joining us today, I'm pleased to bring the second series in our Welcome to Leadership Coffee Talk series to you, Building Your Case for Change. I will be your web support, so if you need any help, feel free to reach out to me in the chat, and I'll be happy to try and assist you. But I'm going to go ahead and first introduce Zain Kana Desai. She holds an MSN, RN, CPEN, and brings over two decades of invaluable experience to the forefront of emergency care. With a career spanning over 23 years, she has navigated the complexities of emergency medicine with grace and resilience. She previously served as a patient care manager and was instrumental in orchestrating efficient and compassionate care daily, even in the midst of the most demanding circumstances. Her unwavering dedication to improving patient outcomes and enhancing operational efficiency has earned her respect and admiration of colleagues and peers alike, and we're very happy to have her working at ENA as a Nursing Content Specialist. So Zain Kana, thank you. ZAIN KANA DESAI Thank you, Dan. Hello, everyone, and welcome to the Second Leadership Coffee Talk webinar series. I am Zain Kana Desai, your host and a Nursing Content Specialist at ENA. We're so excited to have you join us today as we delve into the critical aspects of managing change within your organization. Change is more than just a moment in time, you know. It's an ongoing journey that requires careful strategy and strong leadership. This fast-paced environment of the emergency department demands not just your clinical excellence, but also innovative leadership to drive change. So before we get started, just a quick reminder, if you have any questions, please, please put your questions throughout the webinar. Feel free to drop them in the chat. We'll have a question and answer segment at the end where we will try to address as many as we can. So here's our disclosure statement. We have no relevant financial relationship with any ineligible companies. ENA is accredited through ANCC, and at the end of this webinar, all learners will be awarded 0.5 contact hours for attending the entire webinar. So today we are privileged to have Angie Black with us. She is my mentor, a nurse executive, vice president of operations from Northwestern Medicine at Central DuPage Hospital with over 20 years of leadership experience. She will guide us through the key elements of building a compelling case for change and share strategies that can help you engage stakeholders and drive successful transformation. So without further ado, please join me in welcoming Angie Black. Hi, Angie. Thank you so much for joining us today. Good. How are you? I'm good. It's so good to see you and everybody. You too. Why don't you tell us a little bit about yourself before we get started? Sure, sure. So I have been a nurse for 33 years. I look older than that picture you just had up, so it might be time to update that. And my background is pediatric emergency nursing clinically. So over the years, I started with a diploma in nursing and worked in Peds, PICU, and then eventually moved to Chicago and worked in the pediatric ER for about 12 years, and then came to the organization I'm with now, which is Northwestern Medicine, Central DuPage Hospital. And I have moved through some leadership positions, manager, director, and now I'm the vice president of operations over women's and children's services, emergency services, spiritual care, respiratory care, child life, and some outpatient departments. And I am just thrilled to be here because the ENA is one of my favorite professional organizations. Thank you, Angie. This is awesome. I'm so excited to have you here. So if everyone is ready, let's dive right in. So the first question, what are the key factors you may consider when evaluating proposal for change? Sure. Some of the major key factors for me, and this is, you know, changed over time, is how this change that's being proposed supports our hospital mission, whether it's for our patients or employees, because some proposals are for our employees. Understanding the revenue and expense impact. So understanding what the return on investment or ROI will be. How does this align with our hospital goals and strategic plans? I'd want to understand the why, the how, and the impact this will have and who will be impacted. I'd also want to know up front what the sustainment plan. I don't know about you, but I have had many brilliant ideas and have implemented things and guilty of these great initiatives not having a great sustainment plan. So they fall short or we lose momentum. So I really am interested in a sustainment plan to go forward with this. One of the things I would really highlight too is a change management structure that usually will work in that sustainment plan. So here we use a model by ProSci. It's called the ADCAR model, and it is focused on awareness, desire, knowledge, ability, and reinforcement. And we have a worksheet that really helps teams bring in the key stakeholders and a communication plan. So it really helps with the buy-in. And then I know everybody's kind of on the same page in supporting it. Another way is to make sure that you, or I would want to know the feasibility and the urgency of a project. So I see you have the pick chart up. One way to do this is to do that benefit versus effort matrix. So a pick chart really helps with that. Not that this is something you go through with the executives, but you do in advance so that you can say, I did a pick chart and this is where it landed. And so people feel a little bit more confident that you've kind of thought through all these different things. So is it possible? Is there a plan? And that needs more detail. Implementing, that's something that you can do high benefit, but low effort. That's like a just do it, do now. If there's a challenge, and then of course there's going to be some that really have low benefit, low effort or high effort, and those are ones that you probably should not be bringing forward, but thinking a little bit differently of how you can restructure that. And then once you run through it, you can just kind of share that information. And then the last thing is really about evidence. So there's a lot of evidence-based literature out there. So if you have an idea, search the evidence and see if you have some support for what you're proposing. And if you do highlight that, because that's really important. It's not to say you can't have an innovative idea, you most certainly can, but if there's evidence that can be linked to show