What does it mean to create a feedback culture? What do you think are its unique attributes? What are the qualities of good feedback? How does constructive feedback differ from other types of feedback? What decision should Morewood make (at the end of Part B)? If you were in his position, how would you approach evaluating this decision? What kind of plan should he consider to effectively implement this change of culture outside of his department and across the Temple Health System? What resources will be required? How might the real-time feedback system affect Temple Health's core competencies? For the exclusive use of B

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1. What does it mean to create a feedback culture? What do you think are its unique attributes? What are the qualities of good feedback? How does constructive feedback differ from other types of feedback?
2. What decision should Morewood make (at the end of Part B)? If you were in his position, how would you approach evaluating this decision? What kind of plan should he consider to effectively implement this change of culture outside of his department and across the Temple Health System? What resources will be required?
3. How might the real-time feedback system affect Temple Health's core competencies?

For the exclusive use of B. Kropelunski, 2021. W20203 TEMPLE HEALTH SYSTEM: REAL-TIME FEEDBACK AND PEOPLE ANALYTICS (A) Tony Petrucci and Michael Rivera wrote this case solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. This publication may not be transmitted, photocopied, digitized, or otherwise reproduced in any form or by any means without the permission of the copyright holder. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Business School, Western University, London, Ontario, Canada, N6G 0N1; (t) 519.661.3208; (e) cases@ivey.ca; www.iveycases.com. Our goal is to publish materials of the highest quality; submit any errata to publishcases@ivey.ca. i1v2e5y5pubs Copyright © 2020, Ivey Business School Foundation Version: 2020-03-30 In the spring of 2017, Dr. Gordon Morewood, chair of anesthesiology at Temple University Health System (Temple Health) in Philadelphia, Pennsylvania, faced a rapidly changing health care environment. Expectations for improving patient outcomes, patient satisfaction, and financial performance were rising. Morewood was responsible for training anesthesiology residents and for all anesthesiology patient care across the system. His goals were to revolutionize medical education and improve cross-functional communication in health care, which had long operated in silos. There were clear opportunities to advance these goals by enhancing face-to-face communication and complementing it with digital feedback methods. TEMPLE UNIVERSITY HEALTH SYSTEM’S CHALLENGES Temple Health, one of Philadelphia’s leading academic medical centres, was home to more than 1,000 physicians and scientists who shared the mission of bringing innovative treatments to patients. Giving patients access to some of the world’s most advanced therapies—and helping patients to achieve outcomes once thought impossible—was the driving force for all of Temple Health’s clinical care, research, and medical education. The health system operated over a dozen research centres at the Lewis Katz School of Medicine at Temple University and the Fox Chase Cancer Center. Over the course of a year, Temple Health managed over 500,000 patient visits and 25,000 surgeries. Morewood saw a need in the evolving value-based health care environment for more efficient organization, data-driven decision-making, and improved communication within teams, departments, and across the institution: A key component of driving performance is focusing on your people, ensuring they have critical skills and competencies that are aligned with the organization’s goals and outcomes. Feedback is clearly one way in which we can increase communication and help employees receive insight into their competency performance. Our existing performance management model is not designed to optimally support this outcome, and we also just don’t have a culture yet that fully understands and prizes feedback. I think a major barrier is the fact that we just don’t have a culture of giving, receiving, and seeking feedback. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 2 9B20C018 Value-based health care was a health care delivery model where compensation was based on patient outcomes. This differed from a fee-for-service model where payments were charged based on the services provided alone. The value in this context was derived from measuring the health outcomes against the cost to deliver them. Morewood and his team wanted to incorporate leadership and management skills in physician education and training. The limitations of traditional performance review systems were apparent to both of them. If the organization was to develop new competencies in leadership and management skills, employees and students would need the opportunity to gain insight into their performance more frequently than once or twice a year. Implementing a real-time feedback system and integrating it with the existing annual performance model seemed challenging. While ineffective and suboptimal, the annual performance review process was something employees were at least familiar with. Success would require change in how people were aligned with organizational objectives, requiring a shift in strategy, mindset, framework, processes, and how they used feedback to drive performance. To accomplish these goals, Morewood consulted with some key people: ? ? Dr. Abiona Berkeley, an associate professor of anesthesiology and director of the residency program in anesthesiology at the Lewis Katz School of Medicine. Berkeley played a vital leadership role throughout the entire process. Leadership Analytics Group LLC (Leadership Analytics). Cliff Tironi, managing director of Leadership Analytics, attended strategy meetings with Morewood and Berkeley to provide consulting expertise in realtime feedback and people analytics. Leadership Analytics’ support included the use of their feedback application (app), DevelapMe, to facilitate real-time, competency-based feedback across the organization. The competency-based feedback was designed to capture real-time feedback on the competencies (or skills), knowledge, and experience that were most critical to the evaluated organization. After a monthly team strategy meeting, Morewood spent a few minutes debriefing with his leadership team and Tironi. Morewood explained: I’m still on the fence whether or not we should move forward with the project. It seems like the right thing to do, but it has been less than a year since we invested substantial resources in improving the department’s existing performance appraisal system. Here we are, considering not only a major change again but also one involving a new technology and a paradigm shift of how we evaluate performance and use human resource data. The app supports capturing interactions between people around competencies and work behaviours. While I’m not seeking to make another change, I believe that the performance appraisal system we have been using is not ideal. Being able to incorporate a real-time feedback process as a complement would certainly be a valuable innovation. This also seems like an important strategic opportunity, since real-time feedback would help facilitate communication and increase feedback to drive performance objectives. The performance objectives are patient outcomes, patient satisfaction, cross-departmental communication, and more effective resident training. Competencies are developed in each of these key areas. Feedback scores show how individuals are doing in this area and capture the areas in which they have improved. Communication between cross-functional groups has been limited. Both the leadership team and Tironi understood Morewood’s perspective. The challenges and opportunities with changing traditional communication methods were clear, but change was not without its own set of risks. Tironi replied to Morewood?, This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 3 9B20C018 Our consulting work has highlighted the existing pain points or challenges. Our information indicates that employees are not happy with the current performance appraisal process, they are not receiving enough feedback or receiving feedback in a timely manner, and the feedback is generally coming from people only within their immediate teams. Not to mention the current system does not allow your team to collect data on employees across the organization that can then be easily aggregated and analyzed. With the right kind of people analytics facilitated by the DevelapMe app, we can generate actionable insights that will improve performance in individuals, teams, and the organization. For example, if a physician scores low on teaching techniques, the physician will receive feedback in real-time and the physician’s performance then measured to determine