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Transformation

by Newsweek Pakistan

Asad Rezzvi, left, working with the AKUH core team on executing the proposed changes

Management consultant Asad Rezzvi talks workplace culture and his most recent success at Karachi’s AKUH

Asad Rezzvi believes the best companies are those that have dissected and understood customer needs far beyond the industry norm. His management consulting firm, Veritas Ventures, has worked with several high-growth companies and startups to maximise their output. His most recent project, the Aga Khan University Hospital, is the first of its kind in Pakistan and focuses on patient needs over industry demands. He sat down with Newsweek Pakistan to discuss why his strategies work when so many others struggle to make an impact. Excerpts:

Your company focuses on transforming organizations and giving them an edge over their competitors. How do you go about that?

We’ve created a framework, which drives transformation. First, we get laser sharp clarity about the business focus—“what business does my customer think I’m in?” This is a critical question that drives every single aspect of day-to-day operations! The answer to this question can help companies gain a huge edge to the point where their competition can be made irrelevant. Once this has been established, we align employee output and culture toward this focus. Many companies talk about customer centricity, but in my experience very few even know what that looks and feels like. You cannot have a customer-centric organization that’s not employee-centric; it’s the employees that take care of the customer and their mindset is determined by the culture prevalent in the organization. Finally, we re-engineer systems and processes to match the organization focus. In essence, we transform an organization by creating alignment and synergy between company focus, employee output and mindset, and direction of systems and processes.

Tell us about your work with Karachi’s Agha Khan University Hospital—the first of its kind in Pakistan.

Analyzing patient requirements of the healthcare industry, it was clear that the core business of hospitals and doctors needed to focus on managing and eliminating fear and uncertainty of patients. We live in a society that is saturated with unpredictability and risk. Analysis of patient spending patterns revealed that, in terms of medical attention, we shop around for everything from lowest consultation fees, wait times, lab test prices, common procedure prices and cleanliness. However, when we find a doctor that gives us attention, care and compassion all other factors are pushed aside! The patient puts a premium on feeling a sense of certainty even above quality of care—that’s a significant distinction. Organizations are unaware that today, thanks to technology, the buyer is the one in charge and not the organization. Using Facebook, Twitter and Whatsapp, it takes a few minutes for any average person to communicate with a 100 or so people and get a rapid response about prices, procedures and doctor reputations. In this scenario, who do you think is in charge, the patient or the doctor? Yet, most doctors are surprisingly unaware of these dynamics. In the U.S., insurance companies do not reimburse hospitals unless the provision of care metric meets their minimum standard—they know who’s in charge. So the specific goal of this transformation was to bring a sense of certainty to the patient at every segment of the hospital experience. Bottom line: for today’s highly empowered consumer, the company that comes out on top manages to closest match the customer’s needs.

Many companies try to alter their management style, but the average statistics are gloomy: a 65 percent failure rate and a 7-year timeline. How did you manage to create real change in just 7 months?

Companies use folklore instead of science, which is the reason for the high failure rate. Typically, a large organization will contract a consulting firm to do a study. The consulting firm will then submit their report and walk away. It’s up to the organization to execute the findings, which usually happens in a top-down autocratic manner—there is little if any buy-in from employee tiers. Employees usually look at such initiatives as an indulgence, with cynicism, and resist change. When, and if, progress takes place it’s slow, as part of the ‘daily grind.’ This results in execution at a snail’s pace, and results are scarce, if any.

At Veritas, we use proven research criteria, scientific methodology, data analysis and rigorous measurement to ensure we not only get upfront employee engagement but results as well. At AKUH, we setup a core team of eight people who spent approximately 100 man-hours understanding and committing to the execution plan. That team then drove the momentum. Next, we rolled out workshops to engage almost every member of the paediatric hospital, from the academic chair down to the floor staff. The workshops brought immediate, real time and credible voices face-to-face with the top management, allowing us to uncover problems and pain points, while encouraging buy-in from all tiers. Plus, it allowed us to set a standard of engagement and execution with the employees without being dogmatic—a critical factor in gaining trust throughout the organization. All this happened within two months.

How did you overcome the resistance and cynicism that usually plagues such initiatives?

We set up a robust internal communication module. Using the research of Dr. Robert Cialdini—author of the bestseller Influence, and consultant to Fortune 500 companies—we created six distinct avenues of communication to influence mindsets and actions and effect results. By using social media, Whatsapp groups, email, large group meetings and one-on-one meetings, we fast-tracked teamwork, collaboration and problem-solving. By sidestepping bureaucratic procedure, we managed to complete goals within minutes and hours that usually take days and weeks. Measuring and analyzing engagement levels weekly ensured that results were visible on the ground. To erode resistance and cynicism, it was imperative to get the overall psychology aligned in the direction of change as quickly as possible and build momentum. Every week, videos of progress were created and posted on a private Facebook page and Whatsapp group highlighting short-term wins, to snowball the transformation foothold. Large meetings allowed people to discuss execution plans and problems, and devise solutions and set up teams. One-on-one meetings helped refine and finalize plans and deploy them swiftly. Within days of execution, we started calibrating results and course-correcting to ensure any milestones were in service to the ultimate target. As the momentum built up, buzz was created, morale was boosted and hierarchy and silos morphed into teamwork and collaboration.

