Observations

Will this be possible in 2020?

The following are some random observations from this first week of COVID-19 social distancing at our company.   

Be kind.  Some people are fine, until they’re not and you see the stress on their face as they recount dealing with their employees fears of potential job loss.  Some people are strong, until they’re not while trying to figure out how they will share space with family and pets.  Some people are stoic, until you hear their voice tremble as they share their concerns for a vulnerable relative.  It’s difficult enough to be empathetic with co-workers when we’re in the same office, but now with remote work it’s even more difficult.  So be kind.

How are you?  This past week I’ve opened my meetings and casual remote chats with this question.  At first, I was afraid people would get tired of it.  But I’ve found that with this fast news cycle and working remotely, a person’s response can change throughout the day.  At this point in time, I’m not sure we can ask this question too often.

Pick an emoji.  I frequently start meetings asking team members to pick an emoji from my stack of 50 emoji cards.  Now that all my teams are remote, I’ve continued this in Microsoft Teams by asking everyone to open the chat window and pick an emoji from there.  This not only allows everyone to check in during this stressful time, but it brings something familiar to our new way of working.

Guided meditation.  Last week, utilizing a company-wide Microsoft Team, our clinical director led a company-wide guided meditation session.  The session was available to employees and people we serve.  I found it touching to see many employees logged on and sharing the experience.  Even though I only saw their profile picture on the screen, just seeing everyone in the same space was nice during this time of social distancing.

Close your closet door.  I know you’re having to make-do with improvised work space because your spouse has taken the kitchen table and you’re stuck working from your bedroom.  But can you please close your closet door in the background?  Thanks.

 

New Ways of Working in a COVID-19 World

The following is a collection of suggestions I’ve gathered from recent Agile Uprising podcasts and LinkedIn Learning resources which address the topic of working remotely.  Since many in our industry are not accustomed to working remotely I thought this might be helpful.

Work from home tips for employees

• Make your work space comfortable.  Use a comfortable chair.  Arrange lighting to reduce eye strain.  Set a comfortable temperature.  Make the space a quiet area so you’re not distracted and to minimize distractions during calls.  Use a space that affords the privacy and confidentiality of confidential information.  Remember that HIPAA still applies.
• Have boundaries on your time so you don’t work too many hours.  Set a start and stop time and honor it.  Have a dedicated work space.  Turn off your computer when not working.  On your mobile phone put work related apps on one screen that you can swipe away from when not working.  Turn off work-related notifications on your mobile phone during non-work hours.

Tips for Supervisors

Employee check-in during times of change
Questions you can ask employees to check on their personal change.

1. Is there anything confusing or unclear about the change that I can help you better understand?
2. What will this change take away from your work? What does the change add to your work?
3. How do you see this change supporting our values and our strategy?
4. On a scale of 1 to 10, how agreeable are you to this change?
5. What needs to happen to increase that number?

Be kind

• Be understanding that our life rhythms have been disrupted.  Waking up, getting ready for the day, going to work or school, coming home, our free time, these rhythms have changed.  It may take a few days or weeks for people to figure it out.
• How are you?  That may be a good way to start a meeting with a team or an individual.  Listen, and hear where people are.  If the person or team is checked out, this may not be a good time for this meeting.  Reschedule and agree to be more ready at that time.  Ask if there is anything you can do to help them be ready for this or other meetings.

We will be less productive

• Things will take longer.  Communication will be more difficult.  Finding people and information and documents will take longer.  Acknowledge this, and plan for it.
• Reduce the size of goals or tasks.  Chunk things down.  Working remote will make large tasks or goals more difficult.

Leaders may need to temporarily adjust their approach

The Merrill-Reid model for personality traits: Driver, Analytical, Amiable, and Expressive.   If you’re a Driver or Analytical, during this time you may want to try to be more Amiable and Expressive.

Questions to ask people about this new remote working.

1. What do you like about it?  
2. What are your challenges?  
3. Have you worked remote previously?

Continue meetings but be open to change

• Continue to have your meetings, but the time and frequency may change.  You may need more frequent but shorter meetings.  Talk to the team and individuals about this.  
• You may need to work around family and household timing and issues now.  Maybe you need to work around childcare issues.  
• Consider scheduling meetings to start 5 minutes after the hour to allow a quick break to people who go to back-to-back meetings.
• Use video during remote meetings.  Face to face contact makes meetings more effective, and teams better functioning.  We’re isolated enough, take these opportunities to connect.  
• Be prepared to change how you run your meeting.  Maybe include a short “Meet the Family & Pets” segment where the team can learn a little more about a family member or the family can ask a question of the team.  Or “Share your Hobby” where someone can show what they are working on.