whether they have improved in that area. The DevelapMe app will also create a feedback culture. A feedback culture would help employees within the organization prize feedback exchanges, especially as they relate to growth-oriented insights. Developing a feedback culture would mean observing communications flows and delving into detailed feedback provided by givers and receivers, such as feedback regarding areas of employee strength and opportunities for improvement. Morewood was excited about the process of real-time feedback: While much importance is placed on collecting feedback from patients through satisfaction surveys, we have yet another reason to believe in the value of capturing and analyzing interprofessional interactions. In the past two years, we have followed a structured program targeted at enhancing the communication patterns among our clinical staff: faculty, residents, and nurse anaesthetists. This programmatic change is not simply aimed at meeting abstract educational objectives; a wealth of data indicates that good physician communication skills may help to prevent adverse patient events. Morewood committed to deciding before the next meeting whether to proceed with implementing real-time feedback within the span of his own team and would announce his decision to the team at that time. TRADITIONAL PERFORMANCE APPRAISAL SYSTEMS Over their years of working together, Morewood and Berkeley had many conversations regarding Temple Health’s current performance appraisal system. From their perspective, the current performance appraisal system was a cyclical process where employees aligned individual goals with outcomes and priorities identified by the organization. Employees were evaluated on those goals once a year, twice a year, or sometimes quarterly, depending on an employee’s manager. The two physicians agreed that evaluations did not occur frequently enough and that feedback was not as efficient and effective as it could have been. To affect a person’s behaviour, you needed to provide them with specific instances and examples of their work. While managers did their best to observe, capture, and convey information about an individual’s performance, these instances were often forgotten before the next formal evaluation period. If a meeting to provide feedback did not occur in a timely manner, feedback provided to the employee could be less meaningful and harder to accept, especially if the feedback was constructive criticism. In addition, the current model left out feedback from many important individuals. The model focused on managerial feedback but did not accommodate feedback from peers and direct reports, which could provide This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 4 9B20C018 valuable insight and a broader perspective on performance. A more holistic view of performance was important, not only because annual reviews could affect compensation but also because the team-based environment of a hospital necessitated it. The work being done in the hospital involved the lives of patients, and those patient outcomes were critical to the quality of care being provided. In addition, given the complexity of the work, it was a true work product of a team of individuals. Effective communication was needed to ensure tasks and objectives were achieved. COMPETITIVE AND PERFORMANCE OPPORTUNITIES USING REAL-TIME FEEDBACK In 2017, the global trend of real-time performance feedback was in its nascent stages, with all indicators suggesting that this new approach would render traditional performance appraisal systems obsolete in current form.1 If Temple Health moved to a model of real-time feedback, the shift in approach to performance appraisals could drive 360-degree feedback across the organization, enhance communication, increase competency development, support goal obtainment, and provide actionable insights on performance trends and feedback patterns. Individual users would receive real-time feedback from others regarding their performance, and managers would be able to look at performance data across the team to identify employees who may have needed additional support or who deserved recognition for outstanding work. The evaluation of the work was focused on the new behaviours needed to change the health care system as a whole. Morewood felt that medical faculty needed an updated understanding of their roles. While modern medical training focused almost entirely on acquiring biomedical knowledge, many of the health care industry’s greatest challenges required cross-functional collaboration and communication acumen that many medical professionals had not been trained to use. It was critical that communication among key stakeholders such as surgeons, nurses, anaesthetists, technical support, patient transport, radiology, and administrative staff was real-time, precise, and technical. The current model’s deficits were akin to a master of business administration program consisting of only finance lectures but no leadership or management theory. Important generational issues complicated Morewood’s decision. Many of the medical residents were millennials (i.e., born in the 1980s and 90s), while the majority of the medical faculty belonged to older generations. Millennials, on the whole, preferred frequent, detailed performance feedback that addressed areas of strength and opportunities for improvement that would propel them along a career path. Millennials were looking for a coach, not a boss. They were also born into the digital age and preferred communicating through digital devices, both socially and professionally.2 Given generational trends, Morewood’s team assumed that the older faculty members might be resistant to new technologies and prefer using communication methods they were more familiar with. Morewood knew that there were several significant organizational issues in health care to overcome, such as the following: ? ? ? ? medicine’s traditional, strictly top-down hierarchy; the need for flawless personal performance and judgment among physicians; generational dynamics among the health care workforce; and a need for a modern vision of cross-functional collaboration among physicians and administrative leadership to optimize health care delivery. 1 Peter Capelli, “The Performance Management Revolution,” Harvard Business Review, October 206, accessed March 29, 2020, https://hbr.org/2016/10/the-performance-management-revolution. 2 Sue Shellenbarger, “The Office Rookies Who Ask for the World,” The Wall Street Journal, April 8, 2019, accessed January 14, 2020, www.wsj.com/articles/the-office-rookies-who-ask-for-the-world-11554730098. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 5 9B20C018 LEADING AND MANAGING THE CHANGE PROCESS As Morewood and his leadership team evaluated their options, they consulted with Tironi regarding how to accomplish their objectives. Digital real-time feedback was a new approach that would require a change management process, and Tironi provided guidance concerning the best strategies for change leadership. Tironi explained the key myths and important considerations about implementing digital real-time feedback: Many organizations are moving to—or considering a move to—more real-time feedback. Given the fast pace and complexity present in modern organizations, there is a heightened need for realtime communication among colleagues. This includes peers, supervisors, and direct reports. Additionally, colleagues require cross-functional communication. The goal of real-time feedback is better information sharing, feedback to recognize positive behaviours, and feedback to help people grow. The feedback process includes giving, seeking, and receiving feedback. Tironi went on to say, It takes trust for people to feel comfortable giving important feedback to others. Context for feedback is also crucial in order to explain why the feedback is important, how it connects to the organization, and if acted upon, how it can impact the individual receiving the feedback. Given that millennials and their successors, Gen Z [Generation Z], want higher-quality feedback at more frequent intervals... [and] are comfortable communicating through mobile devices, real-time feedback through mobile apps is emerging. Digital real-time feedback offered Temple Health many advantages over a traditional performance review system. Some of these advantages included a potential increase in organizational transparency; the ability to monitor key organizational and performance drivers through the analysis of feedback data made available on the app platform; evidence of an institutional investment in a growth feedback culture; enabling effective communication in a complex environment; a step toward migrating from a traditional hierarchy to agile networks of teams; and increased face-to-face and digital communications throughout teams. Agile teams were created within the app, as users were empowered to create teams as needed for a given function, project, initiative, or task. Digital feedback exchanges were often used to prompt in-person discussion regarding the content. Transparency was increased due to more accurate context in the real-time nature of the feedback and the increased focus on creating a feedback culture. Given these benefits, Morewood felt that real-time feedback through mobile devices was a good way to enhance and enable Temple Health’s overall communication goals. CREATING A FEEDBACK CULTURE Knowing the culture of Temple Health, Morewood could anticipate some of the potential pitfalls that Temple Health might encounter as they implemented the new review system. He felt there would be little doubt that capturing and analyzing real-time data on the quality of professional interactions between hospital staff could improve individual performance and ultimately improve patient safety and care outcomes. However, Morewood’s experience suggested that new tools and skill sets needed to be carefully cultivated to achieve the full potential of continuous personal improvement. It was also clear to him that this change would affect the existing culture and that the organization would need to focus on creating a feedback culture. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 6 9B20C018 To best effect change, Morewood believed that feedback had to be given in near real time, when the memory of events was greatest for all parties. While two-way communication in an annual performance review could offer some limited insight, capturing and measuring feedback in real time across a variety of interactions seemed to drive immediate performance improvement for individuals across all levels of the organization. Of course, this was not always possible or necessary during a crisis or when working under time constraints. Tironi and Morewood reviewed the steps and success factors required to implement real-time feedback (see Exhibit 1), as well as what real-time feedback should do for an organization. Success factors that would enable implementation of digital real-time feedback included the following: ? ? ? a commitment from senior management to a full change management process; easy-to-use technology to ensure even adoption across the organization; and perhaps a partner firm who could advise, implement, and execute the strategy. THE DECISION: PROCEEDING WITH DEPARTMENT IMPLEMENTATION After spending some time using the DevelapMe application, Morewood recognized the potential opportunity and was faced with deciding whether he was ready to roll this system out across his department and further evaluate proposing to scale the technology across the organization. Morewood said, It is clear to me that it is worth evaluating this tool and the potential change process that would be needed to implement real-time feedback in order to create a culture of feedback within the organization that prizes constructive feedback. This app very well could help us build a growth feedback culture to address the performance and feedback challenges we have been facing as an organization by helping employees get the feedback they need in the moment. If Morewood were to proceed, his goal was clear: to capture real-time interactions, as they happened, through the app and categorize them by key organizational drivers or competencies (see Exhibit 2). The competencies would then be analyzed by team management using advanced people analytics to identify areas of high performance and opportunities for improvement. The rollout of real-time feedback would be positioned to revolutionize Temple Health’s communication and performance. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 7 9B20C018 EXHIBIT 1: STEPS FOR IMPLEMENTING REAL-TIME FEEDBACK 1. 2. 3. 4. Create a need for the change. Change must be led from the top. Team must be trained on seeking, giving, and receiving feedback. Team must be trained on how to seek, give, and receive digital feedback, as well as on how digital feedback complements and enhances face-to-face feedback. 5. People analytics must be captured and used to adjust leadership and team behaviour. 6. Artificial intelligence should be used to prompt desired individual behaviours. 7. Continuous focus should be placed on this strategy to create a habit and sustained change. Source: Company files. EXHIBIT 2: TEMPLE HEALTH CUSTOMIZED COMPETENCIES AND BEHAVIOURS FOR DEVELAPME APP 1. Interpersonal and communication skills, such as the minute-to-minute teamwork required to manage operating room throughput. 2. Leadership, including organizing and implementing new care pathways. 3. Medical knowledge. 4. Patient care, including the close attention to detail required during the perioperative period. 5. Practice-based learning and improvement. 6. Professionalism, including acting as the patient’s fiduciary under all circumstances. 7. Systems-based practice, or exercising the coordination and co-operation mandated by the complexity of 21st-century medical care. Note: The perioperative period is the period of a patient’s surgical procedure, typically including admission to the surgical unit (preoperative), anaesthesia and surgery (intra-operative), and recovery (post-operative).App = application. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. W20204 TEMPLE HEALTH SYSTEM: REAL-TIME FEEDBACK AND PEOPLE ANALYTICS (B) Tony Petrucci and Michael Rivera wrote this case solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. This publication may not be transmitted, photocopied, digitized, or otherwise reproduced in any form or by any means without the permission of the copyright holder. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Business School, Western University, London, Ontario, Canada, N6G 0N1; (t) 519.661.3208; (e) cases@ivey.ca; www.iveycases.com. Our goal is to publish materials of the highest quality; submit any errata to publishcases@ivey.ca. i1v2e5y5pubs Copyright © 2020, Ivey Business School Foundation Version: 2020-03-30 In late 2017, Dr. Gordon Morewood, chair of anesthesiology at Temple University Health System (Temple Health) in Philadelphia, Pennsylvania, and his team chose to implement digital real-time feedback across the team using the DevelapMe application (app). Their decision was based on the app’s flexibility to adapt to the needs of the organization as well as its ease of use and advanced people analytics. In his efforts to scale DevelapMe across the organization, should he continue to lead the change exclusively with his own team, or encourage further adoption within the broader Temple Health system? What needs to happen to create sustainable change? The need for change was apparent. If Temple Health were to change the behaviours of their physicians, nurses, and residents, a performance system that aligned competencies to objectives was necessary. Cliff Tironi, managing director of Leadership Analytics Group LLC, which developed the app, and Morewood worked together to customize the DevelapMe app with the employee competencies that mattered most to Temple Health for tracking, such as professionalism, leadership, and interpersonal and communication skills. Tironi and Morewood also worked together to develop a rollout process for the app, which would involve a change management process including training for his team on how to give, seek, and receive real-time feedback. However, Morewood still had questions regarding analytics, particularly how the collected data and feedback matrix model could be used to analyze performance. The feedback culture matrix, generated from the data collected using the DevelapMe app, provided a visual means of analyzing the type of feedback given and received within an organization (see Exhibit 1). The ideal quadrant was the growth quadrant where feedback givers gave a mix of positive feedback as well as negative or developmental feedback. This ensured positive recognition of what people were doing well while providing people an opportunity to improve or grow. Users of the DevelapMe app were plotted on this matrix, where each point confidentially represented a different individual in the organization. The true value came in the macro-level picture of the entire organization. Understanding an organization’s feedback disposition supported a deeper understanding of the organization’s feedback culture. Morewood laid the foundation for change by starting at the top, informing his senior management of the importance of enhanced 360-degree, real-time feedback. Tironi trained the staff to provide constructive digital real-time feedback. The app was rolled out, and while not everyone participated, utilization was at This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 2 9B20C019 healthy levels overall—above 70 per cent adoption. Many of the faculty, nurses, and residents began using the app, and the feedback was abundant. Two months after the app had been launched, the feedback culture matrix provided data indicating that the feedback was largely positive, with employees “catching people doing things right.” Capturing these observations reinforced positive behaviours and supported