What are the common mistakes companies make in change management?

The biggest mistake is that instead of making employees stakeholders in the change, companies try to direct them. By directly engaging employees you extend trust and confidence. It’s also, by far, the most pragmatic and effective approach. At every tier, an employee knows the intimate details of daily problems, inefficiencies and pain points. These inefficiencies cumulatively retard organizational progress, erode cross-functional trust and put hurdles in the way of target achievement. By harnessing employee knowledge you demonstrate that you value them, and most importantly get them to take ownership of improving their domains via execution plans. Instead of a top-down approach this method massively accelerates progress—the very people that impede forward movement in traditional initiatives become the ones that drive it. You get to identify problems quickly, set up teams swiftly and step into execution rapidly.

From day one we communicated our desire to engage employees at every level. Instead of telling them what to do, we asked them for solutions; that was the magic wand. It instantly gained us massive currency and influence throughout the ranks. Top-to-bottom, employees shared that they felt valued and trusted. We put all tiers in a room, face-to-face, to deep dive into execution plans. In the meetings people had breakthrough ideas, built relationships and wiped out misunderstandings—it got the wheels turning immediately. Once the results started showing up, we ensured that each execution team was in fact precisely targeting a problem area.

How did you gauge your success? What were the specific metrics being measured?

Initially, it’s critical to gain credibility and create ownership by sparking conversations. We measured Facebook engagement data and the number of employees engaged in execution plans. The second step was to engage as many employees as possible in idea generation and problem solving. When employees feel they are personally growing and progressing, engagement shoots up. Multiple plans were combined, aligned and teams were set up. At this stage, building a sense of community feeds the new vision. People want to believe in a large vision—these, as per an MIT study, are the factors that get people engaged.

The Facebook page served as a virtual community. For the first time, it allowed every single employee to have an open dialogue across all tiers. Floor nurses voiced their challenges, residents shared their concerns, and the leadership responded to everyone—hierarchy was put aside for teamwork. At one point, a nurse brought up the thorny issue of redundant documentation, which erodes the quality of care a nurse can provide a patient. The CEO personally responded to her concerns. Next, the nurses had a face-to-face with the CEO to come up with an execution plan to streamline the problem. Similar conversations took place on multiple levels, leading to actions and solutions within hours and days instead of weeks and months. This had never happened before.

What are some of the achievement milestones to-date?

With 90 percent engagement levels measured week-to-week on our private Facebook page, we knew we had a potent communication platform. Conversations ranged from artificial intelligence deployment for accurate diagnosis to nursing cadre pain points. Coupled with the execution meetings and one-on-ones, the plans matured rapidly—39 execution teams, with a total of 175 people, with a direct impact on 515 employees. The plans covered the gamut—from pneumonia SCAMPS [Standardized clinical assessment and management plans] that utilized a standardized protocol to reduce the price of treatment by 80 percent to implementation of the electronic IPASS tool, allowing timely and accurate handover of data during shift changes. Others were more employee-focused, such as the Nursing Mentorship plan, a growth module for nurses to drive a culture shift so that nurses and doctors are partners in patient care and not boss and subordinate. This translated into more thorough care for patients. Another plan created electronic dashboards designed to highlight live data so there are no lapses from the moment a patient is assigned a bed to their discharge several days later. It records and reflects in real time the minutest details, such as quality of food, cleanliness, nurse attentiveness, medication and doctor rounds. If an error occurs, interventions can be made in real time so patient care is preserved and enhanced.

This sounds revolutionary! What are the parameters required for such a transformation?

It takes a very clear and specific focus. First, specific factors that can dramatically impact cost, product offering or spend patterns must be isolated, allowing a business to create a Blue Ocean effect in its industry—there is a vast difference between factors an organization competes on vs. the factors a buyer values. Second, employee buy-in must be obtained and workflow alignment shifted toward your business focus.

Third, rapid execution and results on the ground, correlated to the ultimate outcome of the initiative, must be rigorously measured to ensure focus.

We’ve developed frameworks to enable the transformation at each stage, which helps, as it can get overwhelming. The payoff is huge—an organization can gain a massive advantage in a very short time, and go from merely average to a dominating presence within its market. We’ve seen this working with a diverse array of sectors, including telecom, energy, venture capital, healthcare and even the Pakistan Cricket Team, helping them go on a winning spree in 2016 during the ICC Champions Trophy. In each case, we brought game-changing insights, coupled with execution and results, producing breakthroughs. Unfortunately, most companies still work off a business plan. Not only do they not have a real-time execution roadmap, the most destructive aspect is that they don’t harness the energy and creativity of their employees. CEOs today don’t realize that they’re running small cities in terms of the number of employees they manage daily—they need to harness that collective energy, focus it and get it moving toward results. Organizations need to have robust teams covering influence and communication, result execution, and calibration to drive overall progress and hold people accountable not just from one quarter to the next, but week-to-week. That is what transforms a company and catapults it to the forefront of the industry!

From our June 2 – 9, 2018, issue

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