This article was written by Lydia Hooper of Fountain Visual Communications for the August 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center. Networks are able to solve problems that individuals and organizations cannot on their own. Often when we think of them, we think about coordinated resources and activities, but we also need to think about the coordinated flow of information and ideas. After all, the reason networks are more effective at addressing large-scale issues is that multiple clusters of expertise can inform one another in order to be both more efficient and more responsive to needs. Just as human organs are composed of cells and tissues, networks are made up of individuals and organizations working together to perform various functions simultaneously. To do so, they need to be in consistent communication with one another. Communication in networks is different than in organizations. When we understand this, we can recognize and capitalize upon the incredible opportunities they present. Here are four ways communication is different for networks and four strategies for success. 1. Communication is multi-directional. In contrast to networks, the hierarchical organizations and systems we are accustomed to seek to maximize control and stability by having leaders decide what and how to share information, both inside and outside the organization. Unfortunately, these systems are breeding grounds for miscommunication and poor strategy because those who aren’t leaders also have valuable information that may not be fully utilized. Networks have an incredible opportunity to re-think how information and resources are used. Instead of looking to an executive, we can look to one another and assess what our goals are and how we might each contribute to get there. Organizations that participate in networks may find that it takes considerable effort to break habits based on organizational norms such as looking for clear directions to follow. Networks that use a collective impact framework may have a backbone organization leading coordination, but this can carry with it a risk that the other organizations will easily revert to the habits of traditional hierarchies that they are accustomed to. The solution: Develop an internal communications strategy. Sometimes networks put the cart before the horse by thinking about marketing or branding before they’ve focused on group clarity and coordination. Establishing group identity and an internal narrative will help your network progress, and it will also help those outside the network better understand what you are doing and why. A strategy should include your network’s shared goals and their coordinated plan for reaching it. A discussion about how resources will be shared should also include how external communication will be supported and executed, preparing the cart for when the horse is really to run. It is important to remember that communication both reflects and drives culture. One network I’ve worked with developed their strategic plan together, but then months later when the network was getting disorganized and losing focus, the plan was sitting on the shelf. A different one continues to reference their shared vision, even sharing best practices with other networks. 2. More people need to reach consensus internally. The strength and potency of networks is not measured by the number of people or organizations involved, but rather by whether there is sufficient diversity of thought and experience to create new solutions and maximize their potential for success. Having many different voices at the table can invite unique challenges such as:
Knowledge-based networks are all about leveraging what “who you know” knows, but before we can do that, we must first know what each of us knows. Sharing with other network members isn’t always easy, especially because our individual need to belong often eclipses our group need to accomplish tasks. But once many voices can learn to harmonize in unison, their volume will be difficult for anyone to ignore. The solution: Invest in building trust. Building trust takes considerable time. Networks may have to ask themselves, “Is it more important to accomplish specific tasks within a given timeframe, or is it more important to reach our goal?” Doing the latter may require sacrificing the former. Building trust also requires leaning into discomfort and conflict, which generally we try to avoid. I have found that the simplest, most effortless way to do this is to use a visual communication tool known as graphic recording to support group members in real-time with understanding complexity and feeling included. Graphic recording is real-time illustration that organizes information during group meetings, supporting members so they can share, understand, and retain more information. For example, one graphic recording I’ve created visually captured a meeting that was a turning point for two networks that had felt in competition with one another. While individuals arrived at the meeting skeptical about engaging in a facilitated process together, they used the visual to work through their conflicts and by the following year recognized the graphically recorded meeting as the one during which they came together as one. 3. External communication is essential. Networks present opportunities to break through former communication barriers that impede progress, but they are still at risk of becoming isolated from the input of information they need to be effective simply because our natural inclination is to associate with those we are most like. Complex networks in nature demonstrate that long-term sustainability depends upon balancing efficiency and resilience. The hitch is that while efficiency depends upon the minimization of diversity and interconnectivity, resilience depends on the maximization of them. Likewise, communication in social networks must balance strengthening existing relationships in order to use current network knowledge and consistently creating new relationships in order to expand that knowledge. Whether your network thinks of this as partnership building, community stakeholder engagement, or marketing, keep in mind that communication is never one-way. Networks may provide information, but they can also get the information they need, for example about the effects their activities are having or the effects they could or should. The solution: Create new ties thoughtfully. Your network will need to apply the same patient, realistic, strategic approach that you practice internally to build relationships with external stakeholders. It is worth the careful consideration this takes in order to ensure that the work of your network stays relevant. Respect the time and contributions of others by thinking about what matters to them. If you seek to build bridges by empowering individuals to voice their concerns, then plan to address those concerns (or better yet to give them the agency to do so themselves) so those bridges don’t then get burnt. One network I’ve worked with is really great at using deliberate facilitative processes but is less practiced at producing early wins that keep stakeholders engaged and hopeful. Others I know can get so focused on producing certain outcomes by deadlines set by a funder, such as having a certain number of people attend meetings, that progress toward their primary goal, such as to have those people inform solutions that will work, is stunted. 4. Messaging (including data) is dynamic. While the organizations that comprise them may focus on offers of services or products that solve concrete needs, networks are in the business of sharing ideas that are often complex and sometimes invisible. Furthermore, networks themselves are fluid, and as more information becomes available messages will need to change. Networks also have to communicate with multiple audiences, which can challenge individual organizations who may relate differently to them (for example, one organization in the network may rely upon a critical partner who is a perceived threat to another organization). The solution: Create structures for consistent learning and reporting. As their work ebbs and flows, networks need to stay focused on what’s currently happening. Through thoughtful collection and reporting of high-quality data (both quantitative and qualitative), networks can position themselves to be able to intentionally adapt.