the benefits and successes, I would definitely highlight those. That's a great point. Having a framework in place for this proposal is very important. Having this approach also reduces ambiguity. So with that, how do you prioritize competing initiatives and proposals from different departments? Yeah. For me, safety will always take priority over everything else. So if it's linked to a safety issue, for sure, that's going to bubble to the top. But I think thinking through who you're proposing this to, because your different audiences will have different wants and needs. So for me, linking a proposal back to patient, employee safety, if it's feasible, that's important. If you're presenting to a CFO or chief financial officer, definitely understand what your return on investment will look like and be creative around that. And we'll talk more about that, I think, in a little bit. But also, is it going to cause some growth? Will it improve some efficiencies? Understanding really who those decision makers are and what they're focused on. Our CNA, for example, chief nurse executive, really focused on safety and patient outcomes. So linking it back to that. And our chief medical officer will want to know, how does this impact my doctors? So being able to answer all those questions. And then, of course, the president or the CEO is really going to be interested in all the above. So again, thinking through those things when you're prioritizing. I'm sure there are a lot of proposals that may end up on, that you see or the executive sees on a day-to-day basis. What common mistakes do you see when departments present their case for change? So I'm guilty. I've made some of these mistakes myself. So I'm going to put that out there. But that's how we learn, right? So common mistakes that I've seen are when departments present a case that is solely focused on their department. And they don't include what that bigger picture impact would be. So that will really narrow it and make it challenging. So executives thinking of what their responsibility and scope is, it's up the entire organization. In our case, it's also a system, a health system. So what we do in our ER could impact all ERs in our system. And so we have to think through that and be prepared to answer some of those questions for the greater good. Another mistake is not identifying the scope or the impact of the change. So we might roll something out that's going to have a really positive impact in the ED, but what's it going to do to the inpatient areas or to procedural areas? And so really thinking through that, one way you can do that is perform a failure mode and effects analysis. So that's the FMEA when assessing change. And that can help you identify the downstream or unintended consequences, knowing these in advance and being able to speak to them and what the impacts may be. And what you would do to mitigate them really will gain confidence from the executive team to understand that you have really thought through all the possible issues that could come up and how to mitigate those. I would also really anticipate a lot of questions from your executives, especially if they don't know much about your operations. And I think we all feel that if you haven't worked in an ER, it's really hard to understand what an ER is like. So you might have to do a little bit of educating around that, but that return on investment really important for selling the change. Partner with your finance and your strategy team to help identify some of these things. One example, when we have to bring in a new subspecialty in our pediatric program, we consider the return on investment or the downstream impact. So if an endocrinologist comes, we're going to have a lot of labs that come along with that. A new orthopedic surgeon, there's a lot of radiology. So when you're thinking through your return on investment, think of those downstream impacts too, that you're going to get more bang for your buck. Also highlight your outcomes. Are you going to decrease your left without being seen or decrease your staff turnover? Because there are finances associated with that. So in the spirit of election time, make sure to fact check also or QA your own work. If you are provided data from someone else, make sure you know where it came from and how it was analyzed. I have made the mistake of just spitting it back and presenting it, and I didn't really understand the data. And I had a lot of questions that really kind of left me a little embarrassed and I had to come back. So making sure you know your data really well. And if it doesn't make sense, challenge where you got it from and making sure it makes sense. Confirm that your math is correct. I have seen executives pull out their calculator and calculate things while they are looking at a slide during the presentation. And it's really embarrassing to call out a math error. Making sure your spelling and your grammar is spot on. And I know that sounds silly, but that is very distracting for people, especially those that are perfectionists. So making sure you have someone else kind of QA your work too. Yeah, Angie, I recently made a mistake of presenting with so much detail that I lost the attention of the executive team. So with that, what are some of the strategies for framing a proposal to make it resonate with the executive leaders? Yeah, I would say concise, concise, concise. So consider your audience. Learn what they want or need to be able to make decisions. And sometimes that comes over time. But if you know someone who presents often to the executive team, set up some time and talk to them and learn from them and their experiences. Most executives do not want every single detail, but there are some that do. And so the best way to handle that is most people have a deck when they're presenting their case, use an appendix for that. And so what I often do is I'll create a deck and it has way too many slides every single time. And then each time I go into it, I start moving things into the appendix, and that helps me get very concise. So as you pitch the proposal, do it in a way that shows how it fits into your organizational priorities and reference your appendix if they have questions about more details. Our priorities, for example, are around throughput, patient experience, safety and quality. I imagine most others are the same, but really link what you're trying to accomplish to those things. I did attend a two day workshop on enhancing presentation skills. It was wonderful and awful. At the same time, I was videotaped about 20 