Create a Remote Team Working Agreement

Agree on how you’ll work together.  

• How will we meet?  
• What information do we need to share?  Where is that information?  
• How will we talk to each other?  
• How do we know what each other is doing?  Do we need to know what each other is doing?  

Common mistakes supervisors make

Need to over communicate slightly because you are no longer walking around.  Instead of just posting a general email or general chat, you may need to call people out, and you may need to communicate in multiple ways, like Teams and email.  Once people tell you they have heard you and you can back off, then you know you can back off.

Since we can’t manage by walking around when remote, it’s an opportunity to have one-on-ones.  You can ask questions like: I really want to understand what you’re doing.  I don’t want to micro-manage you.  I don’t know how.  Please help me understand so I understand your way of working.  So I understand your impediments, where you need help, where I’m helping and where I shouldn’t, where you might need coaching.  I need you to help me understand how I should manage now that we’re not together.

Don’t be a seagull manager.  A seagull manager is a manager who flies in, makes a lot of noise, dumps on everyone, then flies out.  Instead of focusing on tasks, focus on relationships and building your team.

A Very Short Story – Meeting game

Starting a meeting with everyone’s full attention is important.  Getting their head in the room and away from whatever they were working on can be a challenge.  And getting them engaged after a break can also be a challenge  This quick game is a fun way to get people engaged and hopefully laughing.  The basis for it is from rule #4 of Emma Coats’ 22 Rules of storytelling according to Pixar.  I think I’ve seen a similar game while bouncing around the Internet but I can’t seem to find it.  So I can’t definitively claim this as an original idea by me.

You can copy the below sections into 2 pages of a document.  The first page is facilitator instructions.  The second page is a handout for participants.  It is setup for a page which can be cut in half for 2 participants.  Enjoy, and if you have improvements please share!  Thanks for reading.

Page 1

A Very Short Story  - Facilitator instructions

 Credits:  The sentence fragments are from rule #4 of Emma Coats’ 22 Rules of storytelling according to Pixar, a series of Tweets.  I found them here https://io9.gizmodo.com/the-22-rules-of-storytelling-according-to-pixar-5916970.  I created my own game around it.  Enjoy – Bob Oakley

Goal

The goal of this game is to have fun and get people talking.  It can get creativity going before brainstorming or planning sessions where you want people open to divergent thinking.

Supplies

Instruction sheet, pen/pencil for each participant.  A stopwatch or timer to countdown time (preferably one participants can see).  For a timer, try Googling “timer” and the first option is usually a timer you can use.

Instructions

1.       Hand out the questions page to each participant.  Make sure they have something to write with.

2.       Instructions to participants:  Without talking, legibly complete the sentences to create a short story.  You can only use the available line, no extra space.  Don’t worry about being creative, just tell a story.  You have 2 minutes. 

3.       Use a timer for the countdown.  It’s best if everyone can see the timer.

4.       After everyone is done, ask them to number each line 1-7 like this:

1 Once upon a time

2 Every day

……..and so on

5.       Pick someone to start.  Ask them to read line 1, the person to their left to read their own line 2, and so on until all 7 lines are read.  Depending on the number of people you may need to continue going.  The end result is usually pretty funny. 

6.       Go through the reading again, but now you can mix things up.  Examples: start with someone else, go opposite direction, pick people at random, pass stories around and have other people read them.

Alt versions

After doing the original version, at the start of each sentence add the following or your own starters.

Never once upon a time…  Never every day… Never one day... and so on

Surprisingly once upon a time...  Surprisingly every day...  Surprisingly one day...  and so on

Predictably once upon a time… Predictably every day…   Predictably one day… and so on

Page 2

A very short story

Complete the following sentences to create a very short story.  Make sure it is legible.  It doesn’t need to be creative or original unless you want to be.  You have 2 minutes.

Once upon a time there was ____________________.

Every day, ________________________________________________________________.

One day ________________________________________________.

Because of that, ___________________________________.

Because of that, _______________________________________________________________________.

Until finally ___________________________.

The end.

