CASE 2: SURVEY FEEDBACK AND PLANNED CHANGE AT HEALTH SOLUTIONS Health Solutions ( www.cambiahealth.com) is a nonprofit total health solutions company dedicated to transforming the way people experience the health care system. Located in the Pacific Northwest and intermountain region of the United States, Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans; pharmacy benefit management; life, disability, dental, vision, and other lines of protection; alternative solutions to health care access; and freestanding health and wellness solutions. The largest business in the portfolio is Regence Health, a health insurance plan associated with the Blue Cross and Blue Shield brands. Regence Health is over 90 years old and operates in Washington, Oregon, Idaho, and Utah.   To support this increasingly broad portfolio, had restructured itself into two divisions: Regence Insurance Holding Company and Direct Health Solutions. All the start-up, alternative health care products and services were housed in the direct health solutions division. The organization was concerned about the health care reforms emanating from "Obamacare." What were the implications of establishing regional health exchanges and accountable care organizations? How would the organization have to change? Was the organization's culture "fit for the future?"   As corporate sponsors of USC's Center for Effective Organizations, the vice president of human resources and the director of organization development called the Center to talk about the latest thinking in organization culture and how they might go about managing cultural change. After several conversations about different approaches and the research being done at the Center regarding organization design, change, and agility, the researchers proposed an assessment process of 's current organization in terms of how people saw the strategies, structures, systems, and culture. A design team composed of the executive vice president of corporate services, the VP of HR, the director of OD, and an internal HR business partner worked with the researcher to make the assessment relevant.   This process resulted in a three-page diagnostic survey that was administered to all managers with titles of assistant director or above, a population of about 150 people. In addition, 16 senior leaders were interviewed from the headquarters and regional organizations. The leaders represented a good mix of functions and tenure with the organization.   The survey consisted of about 50 items to be rated on a scale of 1 to 5 where 1 = "Not at all" and a 5 = "To a great extent." These pretested items fell into 14 dimensions, including the extent to which the organization formulated "robust strategies," engaged in future focused environmental scanning, had flat and responsive structures, rewarded performance and change, leveraged information systems, developed its talent well, and managed resources flexibly. In addition, the survey asked several questions about the organization's cultural values and how members perceived leaders spending their time. The hour-long interviews asked questions addressing similar issues in terms of strategies, processes, and culture but were focused more on gathering rich stories and examples that might help the survey data "come alive."   The results of the survey were placed into a spreadsheet and analyzed with statistical programs that generated summary tables and charts of the data. The interview data was summarized using content analysis procedures and preliminary themes were discussed with design team members to ensure that the interview responses and categories had meaning for the organization.   The summary results were then placed into three categories: "Positive issues," "Areas of Concern," and "Problems." Compared to the overall scores from other firms, 's scores were generally below the overall average of other firms but were similar to other financial services firms. The economic recession and financial crises of the time had affected the culture of many of these firms and it was not surprising that the financial services sector scores were lower.   The key "positive issue" was that people reported a strong sense of shared purpose in the organization. Captured by "The Cause," a long-held value that the organization would be a "catalyst for change" in health care, there was broad support for this clear direction. The Cause and the organization's history also supported a clear "member-focused" culture. People liked working for a not-for-profit insurer and believed that such a corporate form was an important differentiator in the way the organization did business. This belief was reflected in the survey data as a very healthy balance between driving for results and taking care of people.   In the areas of concern category, and despite the strong shared sense of purpose scores, people struggled with what The Cause meant to their day-to-day behaviors. It was one thing to be clear about "being a catalyst for change" in health care, but how did that translate into how organization members were supposed to treat customers? In this sense, people were concerned about "who we are" as an organization and did not see how The Cause helped them have a real "voice" in making day-to-day decisions.   The recent reorganization into a health care business and a set of entrepreneurial "start-up" businesses that were intended to explore the future of the health care industry clearly reflected The Cause. However, people were concerned about what it meant for the culture. A lot of senior management's attention was focused on the innovative nature of these new businesses, and some people in the insurance division felt left out. The culture of was clearly changing, but was the Regence culture expected to change as well and if so in what direction? The Cause helped people understand where the organization was headed, but it didn't really help people answer the question "who are we?" and make decisions. People were frustrated by this.   In general, people were also concerned about how well the new direction was being supported by different organizational systems. They believed that recent structural and reward systems changes were heading in the right direction, but other comments raised questions over other features, such as the way organizational and individual goals were set, how the organization responded to opportunities, and the way information and communication moved throughout the organization. These systems were not changing and did not necessarily align with the new direction. The IT systems had a very bad reputation. A complex systems changeover was generally regarded as an example of poor execution, and was producing several headaches around the organization.   Finally, two big problems loomed. First, there was widespread agreement that the organization did not have the change and learning capabilities to execute a change of this magnitude. As a 90-year-old organization in a slow-moving and regulated industry, there was little expertise in the organization regarding how to manage change. Second, in a related way, the organization was relying on innovation in both the new start-up businesses and the traditional health care business as part of The Cause. However, the organization lacked the resources, processes, and experience to generate new product/service ideas or identify and implement process improvements. The processes that had helped them to adapt in the past were unlikely to be effective in the future.   