times presenting, but it helped me learn different techniques. And one of the things I took away that I loved the best was ask up front. Tell them what you're going to ask them for at the very beginning of your presentation, because oftentimes when we're presenting, they're trying to figure out what you're going to ask for, and they're a little bit distracted. So if you can start with an executive summary that's really concise, this is what we're here for, this is the purpose, and when we're done today, this is what I expect, can really help move things along and keep it concise. Be clear on that purpose. Your visual aids, they can be a powerful tool, but make sure they are helpful to the conversation and not something you're reading from or taking away too much from the content. A good graph, a good dashboard is really helpful, but be very concise with that. Yeah, I know as a previous CD manager, I know data spoke volume when I was telling my story. So can you tell us how important it is to include data and metrics in your proposal, and what type of data is most important or persuasive? Sure. Data and measurable outcomes or metrics are really very, very important, but it depends on the proposal, of course. So we want to make sure the data matches what you're actually asking for, and I know I have been in presentations in the past where I'm thinking this is so distracting because it has nothing to do with what you're asking for, but it's really good data. So making sure you don't get sucked into that data world where you're like, this is so cool, I want to present it, when it really isn't helping. So I think using it wisely, making sure it tells your story of why the change is needed. Data does help our organizations make informed decisions, reduces our risk, and this is how we know if we're successful with our change. So you want to make sure you do investigate that. I've also found that both providers and executives are really data driven, so they will ask a lot of questions, kind of like what I just talked about, so your accuracy is really important. They may also ask for more data, and this doesn't mean you did anything wrong, it just means they're sparking some new questions, and it offers an opportunity to dig a little bit deeper. So be prepared for that. It happens a lot. Metrics are important because that really determines the success of our project or proposal. It shows sustainment, so thinking through what metrics is going to tell me if we are successful or not. I did ask our chief financial officer in advance of this webinar some of the things that are important to him as far as data, because honestly that's not where my mind goes. I go more quality safety, so I wanted to get his input, and he said he really often looks at benchmarks and peer comparisons. So as part of a health system, he's going to look at other hospitals within our system to see how we compare. He obviously looks at actual to budget performance, so are we favorable to budget? If not, why, and why would we need additional resources? Labor productivity is really big at most organizations because labor is really the most expensive thing as part of our health care. So if we're going to add more resources, will we anticipate seeing more volume or acuity to justify those resources? And then financial modeling showing a compelling return on investment to justify the additional expenses. Yeah, absolutely. Telling a story around data can make it resonate more, and especially in your experience. So we have a few more minutes. I have one more question before we open it up to questions and answers. What are the best practices for presenting information to executives who may not be familiar with details? I know you said they need to understand, they don't know how emergency departments work. Yeah. I think presenting complex information requires that clear, concise communication that we talked about. I think being strategic focused and understanding what's important to the organization and the executives and being able to speak to that. Like I said, some executives like a lot of detail and some don't. They just want the bulleted version. So to be able to meet the needs of all of those folks is challenging, but that's why I do like to use that appendix. Sometimes sending your deck out in advance for them to review can help because they can organize their questions or they'll ask you in advance to collect this data before you come and present. So it really helps speed things along. So I would do that. And doing your homework really helps. Starting with your problem, your solution, and your expected impact. And like I've said over and over, linking it back to those broader organization goals. When using data, have the detail available to highlight and answer those questions, but maybe not necessarily up for everybody to see, but create a really nice legible chart or dashboard so that they can still review it. Never share raw data in a presentation. You'll have it, and if anybody needs to see it, that's fine, but most don't want to get that into the weeds. So being able to answer those questions around risk, return on investment, strategic alignment, and really linking it back to an organizational directive. I think when preparing for questions, what I like to do is to go two to three questions deep. And what I mean by that is there's something called the five whys exercise, and it really feels like you're talking to a four-year-old, but it's, but why, but why, but why? So when you're thinking of an answer and that, that next person comes and says, I don't understand, or why would you do that, that you're prepared to keep going deeper and answer those questions. So some of the questions that you might prepare with are why did the issue go undetected in the first place, or is it new? Why was it not prevented? By answering these questions, you can prepare kind of for some of the questions that might come your way and makes for a much better presentation. I will also say one of the best pieces of advice I got from one of my mentors who has been in an executive position ever since I've known her and presents globally, she's fantastic. She shared with me that she practices over and over and over again before she presents. And I never would have thought that because she's so at ease when she's speaking in public. So I thought if you have to practice, I most certainly should be practicing. So yeah. Yeah. Well, that's, that's great. Thank you. Let's recap and review the five key takeaways I hear you said. Okay. So one is aligning your