  

A very short story

Complete the following sentences to create a very short story.  Make sure it is legible.  It doesn’t need to be creative or original unless you want to be.  You have 2 minutes.

Once upon a time there was ____________________.

Every day, ________________________________________________________________.

One day ________________________________________________.

Because of that, ___________________________________.

Because of that, _______________________________________________________________________.

Until finally ___________________________.

The end.

Presenting at IACP Conference 2020

I’m excited to announce that I’ll be presenting at the IACP Annual Conference & Trade Show on May 6 in Ames on the Iowa State University campus.  The Iowa Association of Community Providers represents approximately 130 community-based organizations who support individuals in need of mental health and disability services. 

In Iowa, most providers of community-based services are small not-for-profits.  Finding information about change management as it relates to their industry can be difficult.  I know, I work for one of them.  There’s an abundance of information about project management and agile as it relates to software development, IT operations, manufacturing, and even human resources.  But information on the unique world of community-based providers?  Not so much.  Which is why I’m excited about this presentation and panel discussion.

The presentation is an interactive retrospective of what we’ve learned at Candeo during the past seven years on our journey from traditional project management to agile mindset and practices.  I’ll be joined by a panel of some of our key stakeholders and product owners: Marcy Davis (CEO), Nancy Baldus (Director of Quality Enhancement), and Steve Gilroy (Employment Services Administrator).  We’ll look at why we started working with project management, and why agile became a better fit for our organization.  We’ll discuss our successes, learning opportunities, and many surprises along the way. 

Team Reboot

We welcomed three new members to our four-member agile human resources team recently.  One was new to the workforce, one an HR veteran returning to our company, and one a mid-career HR rising star.  All presented unique opportunities and challenges for personal and company growth.  When (not if) you have new members on your teams, they also present unique opportunities and challenges.  Addressing these from the start can magnify the former and minimize the latter.

First, let’s just level set on the idea that it’s important to acknowledge that a team has changed, and members will experience things differently because of that.  If you’re familiar with Tuckman’s 5 stages of team formation (forming, storming, norming, performing, mourning) you already know this.  If you’re not familiar with it, Google it.  Lots of good stuff out there on it.

When we first create an agile team, I facilitate a 6-hour kick-off session to jump start the team formation process.  For the most part I’ve taken the structure and games from Lisa Atkins book, Coaching Agile Teams.  In this case we were reteaming, so I assessed what the team needed, then used parts of the full session to give them that. 

Our returning veteran has deep knowledge of HR, company culture from 5 years ago, and personal development.  What she didn’t know was agile, agile HR, and our new agile culture.  Our mid-career member is newer to the management level and new to agile.  The new workforce member is not burdened with any past work experiences.  And the one remaining original member of our agile HR team is deep in knowledge of HR, personal development, agile and our agile culture.  The three new members had joined this team over 6 months.  Due to scheduling issues we were just now having our agile kickoff.  During those 6 months we had already addressed our agile framework, ceremonies, and agile values and principles.  But we were still individuals and not a team.  We were in an extended storming phase.  So this team “reboot” (as we called it) was to focus on norming. 

As we worked through the day, we learned of each other’s values.  Then we created individual “What’s in it for me?” statements, which fed into a team statement, then a company statement, and finally into a “What’s in it for the world?” statement.  It can be a powerful thing when a team sees how it can impact the world.  We ended the day by doing a high-level overview of our annual operating plan, which set us up for a more detailed planning session the following week.

This all happened recently, and I can’t say we are yet in the performing stage.  But something has changed.  Meetings feel different.  Conversations have more understanding.  We’re on our way.

Curiosity over Judgment

Curiosity over Judgement.  It’s the first thing I draw and discuss when introducing agile to a new team or team member.  I picked this up from the very personable  Tim Ottinger at Agile Iowa 2018 (click here to find his presentation) and it really resonates with people.

In agile, we ask our teams to think differently, act differently, and interact differently.  We are setting ourselves up to be judgmental as we navigate a totally new work context.  So why not be curious on why we feel judgmental, why someone is acting a certain way, why the team is doing something in a certain way.  For me personally, I’ve learned that I get judgmental when I’m frustrated when someone doesn’t behave or achieve as I expect they should.  Being curious forces me to take some time and space to reflect.  When I do that (surprise!) I typically find that the situation is different than I knew in the moment of my frustration.  Curiosity allows me to investigate before sharing my often incorrect insights. 

