4. Review the attachment Chapter 6A - Foot Caught in the Door: Healthy Changes in Health Care Companies and answer the following questions:

a. How do you convince senior executives who are set on a particular solution that they "don't know what they don't know" and do this in a manner that helps them save face and that illuminates a path to actually solve their problems?

b. What is the role of your client's beliefs and values in the needs assessment process?

c. How can you discuss organizational problems without making it seem like the client is inundated with problems, even if they are?

d. How can you frame messages to help clients understand the difference between problem causes and problem symptoms?

e. What is one communication behavior that the consultant could have done more effectively during the contracting process?

How do you convince a potential client that what they need in terms of an organization development project is different than what they want? Should consultants bluntly state that if they conduct a project based on their stated desires that their problem will remain unsolved? Once a consultant and client agree on the scope and value of a project, how does the consultant write a useful, mutually beneficial contract? These are the sort of questions that organization development practitioners face on a daily basis, and how practitioners respond to them will quickly build, or hinder, its reputation as an expert. Making things even more interesting, or difficult, is that these important questions and conversations do not occur in a vacuum. For this case, these discussions took place with stakeholders at a rapidly growing telehealth company that was also experiencing a simultaneous structural reorganization, a three-company merger, and an information technology process implementation program. Telehealth companies use communication technologies to deliver health education information to clients. This company's work culture includes an unforgiving pace, continuous change, high turnover, and constant technological innovations. Consultants must be ready to think and respond quickly! A previous client recently transitioned companies and called to see whether I could conduct a 2-hour keynote workshop on conflict management for their management summit. Her new company, Virtual Vitality, is a leader in the telehealth industry but is experiencing a lot of turnover and low levels of trust between different departments and business units. Of course I was interested, but before agreeing to conduct the keynote workshop, I preferred to follow my typical workow process and begin with a needs assessment conversation to better understand the context surrounding the proposed event. This is where things got interesting. The goal of this theory-light, action-heavy case is to challenge readers to think through what I did successfully and what I could have done more effectively to secure the contract. Virtual Vitality (VV) is a 15-year-old internally grown subsidiary of a Fortune 100 health services company. VV has a presence in five states and has a 95% retention rate with current clients. They provide a variety of telehealth services including nurse support lines, member support lines, and answering services with paging. The goal of all these different services is to promote proper medical and health advice to patients and organizations in an efficient manner. VV works at the individual patient level and the health care provider (i.e., company) level, and it aims to answer calls quickly and provide answers accurately. VV has been very successful in delivering its services in an efficient and effective manner, and its success has contributed to rapid nancial and employee growth. In a way, VV is a victim of its own success and its industry trends. Successful health services companies are experiencing a hyperchange stage in their business cycle. To remain relevant and protable, they must constantly respond to the aftermath of regulatory changes, technological changes, and mergers and acquisitions. Saying that VV was suffering from growing pains would be an understatement. For example, their year-to-year revenue grew 200% each year for a 5-year period. The additional financial resources allowed them to develop their talent pool and form a more robust business structure by adding additional business units (i.e., new sources of revenue from new client services) and hiring hundreds of new employees. In a 3- year period, VV experienced 900% employee growth, exploding their workforce from 50 employees to more than 500. Through this rapid expansion of personnel and services, the four- person executive team remained the same. Before discussing the problems that emerged from the rapid change, I need to describe the key players. Ron Coleman has been the chief executive officer of VV since its inception 15 years ago. Ron is a registered nurse and has an MBA degree from an Ivy League university. While he is well respected among the executive team members and senior leaders at VV, he is not well liked within the parent organization. This makes it difficult to secure resources for larger projects and to pursue creative opportunities if they are not first vetted with his superiors. Ron is a very direct communicator, rarely smiles, and has a very dry sense of humor. He is fond of saying, \"I have an open door policy and no one comes by. I do walking tours to connect with our frontline workers. What else do I need to do?\" Ron made clear that he was not a fan of communication training because he didn't see the bottom line value in it. Cheryl Blumberg is Ron's right hand and is the vice president for sales and business development. She understands the benefits of change and is visibly excitable at the prospect of learning how new processes can improve business. Cheryl is a registered nurse and has also been with VV since its inception. Cheryl and Ron are good friends, and their families vacation together at Ron's lake house. Employees in the \"inner circle\" also get invited to these lake vacations. Cheryl supports Ron in every endeavor and never goes against his wishes publicly. Their professional and personal relationship is very clear to the rest of the management team. Lisa Pohler served as the direct sponsor for this project. Lisa was my previous client and the person who reached out to me about the keynote address. She is senior director of informatics and is extremely intelligent. She has held a variety of executive positions in the health care industry, has worked internationally, and sees the importance of communication training and consulting. From the beginning, she was championing the project to her peers. The next section describes the challenges that emerged during the entry and contracting phases of this project. I answered a blocked phone call at 6:00 on a Friday night while I was grilling some New York strip steaks for a family dinner. I was surprised to hear a former client on the other end. \"Good evening, it's Lisa from Prodigy Health. Is this a good time to talk?