I admire the networks I work with who are willing to dedicate adequate thought and resources to this development. I am saddened by those who get distracted by technical tools when they can start now, even with simple paper surveys, ensuring there will be some data to show change over time. The ones that I know are guaranteed to make a difference are those who are willing to discover what isn’t working and be open to change. That kind of resiliency is the very reason networks are capable of exceptional results. Lydia Hooper is a consultant who specializes in helping organizations collaborate and communicate about complex topics. She has partnered with more than 40 organizations and networks, offering services and trainings in data storytelling, graphic recording, and communications strategy. You can read more blog articles and get a free copy of her ebook “Using Visuals to Support Collaboration” at www.fountainvisualcommunications.com.
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Aligning and streamlining your planning efforts for long-term successThis article was written by Bonnie Noble, PhD, RN, Founder of The Ondina Group, for the April 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center. We’ve all heard that familiar quote, “Failing to plan is planning to fail." This is likely a contemporary paraphrase of one of Benjamin Franklin's quotes: "By failing to prepare, you are preparing to fail." And then, of course, Winston Churchill said, "He who fails to plan is planning to fail." OK. You get it. You know planning is important. But, sometimes it feels as if we can spend so much time planning that we don’t have time to get anything done. And, what about all those plans required when we’re seeking funding? Just the other day, a client commented on how the funding agencies “require an odd collection of similar-looking documents—Strategic Plan, Logic Model, and Action Plan.” She groaned when I replied, “Don’t forget about the Evaluation Plan and the Sustainability Plan.” This “odd collection of similar-looking documents” each have a specific purpose and make an important contribution to program and organizational success. Moreover, it is helpful to understand how these various plans fit together in a sort of “less is more” approach that provides simplicity, clarity, and good design while streamlining your planning and writing efforts. First, let’s briefly examine the key purpose for each one of these plans.
So, how do these plans overlap with and link to one another? The following Planning Crosswalk describes, visually, how these various plans are related. It is important that these plans are aligned and integrated. For example, your three- to five-year program goals and strategies identified in your Strategic Plan align with the program-specific impact and outcomes in your Logic Model(s). Likewise, your Work Plan is a more detailed description of the initiatives outlined in your Strategic Plan and the activities described in your Logic Model. The usefulness of each of these planning tools is enhanced by regularly consulting and comparing them. Developing, linking, and using these planning tools will help to ensure that your programs, and your organization, remain focused on its core mission and reaches its goals and vision. Two important Baldridge program concepts are especially useful here—alignment and integration.
Examples of alignment and integration include linking key goals and objectives in your overall organizational Strategic Plan and your program Logic Model(s). Then, the Work Plan provides more detail on how your stated objectives will be achieved and who will be responsible for doing the actual day-to-day work. Likewise, the Evaluation Plan is a drill-down on how you will collect, analyze, and report data to ensure you remain on target towards reaching stated goals. Finally, the Sustainability Plan describes what actions you will take to ensure long-term viability of your program. There is great value in aligning and integrating this “odd collection of similar-looking documents,” and doing so will enhance the effectiveness of your organization and its various programs. And, of course, you will more efficiently utilize the most precious resource—your time. Bonnie Noble, PhD, RN, has an extensive background in the healthcare industry, with more than 30 years of experience working in a variety of healthcare organizations. She has expertise in many quality and performance improvement methodologies, is certified in patient safety, and is a certified professional in healthcare quality. Bonnie has served a National Examiner for the Baldrige National Quality Award and also has managed large federal contracts with the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). She currently serves as the project director for the Mendonoma Health Alliance, a grantee of the Rural Health Network Development Planning Grant Program through the Health Resources and Services Administration (HRSA). [i] Balanced Scorecard Institute. Retrieved March 1, 2017 at http://www.balancedscorecard.org/Resources/Strategic-Planning-Basics
[ii] W.K. Kellogg Foundation. East Battle Creek, Michigan. 2004. https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf [iii] Developing an Effective Evaluation Plan. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Division of Nutrition, Physical Activity, and Obesity, 2011. [iv] The Grant Helpers.com. Five Key Elements of an Effective Sustainability Plan. 2014. Retrieved on March 2, 2017. http://www.thegranthelpers.com/blog/bid/204687/The-Five-Key-Elements-of-an-Effective-Sustainability-Plan-for-Grants [v] Baldrige Performance Excellence Program. 2017. 2017–2018 Criteria for Performance Excellence. Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology. http://www.nist.gov/baldrige Written by Becky Gourde, MPA, program coordinator, National Rural Health Resource Center/Rural Health Innovations Think of the last time you were faced with a change and felt resistant to it. How did you feel? What do you suppose accounted for your resistance? If you’re anything like the rest of us, you probably resist change when you feel you’re losing control over a situation, when you feel your identity is threatened, or when you feel you’re at risk of failing. As leaders of rural health networks, it’s often your responsibility to guide diverse stakeholder groups through periods of change as you work together to accomplish new goals. Maintaining the full engagement of stakeholders is crucial to the successful navigation of a transition. People often have several common questions as they try to wrap their heads around an opportunity for change:
Creating a shared vision People don’t change just because someone tells them to do it. The two main reasons people decide to take on new behaviors or actions are (1) they have the motivation, and (2) they have the ability. Particularly for network leaders, change management strategies will be most effective when you focus on increasing stakeholders’ motivation and ability, rather than simply telling people what to do. Before you can understand what motivates your stakeholders, you need to have an awareness of their goals and anxieties. The vision that you establish should help them meet their needs while reinforcing that the network’s intended destination is one that’s worthwhile to them. A vision workshop, such as the format developed by RHI for rural health networks, is a helpful method for articulating priorities and gaining consensus on a network’s desired future state. Managing loss When facing a significant transition, network members and stakeholders can feel losses of control, power, influence, relationships, or even personal identity. There are a number of techniques that can help ease the losses felt by individuals as they enter a transition.
Maintaining commitment through communication The way you communicate information with stakeholders can have a profound effect on their decisions to stay engaged through periods of change. While communicating during transitions, network leaders can ensure that all voices are heard and stimulate participative conversations. As you engage in dialogue, remember that understanding is more important than agreement. Reaching consensus on an implementation plan will likely be challenging, but the challenge will be even greater if there isn’t a common understanding of the circumstances. Encourage stakeholders to spend time listening to and acknowledging other viewpoints without necessarily coming to an agreement on solutions right away. Even those who are instrumental to a solution often begin the transition by complaining. It may appear tempting to allow complainers to disengage from the process. Instead, prepare yourself upfront for the likelihood that the early stages of planning and transition will involve some negative or uneasy feedback. It’s important to encourage the continued participation of critics, as these stakeholders can be key influencers when designing comprehensive action plans. Implementing and reviewing your plan for change Of course, it’s tough to reach the destination of your vision if you don’t have a plan for getting there. Implementation plans or action plans are an opportunity to develop collaborative processes and maintain the commitment of results-oriented stakeholders.
Colorado Telehealth Network How one network maintains engagement while implementing change The Colorado Telehealth Network (CTN) in Greenwood Village, CO, provides broadband connections for Colorado’s health care delivery systems. Ed Bostick, the executive director of CTN, shares with us how their network has been involved in a collaborative process to engage stakeholders while implementing change in their communities: “Colorado’s health care providers are finding themselves at varying degrees of readiness regarding the integration of primary care and behavioral health services. Telehealth is a tool that can support this shift; however, there is no one-size-fits-all telehealth solution for Colorado. Recognizing these concerns, the Colorado Telehealth Working Group (CTWG) convenes a monthly meeting to discuss issues that may result in barriers to the adoption of telehealth or its implementation. The members of CTWG are voluntary and represent a wide stakeholder group comprised of behavioral and physical health organizations, hospitals, health systems, the State of Colorado, payers, insurance plans and consumers. CTWG hosted a mini-summit in October 2015 to begin identifying and addressing barriers to telehealth adoption and implementation in Colorado. Fifty-one individuals attended the mini-summit, representing 37 distinct organizations operating in Colorado. Attendees examined how telehealth impacts integration of physical and behavioral health, policy and payment reform, clinical outlook and vision, operational outlook and vision, and telehealth innovation. A follow-up consensus conference was held in February 2016 to identify implementation strategies for the development of telehealth service lines. Eighty-six individuals representing 55 organizations in Colorado and Wyoming participated in the conference. The group identified barriers to telehealth and then recommended solutions to those barriers for patients and providers.” -Ed Bostick, executive director, Colorado Telehealth Network In summary
Facilitating conversations with groups of stakeholders, such as through in-person planning events and other collaboration techniques, is a valuable part of effective change management strategies. In the case of the Colorado Telehealth Network, the mini-summit and the follow-up consensus conference provided opportunities for many distinct entities to come together and establish a shared vision, discuss how a change would impact their areas of work, identify barriers that could get in the way of reaching the shared vision, and develop an implementation plan to bring them to the desired future. Engagement from diverse groups helps ensure that all perspectives are taken into account before implementing a change, and their involvement early in the process allows you to start influencing their motivation and ability to change right off the bat. Further reading The topics covered in this article are based on the research and works of Peter Senge and William Bridges. We encourage you to explore their materials as you continue to implement change within your networks. |
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center. Archives
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