John A. Hartford Foundation President Terry Fulmer, left, and David Altman, at the Foundation's annual Change AGEnts conference in Philadelphia. John A. Hartford Foundation President Terry Fulmer, left, and David Altman, at the Foundation's annual Change AGEnts conference in Philadelphia.

This week, about 100 John A. Hartford Foundation Change AGEnts are meeting in Philadelphia for our second annual Change AGEnts conference. It is an exciting event bringing together passionate experts in the care of older adults.

These Change AGEnts are learning from each other and informing us at the Foundation about the biggest challenges and opportunities to improve care for older people across settings and situations.

The conference kicked off with a thought-provoking keynote presentation from David Altman, Executive Vice President and Managing Director at the Center for Creative Leadership (CCL).

David has been building CCL’s leadership development programs in Europe, the Middle East, and Africa and shared several key points about leading change that we can all use as we work to improve care of older adults.

In her introduction, Terry Fulmer, PhD, RN, FAAN, president of the John A. Hartford Foundation, recalled her reaction the first time she heard Altman speak several years ago: “I said, ‘I am impressed. I am inspired.’”

He made the same impression on the Change AGEnts. Here are some take-aways that we want to share with all of the Change AGEnts and Health AGEnda readers who weren’t able to be with us in Philly.

As part of David Altman's keynote address, Change AGEnts engaged in a Visual Explorer exercise, in which they were asked to think about what they would like to learn from a change leader they admire. Participants found a postcard taped under their seat, and they were asked to consider how the image relates to what they want to learn. As part of David Altman's keynote address, Change AGEnts engaged in a Visual Explorer exercise, in which they were asked to think about what they would like to learn from a change leader they admire. Participants found a postcard taped under their seat, and they were asked to consider how the image related to what they want to learn.

Change AGEnts live in a VUCA world.

What is VUCA? It’s an acronym that originated in the military that perfectly describes health care at this moment in our country—Volatile, Uncertain, Complex, Ambiguous.

The Affordable Care Act, new value-based payment and delivery models, electronic health records, and consolidation and mergers of hospitals, health systems, and insurers are all just a few of the highly disruptive factors resulting in a VUCA experience for our Change AGEnts working in clinics, hospitals, nursing homes, social service agencies, and non-profit organizations across the country.

This kind of volatile environment requires a different way of looking at and managing change. As David noted, “In the VUCA world, change leaders have to plan, but they also have to constantly modify their plans to be effective as the sands shift and the conditions change.” Too true.

To help deal with a VUCA world, step back and take a different perspective.

David presented a story about an experiment in which school children were shown a picture of a person in a wheelchair and asked, “Can this person drive a car?” Most children said “no.” In another classroom, the same picture was shown, but with a slightly different question: “How can this person drive a car?” Suddenly the results were different—most children had many creative ideas about how the person could drive.

The lesson is that some of our most vexing challenges in a VUCA world require us to step back, reframe the issue, and ask our questions in a way that opens people to the possibility of solutions.

Understand that change is a complex, continuous, psychological process that requires a “polarity” mindset.

David reminded us that most change initiatives fail, and that this is often due to a mistaken belief that there is a linear, step-by-step process to making change. He pointed to the work of his colleague, Bill Pasmore, who has written about the complexity and simultaneous efforts needed to successfully lead change initiatives. (View or download a PDF of Pasmore's white paper, It's a New Game: Leading Complex, Continuous Change.)

Change may also fail when we don’t recognize and manage the psychological components that come with transitions. Although we often think about change as starting something new, people experience loss, too, as the old way of doing business stops. David sagely reminded us: “Always remember that change begins with an ending.”

He also presented the idea of “polarity”—that change can be challenging because we often have to hold what seem to be opposing ideas in our minds at the same time. We want both efficiency and innovation in our organizations. We say primary care must focus on population health and be person-centered. This requires higher-order intelligence and creativity in how we look at problems.

Change_AGEnts_logo_300pTogetherness is an antidote to VUCA.

David concluded with music to the ears of all of us who have invested in the John A. Hartford Foundation Change AGEnts Initiative. Part of our theory is that by connecting Change AGEnts to each other, we will be able to see improvements in the care of older adults happen better and faster.

David agreed and left us with three recommendations: “Throw your hats together, work together, and walk together.”

His first recommendation stems from an Irish adage: “When you come upon a wall, throw your hat over it, and then go get your hat.” The message to be bold and step up in a united way to climb those walls came through loud and clear. Working together is important because research shows that, given the right conditions, groups as a whole are smarter than the smartest individual in that group.

Finally, he shared the African Proverb: "If you want to walk fast, walk alone. If you want to walk far, walk together."

We are definitely on a lengthy journey toward improving care of older adults. While we want to go fast (and I think we can help each other do so), our “togetherness” and collective action will ensure we go the distance.