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(Written by Allie Sturm Vecchiet*) Have you ever experienced change? Have you ever had to stand before teams that are indifferent, or even hostile, and convince them that change is necessary? In light of the changes to healthcare and pharmacy practice recently, it is very likely that we have all experienced some type of change in our workplaces. Were you successful or prepared to handle or deal with that change?

 Stacking the Deck, written by David Pottruck, is for all leaders facing major change in their organizations. Pottruck presents a 9-step course of action to follow from assembling the right team and communicating the situation. Pottruck based the 9-steps on his experiences leading change as CEO of Charles Schwab. He emphasizes that while success is never guaranteed, the right leadership, process, and team can make all the difference.

 Listed below are Pottruck’s 9 steps and key actions to apply each of the steps to your practice.

1. Step 1: Establish the Need to Change and a Sense of Urgency
   • Tie the change to the organization’s mission and show how the change will help achieve it.
   • Underscore urgency and emphasize that change is not just necessary; it’s necessary sooner rather than later. Once you are confident in this, you will continually have to work to overcome resistance and questions such as, “Let’s think about this some more” or, “shouldn’t we get some more data?”
   • Lagging indicators are the big and important measures of success
     • Examples: reduced number of adverse drug events
2. Step 2: Assemble and Unify Your Team
   • Look for pioneers, for people who are comfortable with a greater degree of risk than the average person.
   • Consider four key elements: skill, experience, enthusiasm, and team fit. Enthusiasm and team fit may be the most challenging.
   • Even with the right people, you have to unify the team and build trust.
3. Step 3: Develop and Communicate a Clear and Compelling Vision of the Future
   • Two recurring themes: 1) critical need to communicate a compelling vision of the future and 2) critical need to communicate that message over and over again
   • Spread your message to different groups and at multiples times to the same group, in different ways and in various situations.
   • Note: this step never ends! Communicating the vision behind the breakthrough change effort is never over.
4. Step 4: Plan Ahead for Known and Unknown Barriers
   • Map the “Bermuda Quadrangle” – be aware for these issues as you move forward:
     • People resist change: what will people resist? What will they embrace?
     • Skills are missing: Get people to adapt, train in-house, or recruit new people
     • Processes are rigid: determine where the organization is set in its ways and decide what it will take to change those institutional habits
     • Organization culture is unyielding: Does the change fit in with the values of the existing culture? How can you make this connection clear?
5. Step 5: Create a Workable Plan
   • All plans start with a thorough assessment of answering: “Where are we?” “Where do we want to be?” “How do we get there?”
   • Plan your goals and deliverables, tasks, deadlines, capital and resources, and then people
6. Step 6: Partition the Project and Build Momentum with Early Wins
   • Choose small goals that can be achieved in 6 months or less
   • Build in celebrations to give the team a sense of accomplishment and achievement
7. Step 7: Define Metrics, Develop Analytics, and Communicate Results
   • Identify your leading and lagging indicators
   • Leading indicators are evidence of success or failure that appear before any of the others
     • Examples: employee engagement, turnover, dose turnaround times
8. Step 8: Assess, Recruit, and Empower the Team
   • This builds on the work you did in Step 2
   • It may be time to strengthen the leadership team for the long haul and you will begin to shift the focus to the broader team that will ultimately do the heavy lifting to bring change from initiative to fruition
9. Step 9: Test with Pilots to Increase Success 
   • This is the “proof of concept” – rests on belief that it makes the most sense to test a new idea on a sample of your customers/employees 

Questions to Consider:

1. Are you currently/have you undergone a practice model change within your institution? What was the leadership’s strategy for managing that change? How closely did it mirror these 9 steps?
2. Which of these 9 steps or crucial ingredients in the change management process have you seen leaders fail to do? What was the effect on the process?
3. For practice model changes, how can we utilize resources from ASHP’s Pharmacy Practice Model Initiative to help guide us through each of these steps?

*Allison Sturm Vecchiet, PharmDPGY1/PGY2
Health-System Pharmacy Administration Resident
Nationwide Children's Hospital
M.S. Health-System Pharmacy Administration Candidate 2016
The Ohio State University College of Pharmacy
Email: Sturm.42@osu.edu