Curiosity over judgement sounds so basic, like something we should have learned in grade school.  And maybe it is, it’s been a long time since grade school for me.  Yet I see people drawing this figure on their notepads in meetings, or putting it on a whiteboard before a difficult discussion. 

Thanks, Agile Otter, for helping me and my teams to be agile.

Create a box instead of “fixing” their problem

I encourage leaders to create a box into which their team can pour a solution.  The box can be defined by a vision of the desired result, regulation, company mission and values, cost, time, common sense, and whatever else seems appropriate.  The key is to create a situation where the team can create the solution.  We also work to ensure there’s a feedback loop so leaders can see the results of the team and support them.  In agile, we talk about creating an environment to support a team, so the team is empowered to do great things.  So often leaders sit in a room, discuss a problem they see from afar, and come up with a solution that is then bestowed upon the team to carry out.  Problem is, the people in the room don’t have direct knowledge of the problem.  And the team doesn't learn how to solve problems.

Leaders should focus more on creating boxes and feedback loops to support and empower their teams.

Seeing impediments without blame

Scrum, Kanban, and Toyota Kata.  I’m struck at the similar effect each has of making it safe to talk about impediments, even sensitive ones.  We focus on the Scrum, Kanban or Toyota Kata framework, the framework brings the impediment front and center, and we address what is obvious to everyone.  The impediment may be virtually anything; a person, a coveted process, a product defect, insufficient training, or even a HiPPO idea.  Whatever it is, everyone sees the impediment.  To mitigate or not are both options.  To ignore is not.

Shipping again

Huh, seven years.  Time flies.  Thank you, Seth Godin, for putting your little brain worms into me over the past decade about the importance of sharing, shipping, and quieting the lizard brain.  In late 2012 I didn’t think I had anything left to share though this blog.  But in the years since, I began to suspect there were new people to ship to.  And I think I now have something to share.    

Acting as a change agent for a small not-for-profit I’ve faced many of the same challenges I faced at a small for-profit business.  Among these is finding information applicable to small business project management and agile.  And more specifically, agile and project management outside the IT department. 

My goal is to provide practical and actionable insights for the small not-for-profit or for-profit leader, of any department, that can’t get initiatives completed, who feels like they're thrashing.  This space will explore my experiences and observations in a small business when introducing and using traditional waterfall project management and agile and lean frameworks like scrum, kanban, and Toyota Kata.  I’ll include some of the domains I’m actually working in; human services, human resources, quality, accounting, strategic planning, operational planning, service delivery, and information services.  I'll also address the interesting demands of one of our niches, community-based services for individuals with intellectual, developmental, and mental health disabilities.

I hope you find value in this blog relaunch.  If you do please share with someone who can benefit.  Thanks for reading,

MediNotes to PeakPractice to MyWay to…..?

My sympathies go out to the doctors and their staffs having to endure the Allscripts MyWay sunset.  Many of you started with MediNotes and were moved to PeakPractice then MyWay when both MediNotes and PeakPractice were sunsetted.  I know your pain, I rode that train with you as your implementation consultant and project manager.  You’ve patiently endured through the 2008 sale of Bond Technologies, 2008 sale of Medinotes, 2010 sale of Eclipsys and now apparent imminent sale of Allscripts.  We’ve patiently sat by while each newly constituted company merged cultures, systems, and software platforms.  You’ve waited for them to announce their “go-forward” strategy and software.  You have put vacations on hold, quelled staff revolts, and suffered lost productivity as you have implemented your “free technology uplift” when your existing EMR was sunsetted.

So what next?  If you’re a 1-10 provider medical practice, do you stay with Allscripts or move to another vendor?

Well, that’s a difficult question, and one I don’t think can be answered yet because there are so many other unanswered questions. 

Can a privately-owned Allscripts profitably make and support a competitively priced small-practice EMR and practice management software, when they have shown they can’t do this in the past?  Or do they even want to at this point?  Or do they want to focus on the acute care and large ambulatory care market segments, but feel forced to offer their existing mid-size practice software (Allscripts Professional) to their existing small-practice customers?  What will the future pricing of Allscripts Pro look like for small practices?  Can Allscripts overcome their reputation as being more sales-focused than  development and client support focused? 

That’s lots of questions, and I don’t see any answers yet. 