proposal with your organization's mission, vision, and values. A clear, compelling executive summary. Using data and metrics and forecasts to support your case. Very important. Storytelling. Communicating effectively. Tailoring your message to your audience because you're right. They don't know, you know, from inpatient pediatrics to emergency departments. So you have to communicate that. And understanding the executive's perspective. Yep. So as we wrap up what advice would you give ED leaders who are looking to initiate change in their department? That one advice. Hmm. I think I would just prepare, prepare, prepare, be concise. You know, I've heard a lot about executive presence and understanding what that means. It's really coming prepared and confident in your request and linking it again, back to the organizational strategic plans. So. Thank you. Thank you so much for sharing your insights today, Angie. Your experience and advice will undoubtedly inspire the audience to lead effectively in their own emergency departments. Thank you. So we have a few insightful questions that came in. So let's go through them. We have about five more minutes before we're done. So some of the questions, one of the questions are, you know, I know, as a leader, it's really, really hard to hear objections like the answer. No. So how can ED leaders anticipate and address potential objections for concerns from the executive team? Because I know that was hard on me. Yeah, yeah. Well, every opportunity to learn is an opportunity. And so sometimes things don't go your way. And don't think that it's not something that you're going to gain some insight from. So I would definitely do that. But Wayne, I think ways to anticipate that possible objections or concerns is that failure mode affects analysis that I talked about. So that's a systematic process to identify and address potential problems early and create mitigation strategies. So I think telling your executives that you've done that will help gain some confidence. Some other strategies, I think understanding their perspective, which usually is focused on those organizational priorities or risk management, or a long-term impact. So being able to speak to those. And then any financial concerns, evidence-based practice. One of the things you can consider, you know, if initially it's like, oh, I don't know, I don't feel comfortable with this big scale, consider a pilot or a phased approach. So you have that in your back pocket that you can pull out. And I've done that several times, and it's really helped us move forward on some things. But again, being that concise, pre-reads are great. And then if in the end, they still say no, maybe set up some time afterwards to get feedback. Um, it might have nothing to do with what you presented, it might have been a great idea, and they wanted to support that. But at the time, we just don't have the finances for it. So you want to get that feedback. True. I have one more question that came up. So what factors do executives consider most important when deciding whether to approve to approve a change proposal? I think, like I said, the strategic alignment, or if, you know, there's a key initiative that's going on, how is it going to link to that? Is it a growth opportunity? What's going to be the impact to the market? And then some, we talked about the return on investment, potential for risk, the scalability and feasibility, and then the impact on the stakeholders. So understanding, you know, who is going to be impacted by this and being able to speak to that, and then does it fit with your culture of your organization or within the unit? So remember to think big, think like an executive. I had one president say to me when I was the manager of Pete's and pick you, Angie, you're the CEO of this department, I need you to behave like the CEO of this department and make good sound decisions. And that stuck with me, that was 20 years ago. And so I say be the CEO of your emergency departments and speak like that when you're going to the executives. So true. So important. Thank you. Do we have time? We have time for one more. So how can they build partnership? I know you say stakeholders is very important, getting those stakeholders involved. And you know, you do have to think broader, it's your ED, and how is it going to impact the other departments? So how can they build partnership with organization to strengthen their case for change? I think building those partnerships are really important, especially external of the emergency department. So I would recommend doing a formal stakeholder analysis to identify all individuals and departments that can be impacted. This is a project management tool that really, again, can identify those stakeholders and any issues that they care about, that might be impacted in the project to be able to speak to that. Creating that will outline the essential people that need to be communicated with and updated about progress or weigh in on the scope of the project. But ultimately, they can be your cheerleaders and your supporters in the background. So if you have them in your back pocket up front, or on your side, it's going to help. Some components of what a stakeholder analysis is, is their expectations of the project. So a staff nurses is going to be different than the nursing director than the physician, than lab. What's their level of interest? What's their level of influence? That's important to know. And their level of engagement, you know, and you kind of can rank that. Are they supportive? Are they resistant? Are they neutral? Are they going to take a lead? So those are some key things that you can include on the stakeholder analysis. And then other departments that can also help like quality, supply chain, just think through those types of things. Yeah, because everybody has an impact, right? You're, you're not just, you know, you're going to be getting involved at the entire hospital, everybody from their department. Yeah. Thank you so much, Angie, for joining us today. This was wonderful. I hope our audience found this discussion valuable, and be able to take this advice from you and bring it back to their department to make that change. So be sure to tune in for our next webinar. Have a great day, everybody. After this webinar, you will receive a link to fill out a survey and claim your CME. So make sure you guys do that. Thank you.

organizational change

emergency departments

executive communication

stakeholder analysis

evidence-based practices

strategic alignment

leadership development