\" I was caught off guard but decided to chat. \"I'm not sure if you heard, but I transitioned to Virtual Vitality a few months ago. We are having our management summit strategic planning event in a month, and we would love for you to present a 2-hour keynote workshop on conict management.\" I instantly felt internal gratication and was thinking, \"Of course I'll do the keynote, Lisa.\" I would have waived my fees just to gain the experience and exposure from such a reputable company. But before I articulated those thoughts, I regained my composure and asked to set up a time early next week to conduct a needs assessment to better understand their situation. Lisa responded, \"I can chat now if that works for you.\" I could tell that Lisa really wanted to chat, and while it was not a convenient time for me, I asked if she could give me 15 minutes to get prepared and call her back. She agreed, and our first needs assessment conversation lasted 25 minutes. Before I crafted the project proposal, which doubles as my contract, it became clear that I would need to speak to other executive team members to learn their perspectives and determine if I could meet their needs. I also wanted to further probe whether they had the right \"needs\" in the first place. The next conversation took place in Cheryl's comer ofce on the 10th oor of VV's corporate headquarters. They ordered a fancy catered lunch and looked to me to guide the conversation. Before we dove into the project needs, two things had me concerned: the fact they wanted a \"keynote workshop,\" which is different than a traditional keynote address, and that the workshop content was about conict management strategies. I want to reiterate that we had not signed a contract yet', we were merely discussing whether I would be the best t for the project. I Lisa and Cheryl couldn't pinpoint what the exact issues were or where they originated. During our conversation, the two of them amicably disagreed over many issues including decision-making authority, reporting accuracy, scheduling errors, and ranking the effectiveness of each other's team members. It was evident the VV executive team members had never discussed these issues as a team. Due to the structural changes, their company had a heightened sense of uncertainty regarding job security, which allowed nger-pointing and blaming to become the norm. The \"that's not my job\" mentality had taken over. Even more significant was that these internal issues were beginning to affect patient care, and this was the breaking point. I decided to be completely honest and tell them that a keynote address or keynote workshop would not solve these issues, at least not without a combination of other services. I was so blunt, I eventually said, \"Thinking a keynote could solve these issues would be like putting a band aid on a severed head. Not gonna help without surgery and medicine.\" After another hour of intense, productive conversation, they understood my perspective and I had a much more holistic grasp of their issues and needs. I told them I would put together a proposal that would include three differently valued packages for how to address these issues as well as my nonnegotiable fees. As part of my normal workow process, I reiterated a few key ideas and got their verbal confirmation on them: (a) My proposal serves as the contract and scope of work to be performed, and (b) I only reduce fees by removing services from particular packages. A day later, Lisa and Cheryl received my proposal that included three different packages ranging in mutual value. The bronze package, which is the one I assumed they would select, included the keynote workshop and a data collection phase to help them discover the root of their conicts. I priced the packages very competitively, and the bronze package was the most affordable. The following day, Lisa called me and said, \"We ran the packages by the executive Lisa and Cheryl couldn't pinpoint what the exact issues were or where they originated. During our conversation, the two of them amicably disagreed over many issues including decision-making authority, reporting accuracy, scheduling errors, and ranking the effectiveness of each other's team members. It was evident the VV executive team members had never discussed these issues as a team. Due to the structural changes, their company had a heightened sense of uncertainty regarding job security, which allowed nger-pointing and blaming to become the norm. The \"that's not my job\" mentality had taken over. Even more significant was that these internal issues were beginning to affect patient care, and this was the breaking point. I decided to be completely honest and tell them that a keynote address or keynote workshop would not solve these issues, at least not without a combination of other services. I was so blunt, I eventually said, \"Thinking a keynote could solve these issues would be like putting a band aid on a severed head. Not gonna help without surgery and medicine.\" After another hour of intense, productive conversation, they understood my perspective and I had a much more holistic grasp of their issues and needs. I told them I would put together a proposal that would include three differently valued packages for how to address these issues as well as my nonnegotiable fees. As part of my normal workow process, I reiterated a few key ideas and got their verbal confirmation on them: (a) My proposal serves as the contract and scope of work to be performed, and (b) I only reduce fees by removing services from particular packages. A day later, Lisa and Cheryl received my proposal that included three different packages ranging in mutual value. The bronze package, which is the one I assumed they would select, included the keynote workshop and a data collection phase to help them discover the root of their conicts. I priced the packages very competitively, and the bronze package was the most affordable. The following day, Lisa called me and said, \"We ran the packages by the executive