the creation of a recognition culture. Morewood was looking for more, though. He wanted growth feedback that would help individuals share developmental growth opportunities and improve their core competencies. Seeking and receiving more growth feedback would be a sign that the organization was shifting in this direction. Tironi and Morewood developed a strategy to move from a friendly feedback culture to a growth feedback culture. Morewood led the change, asking each member of his team to provide feedback on one area that Morewood could improve as a department leader. Team members responded with strong, constructive feedback, marking the beginning of an organizational shift toward a growth feedback culture (see Exhibit 2). DRIVING GROWTH AND DEVELOPMENT Morewood’s request for feedback started the ball rolling. His team offered not only positive feedback but also helpful, constructive feedback with specific context to help both individuals and the team grow. Morewood’s request for feedback soon resulted in other team members providing feedback to each other. For example, a physician who had received nearly exclusively high scores (4s and 5s on a 5-point scale) for several weeks received a constructive score of 2 for professionalism. A comment was provided with the score, which read, “Discussed the importance of not discussing another patient or case in the presence of another awake patient.” The constructive feedback addressed a specific, infrequent issue—exactly the sort of feedback that would be lost in an annual performance review, yet could be critical to patient satisfaction and the training of residents (see Exhibit 3). Relatively minor improvements among an organization’s staff could result in significant changes to critical metrics, such as patient satisfaction scores. An annual performance review alone would be unlikely to catch infrequent lapses in judgment and would certainly not allow for immediate improvement. Real-time feedback enabled the physicians to immediately correct their behaviour, an adjustment that directly improved patient satisfaction. In another example, one Temple Health physician received 15 instances of feedback from resident direct reports, 14 of which were constructive or growth feedback (i.e., a score of 3 or lower on a 5-point scale). The average feedback score was 2.67. Crucially, 10 of the pieces of feedback contained comments providing specific advice for improvement, demonstrated in the following example: In a recent case, Dr. [XYZ] was less than encouraging in providing feedback during a technical procedure—i.e., speaking to every movement of my hand as I performed a line procedure and not allowing the learner to properly think, process and concentrate to execute the line. Having performed previous lines many times before, this was very distracting. Because of the specificity and timeliness of the feedback, the physician receiving the feedback knew exactly which developmental areas to focus on. Three weeks later, this physician received 13 additional instances of feedback with a score of 5 on all of them, representing a massive increase in the feedback score. The physician earned perfect scores in the areas that had previously received constructive criticism, such as professionalism, leadership, and interpersonal and communication skills. In this case, constructive feedback This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 3 9B20C019 galvanized the physician’s desire to improve their performance, and the improved scores increased the physician’s engagement with and support of the benefits of real-time, constructive feedback. In yet another instance, a resident gave upward feedback—feedback provided to someone who is higher than you in the organizational hierarchy—to a physician faculty member, suggesting how the person could better develop and use the certified registered nurse anaesthetists (CRNAs). The context of the comment was rich, technical, and specific. The feedback led to behaviour change shortly after the feedback was received, evidenced by more high evaluations of this same physician faculty member (see Exhibit 4). Slowly, Temple Health employees who had initially shown reluctance to give constructive feedback began to realize the immediate benefits that the system provided. In fact, the data revealed that instead of being hurt or reacting negatively to constructive feedback, employees significantly improved their performance. Morewood had learned that many change efforts failed because victory was declared after the first performance improvement. Consequently, the change effort would not be institutionalized, and many of the gains would be lost.1 It would have been easy to declare success after noting the physicians’ rapid, dramatic improvement in response to the constructive feedback and largely allow a return to the status quo (see Exhibit 5). But rather than declaring victory and lagging in commitment to continued use of the app, Morewood continued with his plan, and increased performance was sustained. Six months after instituting the feedback system across the organization, scores continued on an upward trajectory. INTEGRATING ARTIFICIAL INTELLIGENCE Artificial intelligence (AI) was used to identify trends and patterns in the feedback. Based on patterns and trends using all the data, the system would make specific recommendations. Temple Health found that the feedback analysis aided by AI painted a more accurate picture of individual employees’ overall performance. More traditional feedback systems, such as the annual or bi-annual performance evaluation, failed to note many types of human mistakes, whereas AI did not. When supervisors used a traditional performance evaluation, they were likely to focus only on instances of behaviour that stood out in the supervisor’s memory because the behaviour was exceptionally good or bad. Supervisors also tended to focus mostly on recent behaviour. This left so much of the employee’s day-to-day performance unevaluated. In contrast, apps and other digital systems that used smart technology and AI would take into account all reported feedback. Further, the digital systems could prompt the user for input on a regular basis and monitor change over time, creating a holistic and authentic evaluation of employee performance. As companies continued to shift away from traditional feedback systems, they could expect AI to play a central role. Organizations that adopted AI technologies for performance management and feedback would see multiple benefits. While humans could only review feedback data when they had time, AI could constantly analyze and interpret that data. For example, if an employee’s feedback scores began to fall below the standard, AI could notice that shift immediately, allowing the issue to be addressed as soon as possible. The system could also remind those giving feedback to provide follow-up feedback at a later date to help the recipient gain insight into their evolving performance. 1 John P. Kotter, “Leading Change: Why Transformation Efforts Fail,” Harvard Business Review, January 2007, 1–11. Available from Ivey Publishing, product no. R0701J. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 4 9B20C019 DECISION POINT: SCALING DEVELAPME ACROSS THE ORGANIZATION Pioneering physicians and institutional leaders could transform health care into a more effective and efficient industry. Hospitals and health systems strove to achieve the triple aim of improving quality, lowering costs, and enhancing patient experience. Success in these goals depended on the coordinated efforts of teams of highly organized and skilled individuals employing advanced communication technologies to facilitate and keep detailed records of performance over time. Rigorous use of meaningful data to foster enhanced personal performance was going to be necessary if hospitals were to reduce adverse events, produce well-oiled efficiency, and drive out unnecessary use of resources. Through the use of the app, Morewood identified critical needs to change medical education and clinical care at Temple Health, and he could see how those changes could be effected throughout the industry. He had focused on increasing communication and improving leadership, and he brought about change that included behaviour change and sustained improvement in performance. As an early adopter and pioneer with these new technological systems, Morewood felt that his organization would not have fully integrated this new system until senior physicians and leaders actively sought feedback for areas of improvement on a regular basis. He took his plan for app-based, real-time feedback beyond the individual level to the department level, but Morewood had not achieved complete involvement in this change. He had a clear vision for the role that this technology would play across the entire organization. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 5 9B20C019 EXHIBIT 1: FEEDBACK TYPES Source: Company files. EXHIBIT 2: RESULTS OF FEEDBACK SEEKING FOR GORDON MOREWOOD Note: app = application. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 6 9B20C019 EXHIBIT 3: LINK BETWEEN REAL-TIME FEEDBACK AND CONSTANT GROWTH Source: Company files. EXHIBIT 4: PERFORMANCE IMPROVEMENT Notes: CRNA = certified registered nurse anesthetists; a-line = arterial line; PIV = peripheral intravenous line. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 7 9B20C019 EXHIBIT 5: LINK BETWEEN CONSTRUCTIVE FEEDBACK AND IMPROVEMENT (FEEDBACK FOR PHYSICIAN FROM RESIDENTS) Note: Avg. = average. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. W20203 TEMPLE HEALTH SYSTEM: REAL-TIME FEEDBACK AND PEOPLE ANALYTICS (A) Tony Petrucci and Michael Rivera wrote this case solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. This publication may not be transmitted, photocopied, digitized, or otherwise reproduced in any form or by any means without the permission of the copyright holder. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Business School, Western University, London, Ontario, Canada, N6G 0N1; (t) 519.661.3208; (e) cases@ivey.ca; www.iveycases.com. Our goal is to publish materials of the highest quality; submit any errata to publishcases@ivey.ca. i1v2e5y5pubs Copyright © 2020, Ivey Business School Foundation Version: 2020-03-30 In the spring of 2017, Dr. Gordon Morewood, chair of anesthesiology at Temple University Health System (Temple Health) in Philadelphia, Pennsylvania, faced a rapidly changing health care environment. Expectations for improving patient outcomes, patient satisfaction, and financial performance were rising. Morewood was responsible for training anesthesiology residents and for all anesthesiology patient care across the system. His goals were to revolutionize medical education and improve cross-functional communication in health care, which had long operated in silos. There were clear opportunities to advance these goals by enhancing face-to-face communication and complementing it with digital feedback methods. TEMPLE UNIVERSITY HEALTH SYSTEM’S CHALLENGES Temple Health, one of Philadelphia’s leading academic medical centres, was home to more than 1,000 physicians and scientists who shared the mission of bringing innovative treatments to patients. Giving patients access to some of the world’s most advanced therapies—and helping patients to achieve outcomes once thought impossible—was the driving force for all of Temple Health’s clinical care, research, and medical education. The health system operated over a dozen research centres at the Lewis Katz School of Medicine at Temple University and the Fox Chase Cancer Center. Over the course of a year, Temple Health managed over 500,000 patient visits and 25,000 surgeries. Morewood saw a need in the evolving value-based health care environment for more efficient organization, data-driven decision-making, and improved communication within teams, departments, and across the institution: A key component of driving performance is focusing on your people, ensuring they have critical skills and competencies that are aligned with the organization’s goals and outcomes. Feedback is clearly one way in which we can increase communication and help employees receive insight into their competency performance. Our existing performance management model is not designed to optimally support this outcome, and we also just don’t have a culture yet that fully understands and prizes feedback. I think a major barrier is the fact that we just don’t have a culture of giving, receiving, and seeking feedback. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 2 9B20C018 Value-based health care was a health care delivery model where compensation was based on patient outcomes. This differed from a fee-for-service model where payments were charged based on the services provided alone. The value in this context was derived from measuring the health outcomes against the cost to deliver them. Morewood and his team wanted to incorporate leadership and management skills in physician education and training. The limitations of traditional performance review systems were apparent to both of them. If the organization was to develop new competencies in leadership and management skills, employees and students would need the opportunity to gain insight into their performance more frequently than once or twice a year. Implementing a real-time feedback system and integrating it with the existing annual performance model seemed challenging. While ineffective and suboptimal, the annual performance review process was something employees were at least familiar with. Success would require change in how people were aligned with organizational objectives, requiring a shift in strategy, mindset, framework, processes, and how they used feedback to drive performance. To accomplish these goals, Morewood consulted with some key people: ? ? Dr. Abiona Berkeley, an associate professor of anesthesiology and director of the residency program in anesthesiology at the Lewis Katz School of Medicine. Berkeley played a vital leadership role throughout the entire process. Leadership Analytics Group LLC (Leadership Analytics). Cliff Tironi, managing director of Leadership Analytics, attended strategy meetings with Morewood and Berkeley to provide consulting expertise in realtime feedback and people analytics. Leadership Analytics’ support included the use of their feedback application (app), DevelapMe, to facilitate real-time, competency-based feedback across the organization. The competency-based feedback was designed to capture real-time feedback on the competencies (or skills), knowledge, and experience that were most critical to the evaluated organization. After a monthly team strategy meeting, Morewood spent a few minutes debriefing with his leadership team and Tironi. Morewood explained: I’m still on the fence whether or not we should move forward with the project. It seems like the right thing to do, but it has been less than a year since we invested substantial resources in improving the department’s existing performance appraisal system. Here we are, considering not only a major change again but also one involving a new technology and a paradigm shift of how we evaluate performance and use human resource data. The app supports capturing interactions between people around competencies and work behaviours. While I’m not seeking to make another change, I believe that the performance appraisal system we have been using is not ideal. Being able to incorporate a real-time feedback process as a complement would certainly be a valuable innovation. This also seems like an important strategic opportunity, since real-time feedback would help facilitate communication and increase feedback to drive performance objectives. The performance objectives are patient outcomes, patient satisfaction, cross-departmental communication, and more effective resident training. Competencies are developed in each of these key areas. Feedback scores show how individuals are doing in this area and capture the areas in which they have improved. Communication between cross-functional groups has been limited. Both the leadership team and Tironi understood Morewood’s perspective. The challenges and opportunities with changing traditional communication methods were clear, but change was not without its own set of risks. Tironi replied to Morewood?, This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 3 9B20C018 Our consulting work has highlighted the existing pain points or challenges. Our information indicates that employees are not happy with the current performance appraisal process, they are not receiving enough feedback or receiving feedback in a timely manner, and the feedback is generally coming from people only within their immediate teams. Not to mention the current system does not allow your team to collect data on employees across the organization that can then be easily aggregated and analyzed. With the right kind of people analytics facilitated by the DevelapMe app, we can generate actionable insights that will improve performance in individuals, teams, and the organization. For example, if a physician scores low on teaching techniques, the physician will receive feedback in real-time and the physician’s performance then measured to determine whether they have improved in that area. The DevelapMe app will also create a feedback culture. A feedback culture would help employees within the organization prize feedback exchanges, especially as they relate to growth-oriented insights. Developing a feedback culture would mean observing communications flows and delving into detailed feedback provided by givers and receivers, such as feedback regarding areas of employee strength and opportunities for improvement. Morewood was excited about the process of real-time feedback: While much importance is placed on collecting feedback from patients through satisfaction surveys, we have yet another reason to believe in the value of capturing and analyzing interprofessional interactions. In the past two years, we have followed