297 9

*Identifying Best Practices: A Change Agent Survey (2002), n=156

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 AI298 10

Unmanaged Failure Failure

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 AI001 11

NO Can you blame

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 12

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 MP01 13

• Implementation Plan Define the • Organizational Change

• Targeted Develop Reinforcement Generate

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 HO170 14

Profile #1 Composite 487 Respondents - September, 2003

Probability of Implementation Success

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 15

Section 1: Structure 1 64.4

Section 3: History 3 61.1

Section 4: Sponsorship 4 59.6

Section 5: Target Ready 5 59.5

Section 6: Cultural Fit 6 56.3

Section 7: Agent Capacity 7 65.1

Section 8: Reinforcement 8 57.7

Section 9: Communication 9 59.7

Section 10: Involvement 10 55.0

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 16

2.9 1. Structure is conducive

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 17

1. Explain the objectives

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 MP61 19

C Champions ` Individuals who want the change and attempt to obtain

A Agents ` Implement change. Plan and execute implementation

S Sponsors ` Authorize, legitimize and demonstrate ownership for

Mgr. Mgr. Mgr. Mgr.

Copyright © IMA 2002 www.imaworldwide.com 800.752.9254 MP17 22

Target/Reinforcing 2 VP T1S VP T1S

Target/Agent 3 Mgr. T2AS Mgr. T2AS Mgr. T2AS Mgr. T2AS