Most healthcare organizations are already preparing for the inevitable changes that will come with healthcare reform - from short- and long-term cost reduction plans, to fundamentally new ways to deliver healthcare services. As healthcare leaders identify areas for change, then develop and implement plans, the need for significant change management practices may be easily overlooked.
Ignoring this critical component may limit the success of otherwise well thought-out plans. From our work helping healthcare organizations across the nation manage significant changes, we recommend two straightforward change management steps that can lead organizations to the outcomes they desire to attain.
Step One: Let Employees, Middle Management, and Physicians Catch-Up
Significant change can take months, or even years, to evolve from the initial discussion to full implementation. During the early stages, often ideas and concepts are discussed at a senior leadership retreat, board meeting, or even during informal encounters among executives. Typically, there is a lengthy period of time invested in gaining acceptance for the change, followed by debates over competing ideas on how to move forward, a sharing of opinions and thoughts on implementation strategies, and finally the building of consensus.
Most senior healthcare leaders are people of action. They also feel pressure to start implementing change as soon as possible. The months spent “politicking” to get a plan ready to move forward simply builds up the pressure to move quickly once a consensus among senior leaders and board members has been reached. It is during this time that problems occur.
Commonly, the parties not included in the initial consensus-building – the directors, managers, employees, and key physicians - are simply not ready to embrace the change, just as many of the senior leaders or board members may not have been initially.
It is natural for senior leaders to be anxious about time already wasted and feel the need to move forward quickly. However, it is critically important to guide middle managers, employees and physicians from the beginning stages and allow them adequate time for thought and discussion so they both understand and accept the need for the change, and the implementation approach.
Clearly, a well thought-out plan that will effectively communicate the change is essential, but when time for discussion and understanding by managers and employees is by-passed, we have found that there is little acceptance and higher levels of resistance.
Step Two: Emphasize What is Staying the Same, Not What is Changing
From almost forty years of gathering and analyzing information on hundreds of thousands of healthcare leaders, one commonality seems to exist - most individuals whose career path led them to senior leadership positions are change agents. These leaders are not only open to change, they seek it out. They see a stagnant environment as unresponsive to the natural changing world, and a non-changing workplace is seen as unchallenging, and even boring. This attitude towards change is essential for the success of a healthcare organization since senior leaders are responsible for identifying the needs of the organization both today, and five and ten years into the future, and to plan for that future and move the organization forward.
We have also gathered data on what motivates healthcare employees and middle managers, and unlike senior leaders, most healthcare employees and middle managers resist change and prefer predictability and structure. This natural focus on the “now” is a needed quality and essential to the success of the organization since the day-to-day delivery of care requires following process and procedure – every time, in the same way. Whether it is called protocols, procedures or Joint Commission Standards, healthcare relies on employees and managers to desire the “same” every time.
Therefore, we have a dilemma when an organization needs to make fundamental changes. Senior leaders like and want change – most employees, managers and physicians, do not. Even with this built-in conflict, the less dramatic changes still occur on a regular basis in healthcare, but typically with much gnashing of teeth, a senior presence to push through the resistance and plenty of committee meetings. However, fundamental, large-scale change has much more difficulty overcoming this dilemma.
It may sound simple, but one solution is to focus less on the change and more on what stays the same. Senior leaders and those managers and employees who find change exciting often extol the virtues of the change, singing praises of what will be different and better in hopes of creating excitement about the change. Unfortunately, these efforts can instead have the unintended consequence of increasing anxiety and resistance.
Finding the right balance and knowing your audience is the key. A recent “change” situation provides a good example. The leaders of a major health system were perplexed because they were facing high resistance from employees and middle managers as they planned to move to a newly constructed hospital. The senior leaders were both excited and proud of all the work and effort it took to have the beautiful new hospital reach completion. They had developed an extensive communication plan to focus on the changes and improvement and how all the efforts and expense would lead to a new and better workplace and patient care environment.
The communication plan was implemented, with the focus on communicating the virtues of the new hospital and how much was going to change – which seemed so self evident since the “old” hospital was built in the 1950s. The more the leaders communicated how much better the new hospital was going to be, the more the resistance increased. Senior executives had difficulty understanding why the employees and middle managers were not as excited as they were in moving to what was clearly a better work and patient care environment. Senior leaders faced the same common thought most of us hold – we are excited, what is wrong with everyone else?
After much discussion about the differences in motivation between senior leaders and most employees and middle managers, the health system modified its approach and began to incorporate into the communications messages on what was going to be the same after moving to the new hospital, and how many of the same processes would continue. Even though the “old” hospital was outdated, drab and needing to be replaced, the senior leadership began talking of the “traditions” of the old hospital and how to move some of those to the new facility and how to start new traditions. They found a balance between moving forward and minimizing the anxiety of change.
For those of us who find change as part of the challenge of work, the next five years in healthcare will be exciting as we look to find different ways to deliver care and service under the new demands of health care reform. Understanding that the majority of employees, physicians and middle managers do not embrace the challenge of health care reform the same way, and never will, is one of the keys to success as we move forward. Recognizing this fundamental difference and developing a communication strategy and approach focused on moving the employees and managers forward will be much more successful than trying to convince employees and managers to be more comfortable with change.