a structured program targeted at enhancing the communication patterns among our clinical staff: faculty, residents, and nurse anaesthetists. This programmatic change is not simply aimed at meeting abstract educational objectives; a wealth of data indicates that good physician communication skills may help to prevent adverse patient events. Morewood committed to deciding before the next meeting whether to proceed with implementing real-time feedback within the span of his own team and would announce his decision to the team at that time. TRADITIONAL PERFORMANCE APPRAISAL SYSTEMS Over their years of working together, Morewood and Berkeley had many conversations regarding Temple Health’s current performance appraisal system. From their perspective, the current performance appraisal system was a cyclical process where employees aligned individual goals with outcomes and priorities identified by the organization. Employees were evaluated on those goals once a year, twice a year, or sometimes quarterly, depending on an employee’s manager. The two physicians agreed that evaluations did not occur frequently enough and that feedback was not as efficient and effective as it could have been. To affect a person’s behaviour, you needed to provide them with specific instances and examples of their work. While managers did their best to observe, capture, and convey information about an individual’s performance, these instances were often forgotten before the next formal evaluation period. If a meeting to provide feedback did not occur in a timely manner, feedback provided to the employee could be less meaningful and harder to accept, especially if the feedback was constructive criticism. In addition, the current model left out feedback from many important individuals. The model focused on managerial feedback but did not accommodate feedback from peers and direct reports, which could provide This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 4 9B20C018 valuable insight and a broader perspective on performance. A more holistic view of performance was important, not only because annual reviews could affect compensation but also because the team-based environment of a hospital necessitated it. The work being done in the hospital involved the lives of patients, and those patient outcomes were critical to the quality of care being provided. In addition, given the complexity of the work, it was a true work product of a team of individuals. Effective communication was needed to ensure tasks and objectives were achieved. COMPETITIVE AND PERFORMANCE OPPORTUNITIES USING REAL-TIME FEEDBACK In 2017, the global trend of real-time performance feedback was in its nascent stages, with all indicators suggesting that this new approach would render traditional performance appraisal systems obsolete in current form.1 If Temple Health moved to a model of real-time feedback, the shift in approach to performance appraisals could drive 360-degree feedback across the organization, enhance communication, increase competency development, support goal obtainment, and provide actionable insights on performance trends and feedback patterns. Individual users would receive real-time feedback from others regarding their performance, and managers would be able to look at performance data across the team to identify employees who may have needed additional support or who deserved recognition for outstanding work. The evaluation of the work was focused on the new behaviours needed to change the health care system as a whole. Morewood felt that medical faculty needed an updated understanding of their roles. While modern medical training focused almost entirely on acquiring biomedical knowledge, many of the health care industry’s greatest challenges required cross-functional collaboration and communication acumen that many medical professionals had not been trained to use. It was critical that communication among key stakeholders such as surgeons, nurses, anaesthetists, technical support, patient transport, radiology, and administrative staff was real-time, precise, and technical. The current model’s deficits were akin to a master of business administration program consisting of only finance lectures but no leadership or management theory. Important generational issues complicated Morewood’s decision. Many of the medical residents were millennials (i.e., born in the 1980s and 90s), while the majority of the medical faculty belonged to older generations. Millennials, on the whole, preferred frequent, detailed performance feedback that addressed areas of strength and opportunities for improvement that would propel them along a career path. Millennials were looking for a coach, not a boss. They were also born into the digital age and preferred communicating through digital devices, both socially and professionally.2 Given generational trends, Morewood’s team assumed that the older faculty members might be resistant to new technologies and prefer using communication methods they were more familiar with. Morewood knew that there were several significant organizational issues in health care to overcome, such as the following: ? ? ? ? medicine’s traditional, strictly top-down hierarchy; the need for flawless personal performance and judgment among physicians; generational dynamics among the health care workforce; and a need for a modern vision of cross-functional collaboration among physicians and administrative leadership to optimize health care delivery. 1 Peter Capelli, “The Performance Management Revolution,” Harvard Business Review, October 206, accessed March 29, 2020, https://hbr.org/2016/10/the-performance-management-revolution. 2 Sue Shellenbarger, “The Office Rookies Who Ask for the World,” The Wall Street Journal, April 8, 2019, accessed January 14, 2020, www.wsj.com/articles/the-office-rookies-who-ask-for-the-world-11554730098. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 5 9B20C018 LEADING AND MANAGING THE CHANGE PROCESS As Morewood and his leadership team evaluated their options, they consulted with Tironi regarding how to accomplish their objectives. Digital real-time feedback was a new approach that would require a change management process, and Tironi provided guidance concerning the best strategies for change leadership. Tironi explained the key myths and important considerations about implementing digital real-time feedback: Many organizations are moving to—or considering a move to—more real-time feedback. Given the fast pace and complexity present in modern organizations, there is a heightened need for realtime communication among colleagues. This includes peers, supervisors, and direct reports. Additionally, colleagues require cross-functional communication. The goal of real-time feedback is better information sharing, feedback to recognize positive behaviours, and feedback to help people grow. The feedback process includes giving, seeking, and receiving feedback. Tironi went on to say, It takes trust for people to feel comfortable giving important feedback to others. Context for feedback is also crucial in order to explain why the feedback is important, how it connects to the organization, and if acted upon, how it can impact the individual receiving the feedback. Given that millennials and their successors, Gen Z [Generation Z], want higher-quality feedback at more frequent intervals... [and] are comfortable communicating through mobile devices, real-time feedback through mobile apps is emerging. Digital real-time feedback offered Temple Health many advantages over a traditional performance review system. Some of these advantages included a potential increase in organizational transparency; the ability to monitor key organizational and performance drivers through the analysis of feedback data made available on the app platform; evidence of an institutional investment in a growth feedback culture; enabling effective communication in a complex environment; a step toward migrating from a traditional hierarchy to agile networks of teams; and increased face-to-face and digital communications throughout teams. Agile teams were created within the app, as users were empowered to create teams as needed for a given function, project, initiative, or task. Digital feedback exchanges were often used to prompt in-person discussion regarding the content. Transparency was increased due to more accurate context in the real-time nature of the feedback and the increased focus on creating a feedback culture. Given these benefits, Morewood felt that real-time feedback through mobile devices was a good way to enhance and enable Temple Health’s overall communication goals. CREATING A FEEDBACK CULTURE Knowing the culture of Temple Health, Morewood could anticipate some of the potential pitfalls that Temple Health might encounter as they implemented the new review system. He felt there would be little doubt that capturing and analyzing real-time data on the quality of professional interactions between hospital staff could improve individual performance and ultimately improve patient safety and care outcomes. However, Morewood’s experience suggested that new tools and skill sets needed to be carefully cultivated to achieve the full potential of continuous personal improvement. It was also clear to him that this change would affect the existing culture and that the organization would need to focus on creating a feedback culture. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 6 9B20C018 To best effect change, Morewood believed that feedback had to be given in near real time, when the memory of events was greatest for all parties. While two-way communication in an annual performance review could offer some limited insight, capturing and measuring feedback in real time across a variety of interactions seemed to drive immediate performance improvement for individuals across all levels of the organization. Of course, this was not always possible or necessary during a crisis or when working under time constraints. Tironi and Morewood reviewed the steps and success factors required to implement real-time feedback (see Exhibit 1), as well as what real-time feedback should do for an organization. Success factors that would enable implementation of digital real-time feedback included the following: ? ? ? a commitment from senior management to a full change management process; easy-to-use technology to ensure even adoption across the organization; and perhaps a partner firm who could advise, implement, and execute the strategy. THE DECISION: PROCEEDING WITH DEPARTMENT IMPLEMENTATION After spending some time using the DevelapMe application, Morewood recognized the potential opportunity and was faced with deciding whether he was ready to roll this system out across his department and further evaluate proposing to scale the technology across the organization. Morewood said, It is clear to me that it is worth evaluating this tool and the potential change process that would be needed to implement real-time feedback in order to create a culture of feedback within the organization that prizes constructive feedback. This app very well could help us build a growth feedback culture to address the performance and feedback challenges we have been facing as an organization by helping employees get the feedback they need in the moment. If Morewood were to proceed, his goal was clear: to capture real-time interactions, as they happened, through the app and categorize them by key organizational drivers or competencies (see Exhibit 2). The competencies would then be analyzed by team management using advanced people analytics to identify areas of high performance and opportunities for improvement. The rollout of real-time feedback would be positioned to revolutionize Temple Health’s communication and performance. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 7 9B20C018 EXHIBIT 1: STEPS FOR IMPLEMENTING REAL-TIME FEEDBACK 1. 2. 3. 4. Create a need for the change. Change must be led from the top. Team must be trained on seeking, giving, and receiving feedback. Team must be trained on how to seek, give, and receive digital feedback, as well as on how digital feedback complements and enhances face-to-face feedback. 5. People analytics must be captured and used to adjust leadership and team behaviour. 6. Artificial intelligence should be used to prompt desired individual behaviours. 7. Continuous focus should be placed on this strategy to create a habit and sustained change. Source: Company files. EXHIBIT 2: TEMPLE HEALTH CUSTOMIZED COMPETENCIES AND BEHAVIOURS FOR DEVELAPME APP 1. Interpersonal and communication skills, such as the minute-to-minute teamwork required to manage operating room throughput. 2. Leadership, including organizing and implementing new care pathways. 3. Medical knowledge. 4. Patient care, including the close attention to detail required during the perioperative period. 5. Practice-based learning and improvement. 6. Professionalism, including acting as the patient’s fiduciary under all circumstances. 7. Systems-based practice, or exercising the coordination and co-operation mandated by the complexity of 21st-century medical care. Note: The perioperative period is the period of a patient’s surgical procedure, typically including admission to the surgical unit (preoperative), anaesthesia and surgery (intra-operative), and recovery (post-operative).App = application. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. W20204 TEMPLE HEALTH SYSTEM: REAL-TIME FEEDBACK AND PEOPLE ANALYTICS (B) Tony Petrucci and Michael Rivera wrote this case solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. This publication may not be transmitted, photocopied, digitized, or otherwise reproduced in any form or by any means without the permission of the copyright holder. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Business School, Western University, London, Ontario, Canada, N6G 0N1; (t) 519.661.3208; (e) cases@ivey.ca; www.iveycases.com. Our goal is to publish materials of the highest quality; submit any errata to publishcases@ivey.ca. i1v2e5y5pubs Copyright © 2020, Ivey Business School Foundation Version: 2020-03-30 In late 2017, Dr. Gordon Morewood, chair of anesthesiology at Temple University Health System (Temple Health) in Philadelphia, Pennsylvania, and his team chose to implement digital real-time feedback across the team using the DevelapMe application (app). Their decision was based on the app’s flexibility to adapt to the needs of the organization as well as its ease of use and advanced people analytics. In his efforts to scale DevelapMe across the organization, should he continue to lead the change exclusively with his own team, or encourage further adoption within the broader Temple Health system? What needs to happen to create sustainable change? The need for change was apparent. If Temple Health were to change the behaviours of their physicians, nurses, and residents, a performance system that aligned competencies to objectives was necessary. Cliff Tironi, managing director of Leadership Analytics Group LLC, which developed the app, and Morewood worked together to customize the DevelapMe app with the employee competencies that mattered most to Temple Health for tracking, such as professionalism, leadership, and interpersonal and communication skills. Tironi and Morewood also worked together to develop a rollout process for the app, which would involve a change management process including training for his team on how to give, seek, and receive real-time feedback. However, Morewood still had questions regarding analytics, particularly how the collected data and feedback matrix model could be used to analyze performance. The feedback culture matrix, generated from the data collected using the DevelapMe app, provided a visual means of analyzing the type of feedback given and received within an organization (see Exhibit 1). The ideal quadrant was the growth quadrant where feedback givers gave a mix of positive feedback as well as negative or developmental feedback. This ensured positive recognition of what people were doing well while providing people an opportunity to improve or grow. Users of the DevelapMe app were plotted on this matrix, where each point confidentially represented a different individual in the organization. The true value came in the macro-level picture of the entire organization. Understanding an organization’s feedback disposition supported a deeper understanding of the organization’s feedback culture. Morewood laid the foundation for change by starting at the top, informing his senior management of the importance of enhanced 360-degree, real-time feedback. Tironi trained the staff to provide constructive digital real-time feedback. The app was rolled out, and while not everyone participated, utilization was at This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 2 9B20C019 healthy levels overall—above 70 per cent adoption. Many of the faculty, nurses, and residents began using the app, and the feedback was abundant. Two months after the app had been launched, the feedback culture matrix provided data indicating that the feedback was largely positive, with employees “catching people doing things right.” Capturing these observations reinforced positive behaviours and supported the creation of a recognition culture. Morewood was looking for more, though. He wanted growth feedback that would help individuals share developmental growth opportunities and improve their core competencies. Seeking and receiving more growth feedback would be a sign that the organization was shifting in this direction. Tironi and Morewood developed a strategy to move from a friendly feedback culture to a growth feedback culture. Morewood led the change, asking each member of his team to provide feedback on one area that Morewood could improve as a department leader. Team members responded with strong, constructive feedback, marking the beginning of an organizational shift toward a growth feedback culture (see Exhibit 2). DRIVING GROWTH AND DEVELOPMENT Morewood’s request