The summary data were fed back in multiple forums. The first forum was an all-day meeting of the design team. A PowerPoint deck provided both detailed summaries and analyses of the data as well as charts that made interpretation more intuitive. For example, the 14 scales regarding strategy, structure, and processes were presented as bar charts that allowed the design team to "see" how their data compared to other organizations and overall averages.   The data presentation was broken up by categories. First, the "good news" was presented and discussed. The organization had important strengths that any change process would naturally want to leverage or reinforce. The strong sense of shared purpose in the organization would provide an important base. The discussion among design team members centered on the acknowledgement that a strong history in the different regions had created a "members first" culture. While it was acknowledged as a strength, the design team also wondered whether such a legacy orientation would be strength or a weakness if change was necessary.   The areas of concern and problems were presented next. The group spent quite a bit of time discussing their implications. There was ready agreement on the problems. Design team members believed that the organization needed (and lacked) change, learning, and innovation capabilities. But they also believed that just building these capabilities was not enough and might be a waste of time. They needed to be focused on changing and innovating the right things.   Much of the conversation then centered around the implication that there was a distinction to be made between the clear direction provided by The Cause and the concern that there was no guidance for decision making. The interviews clearly pointed to a frustration about how hard it was to "get things done" in the organization. There was a perception that too many decisions were pushed up to the top for resolution and that silos in the organization prevented the required cross-group collaboration.   From here, the diagnostic conversation turned to a broader subject. The design team members were concerned that not being able to "get stuff done" and pushing decisions up the hierarchy was indicative of a more basic problem. People generally did not have clear goals ("it's hard to get stuff done when you don't know where you are going") and were not held accountable ("it's not my decision"). The culture of "Northwest Nice" was working against such culture change objectives. The design team believed that if change and innovation capability building could be focused on helping the organization more effectively execute specific strategies and goals, then that would represent an important impetus for culture change.   Before the meeting ended, the design team believed it was important to share the data and their conclusions with the CEO to gauge his level of interest in moving a change process forward. The team spent a considerable amount of time sorting through the data to find the most central and most influential data points to tell a story. The CEO's summary was only two pages long and consisted of the high-level summary of positives, concerns, and negatives as well as a summary of the survey scale scores compared to other firms.   The CEO and the VP of HR met with the researcher. After a few brief comments about the data, the CEO began by inquiring about the diagnostic process. He wanted to know if the data he was looking at was "good" data or not. Once satisfied that a sound process had been followed in terms of sampling and analysis, he turned his attention to the actual data. Like the design team, he asked some clarifying questions about the distinction between strategic direction and cultural influences. He also asked some insightful questions about specific words that had been chosen to capture the design team's "sense" of the data.   His attention was mostly on the concerned and negative themes. Many of the issues (both positive and negative) raised were familiar to him and he doubted that the organization could fulfill the promise of The Cause with this set of weaknesses. On the spot, he commissioned the HR vice president with leading the design team to formulate a change strategy to address the issues raised in the assessment.   The HR vice president and the researcher reconvened the design team and added members from other departments, such as IT and the regional organizations, to better represent the overall enterprise. They began to develop an action plan for the change. It began with feedback of the assessment data to other parts of the organization. This happened in two primary ways. First, the results were fed back to the existing senior leadership team. They were tasked with committing to the change and formulating statements that would represent an organizational future state. Second, the data were fed back to the top 150 leaders at the organization's annual leadership summit. This group had been the primary group sampled in the survey and they were given a chance to review the data, ask questions, and provide guidance on a proposed action plan.   The design team also formally commissioned four initiative task forces to address specific issues in the assessment. One team took on the challenge of revising the human capital management process (see Chapter 14, Application 14.1 for a summary of this effort). A second task force was charted to diagnose and explore in more detail the issues surrounding people's beliefs that it was hard to "get stuff done" at . A third team addressed the related issue of strategic planning and corporate communication. Was there a clear, well-understood, and shared process for setting organization objectives that were relevant to the managers and departments in the organization and how were those objectives communicated? Finally, a fourth team was given the task of creating and implementing an organization-wide change-management process.   The design team and VP of HR worked on a variety of organization changes. These included a realignment of the senior leadership group, supporting key leadership changes, changes in the leadership development programs, and the reorganization of several functional groups, including HR, and a complete redesign of the performance management process.   After one year of implementation, the design team commissioned a midpoint review to gauge progress on the action plan. Interviews with the design team members, a sample of managers who had participated on the task forces, and a sample of managers and executives who had not been directly involved in the change effort were conducted. In general, the interview data supported that the change was heading in the right direction. Many people believed that, in fact, the culture was changing and that the work of the design team was an important contributor to that change. The interviewees also made a variety of suggestions for continuing different initiatives as well as suggestions for "next steps."   Questions: 1. Discuss the major purposes of Cambia's survey and give justification for your responses. 2. Describe which approach to feedback of the survey information to organization members that Cambia applied. Give justifications to your answer. 3. Discuss the significant changes in the organization's survey resulted from the feedback process