From where I sit, here’s what I see.  I see an EMR/PM market which had not produced a user interface which has created a devoted following.  No MS Excel, no Word versus WordPerfect debates, no Mac versus PC enthusiasm.  I see regulatory bodies shaping functionality for the EMR/PM platforms.  I see lots of little players in a growing market, but also a market which will see slimmer margins.  I see continued mergers and acquisitions of EMR/PM vendors.  I see more hospitals and health systems subsidizing EMR/PM software for independent medical practices in the hopes of getting their ancillary business such as lab work and radiology.  I see health systems consolidating medical care in their communities.  I see health information exchanges sharing patient information to an increasingly national grid of information networks.  I see the actual EMR/PM software platform becoming less important than the pipes of information that feed it, and those pipes of information will increasingly structure the user interface.

I anticipate medical practices will very likely see their existing EMR/PM vendors be purchased in the coming few years.  And the purchase won’t be for their software, but for their installed customers.  And those customers will also have to endure a “free technology uplift”.

So, I can’t say I have an answer for you at this point.  I think much of it depends on where you’re located and what’s going on in your medical community.  I’m sure most of you have already been approached by other EMR/PM vendors.  If it were me, I’d listen to their pitch, but also remember that any EMR/PM vendor is prone to the same pressures and questions as Medinotes-Eclipsys-Allscripts.

The intersection of YouTube cats and medicine

Ok, so I’m not normally one to watch cat videos on YouTube.  But this is a touching clip of hospital staff at Seattle Children’s Hospital using Facebook and crowd sourcing to bring a young cancer patient in isolation (and missing her own cat) some happiness by creating a “cat immersion” or “virtual feline cocoon”.   Enjoy.

The Informed Patient: What’s a health information exchange and why should I care?

There has been lots of talk the past few years about the changes to healthcare and how it’s delivered.  One of the driving forces of this change has been the desire to reduce the cost of delivering healthcare services while at the same time producing better outcomes for patients.  Health information exchanges, or HIE for short, are one tool which can help drive these changes.

In its simplest form, an HIE allows your doctor to share your medical information with medical professionals  in other organizations.  Just how this is accomplished and what information is available is dependent upon how the HIE is setup.

An HIE may be structured to allow your doctor to send lab or radiology orders to a hospital, and those departments can in turn electronically send back your results when available.

It may also be set up so your doctor can send your medical information to another doctor, such as a specialist you’ll going to visit.  Your information could also be made available so in case you need to go to the emergency department those doctors can access your information even if your own doctor’s office is closed.

An HIE is accessible only by users who have been given access, and they only have access to information which their user account gives them rights to access.  For example, it is typical for emergency room physicians to have special access to records in cases of emergency.  But a physical therapist wouldn’t automatically have access to mental health information.

Information is made available to an HIE when a doctor’s electronic medical record (EMR) software is given access to the HIE.  The doctor then makes patient information available to the HIE.  Typically patients are provided with a form to sign stating whether they wish to make their information available on the HIE or not.  Depending on the state and the healthcare organization, this will take the form of an opt-in or opt-out authorization.

An HIE can be privately run, such as by a hospital, or publicly run, such as by a state.  And an HIE can be connected to another HIE.  For example, multiple hospital systems can be connected through a state-wide HIE.  Whoever is in charge, the cost of the HIE is born by that organization and it will typically charge a fee to subscribers (your doctor or hospital) to access the HIE.  Patients are not directly charged for making their information accessible to an HIE.

HIE’s can be very helpful because in the past sharing patient information between organization has been inefficient and cumbersome.  When a patient was referred to a specialist, someone had to copy the patient’s medical file and mail or courier it to the specialist.  Or someone had to take the medical file apart, fax it, then reassemble it and file it way.  It may not sound time consuming, but when this is repeated multiples times per day every day, it is time consuming and expensive.  Plus, there’s usually a time delay because the doctor must first update the medical record, and if it was done through transcription it could take days before the record could be mailed or faxed.  Additionally, sometimes radiology films and other media end up in the wrong office or not returned to the primary care physician’s office and are lost.

Finally, don’t confuse the term “health information exchange” with “health insurance exchange”.  A health insurance exchange is a place where patients can shop for health insurance.  A health information exchange is where doctors can share patient information with other doctors.

So that’s a very simple explanation of a health information exchange.  For more information I’ve provided links to additional resources below.