for feedback started the ball rolling. His team offered not only positive feedback but also helpful, constructive feedback with specific context to help both individuals and the team grow. Morewood’s request for feedback soon resulted in other team members providing feedback to each other. For example, a physician who had received nearly exclusively high scores (4s and 5s on a 5-point scale) for several weeks received a constructive score of 2 for professionalism. A comment was provided with the score, which read, “Discussed the importance of not discussing another patient or case in the presence of another awake patient.” The constructive feedback addressed a specific, infrequent issue—exactly the sort of feedback that would be lost in an annual performance review, yet could be critical to patient satisfaction and the training of residents (see Exhibit 3). Relatively minor improvements among an organization’s staff could result in significant changes to critical metrics, such as patient satisfaction scores. An annual performance review alone would be unlikely to catch infrequent lapses in judgment and would certainly not allow for immediate improvement. Real-time feedback enabled the physicians to immediately correct their behaviour, an adjustment that directly improved patient satisfaction. In another example, one Temple Health physician received 15 instances of feedback from resident direct reports, 14 of which were constructive or growth feedback (i.e., a score of 3 or lower on a 5-point scale). The average feedback score was 2.67. Crucially, 10 of the pieces of feedback contained comments providing specific advice for improvement, demonstrated in the following example: In a recent case, Dr. [XYZ] was less than encouraging in providing feedback during a technical procedure—i.e., speaking to every movement of my hand as I performed a line procedure and not allowing the learner to properly think, process and concentrate to execute the line. Having performed previous lines many times before, this was very distracting. Because of the specificity and timeliness of the feedback, the physician receiving the feedback knew exactly which developmental areas to focus on. Three weeks later, this physician received 13 additional instances of feedback with a score of 5 on all of them, representing a massive increase in the feedback score. The physician earned perfect scores in the areas that had previously received constructive criticism, such as professionalism, leadership, and interpersonal and communication skills. In this case, constructive feedback This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 3 9B20C019 galvanized the physician’s desire to improve their performance, and the improved scores increased the physician’s engagement with and support of the benefits of real-time, constructive feedback. In yet another instance, a resident gave upward feedback—feedback provided to someone who is higher than you in the organizational hierarchy—to a physician faculty member, suggesting how the person could better develop and use the certified registered nurse anaesthetists (CRNAs). The context of the comment was rich, technical, and specific. The feedback led to behaviour change shortly after the feedback was received, evidenced by more high evaluations of this same physician faculty member (see Exhibit 4). Slowly, Temple Health employees who had initially shown reluctance to give constructive feedback began to realize the immediate benefits that the system provided. In fact, the data revealed that instead of being hurt or reacting negatively to constructive feedback, employees significantly improved their performance. Morewood had learned that many change efforts failed because victory was declared after the first performance improvement. Consequently, the change effort would not be institutionalized, and many of the gains would be lost.1 It would have been easy to declare success after noting the physicians’ rapid, dramatic improvement in response to the constructive feedback and largely allow a return to the status quo (see Exhibit 5). But rather than declaring victory and lagging in commitment to continued use of the app, Morewood continued with his plan, and increased performance was sustained. Six months after instituting the feedback system across the organization, scores continued on an upward trajectory. INTEGRATING ARTIFICIAL INTELLIGENCE Artificial intelligence (AI) was used to identify trends and patterns in the feedback. Based on patterns and trends using all the data, the system would make specific recommendations. Temple Health found that the feedback analysis aided by AI painted a more accurate picture of individual employees’ overall performance. More traditional feedback systems, such as the annual or bi-annual performance evaluation, failed to note many types of human mistakes, whereas AI did not. When supervisors used a traditional performance evaluation, they were likely to focus only on instances of behaviour that stood out in the supervisor’s memory because the behaviour was exceptionally good or bad. Supervisors also tended to focus mostly on recent behaviour. This left so much of the employee’s day-to-day performance unevaluated. In contrast, apps and other digital systems that used smart technology and AI would take into account all reported feedback. Further, the digital systems could prompt the user for input on a regular basis and monitor change over time, creating a holistic and authentic evaluation of employee performance. As companies continued to shift away from traditional feedback systems, they could expect AI to play a central role. Organizations that adopted AI technologies for performance management and feedback would see multiple benefits. While humans could only review feedback data when they had time, AI could constantly analyze and interpret that data. For example, if an employee’s feedback scores began to fall below the standard, AI could notice that shift immediately, allowing the issue to be addressed as soon as possible. The system could also remind those giving feedback to provide follow-up feedback at a later date to help the recipient gain insight into their evolving performance. 1 John P. Kotter, “Leading Change: Why Transformation Efforts Fail,” Harvard Business Review, January 2007, 1–11. Available from Ivey Publishing, product no. R0701J. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 4 9B20C019 DECISION POINT: SCALING DEVELAPME ACROSS THE ORGANIZATION Pioneering physicians and institutional leaders could transform health care into a more effective and efficient industry. Hospitals and health systems strove to achieve the triple aim of improving quality, lowering costs, and enhancing patient experience. Success in these goals depended on the coordinated efforts of teams of highly organized and skilled individuals employing advanced communication technologies to facilitate and keep detailed records of performance over time. Rigorous use of meaningful data to foster enhanced personal performance was going to be necessary if hospitals were to reduce adverse events, produce well-oiled efficiency, and drive out unnecessary use of resources. Through the use of the app, Morewood identified critical needs to change medical education and clinical care at Temple Health, and he could see how those changes could be effected throughout the industry. He had focused on increasing communication and improving leadership, and he brought about change that included behaviour change and sustained improvement in performance. As an early adopter and pioneer with these new technological systems, Morewood felt that his organization would not have fully integrated this new system until senior physicians and leaders actively sought feedback for areas of improvement on a regular basis. He took his plan for app-based, real-time feedback beyond the individual level to the department level, but Morewood had not achieved complete involvement in this change. He had a clear vision for the role that this technology would play across the entire organization. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 5 9B20C019 EXHIBIT 1: FEEDBACK TYPES Source: Company files. EXHIBIT 2: RESULTS OF FEEDBACK SEEKING FOR GORDON MOREWOOD Note: app = application. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 6 9B20C019 EXHIBIT 3: LINK BETWEEN REAL-TIME FEEDBACK AND CONSTANT GROWTH Source: Company files. EXHIBIT 4: PERFORMANCE IMPROVEMENT Notes: CRNA = certified registered nurse anesthetists; a-line = arterial line; PIV = peripheral intravenous line. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021. For the exclusive use of B. Kropelunski, 2021. Page 7 9B20C019 EXHIBIT 5: LINK BETWEEN CONSTRUCTIVE FEEDBACK AND IMPROVEMENT (FEEDBACK FOR PHYSICIAN FROM RESIDENTS) Note: Avg. = average. Source: Company files. This document is authorized for use only by Bridget Kropelunski in HRMS Summer 2021 Group paper assignment taught by WILLIAM NINEHAN, New York Institute of Technology from Jun 2021 to Dec 2021.