Wikipedia

Healthcare IT News

Healthit.gov

Medicity (HIE vendor)

dbMotion (HIE vendor)

American Medical Assocation online article

 

 

When to Join an HIE- HIStalk Advisory Panel weighs in

HIStalk.com has an interesting post where one of it's advisory panels discuss' when is the appropriate time for providers to join a health information exchange (HIE).  Here's the LINK. 

The Informed Patient: Concierge medicine explained

Ask most people what concierge medicine is, and they’ll think it’s getting a Band-Aid from the hotel concierge.  Or they think of it as personal physicians for the very wealthy.  Well, in the past that may have been true, but it’s becoming more mainstream, and more patients will need to make a decision of whether they want to use a primary care physician who has a concierge practice.  This post will explain what concierge medicine is, why it’s becoming more prevalent, and provide links for additional reading.

What is Concierge Medicine?

The basic premise of concierge medicine is that a doctor will see and manage fewer patients, but provide more personalized and thus more effective care for each patient.  For example, a family doctor may reduce their patient inventory from 2,000 to 500.  The doctor would provide his cell phone and email address to patients, and generally be more available to patients as well as provide more personalized attention to their preventative health needs.  The doctor may also be more involved in working with specialists when a patient referred to them.

Concierge physicians will typically use one of two business models, though there are variations.  In the first model, the concierge doctor will charge an annual fee to each patient, ranging from $600 to $5000, averaging out at $1,500.  The doctor will continue to accept insurance in addition to the annual fee. 

In other cases, concierge doctors will charge patients an agreed upon cash rate for their visits, and the patient is free to file their own insurance claim if they wish.  The doctor won’t file claims or accept insurance from patients.

Why is Concierge Medicine Growing?

So why is concierge medicine on the rise?  Much of it has to do with the reductions in reimbursement payments from private insurance companies and public insurance programs (i.e. Medicare) made to primary care physicians.  In order to make up for the reduced payments, these doctors must see more patients.  They will typically reduce or eliminate hospital and emergency room visits, reduce patient appointment length, and increase clinic hours.  At some point many family and internal medicine doctors end up feeling like they’re on a never ending treadmill and can’t get ahead.  They also typically complain that the need for volume reduces the time they can spend with patients on preventative health, which typically reduces the cost of healthcare.  For example, if a doctor can discuss lifestyle issues with a patient and change their behavior instead of just prescribing medication, it’s ultimately less expensive for the health care system and the patient.  So they opt for concierge medicine.

Learn More

Expect over the coming months and years to hear more about concierge medicine and its advantages and drawbacks.  To learn more, check out these links.

 

Concierge Medicine article - wikipedia.org

PBS Newshour report on Conceirge Medicine- July 2012

 Forbes.com article 2012/05/23

Chicagotribune.com article 2012-02-01

 

dailyfinance.com article 2012/04/06

Hospital and Concierge ED: HIStalk interviews Sean Kelly MD, CMO, Imprivata

Healthcare IT blog HIStalk.com recently posted an interview with Sean Kelly MD, CMO at Imprivata.  He has some interesting things to say regarding his hospital ED and concierge urgent care experiences, as well as ED technology.

Better, Worse, or Just Different?

When we’re facing change, it’s easy to assume it will be worse or better.  But what if it’s just different? 

A few years ago I was working with a group of implementation consultants (IC) who were converting customers from one electronic medical record solution (EMR) to a new one.  This group was struggling with client expectations of how the new EMR would function and it’s workflow.  These client expectations were driven by their experience with the original EMR, which in most cases was the only EMR they had worked with.  In the client’s eyes, the original EMR, with its own set of strengths and weaknesses, was the norm.  Anything else was either better, or worse.

Well, in fact the new EMR did have some weaknesses, but it also has many more strengths.  And in many instances, it was just different.  And this was where the ICs were facing struggles.  They had anticipated how to handle the weaknesses, and it was easy to trumpet the strengths.  But the “just different” stuff was often just addressed in passing.  In many cases, these differences were wrongly perceived by clients as weaknesses.

One of the first things we did was to work on the IC notions of what was better or worse, and had them start to identify the things which were just different.  We worked on removing the value statements and inferences from their vocabulary.  We worked on tools to assist then in emphasizing “just different”, such as compare and contrast scenarios for training, small tests the clients could use to compare workflow, and comparative diagrams of old and new functionality and workflows.  Once the ICs began to internalize the “just different” mentality, clients started to get it too. 

So remember, change isn’t always about better or worse, sometimes it’s just different.