IMPLEMENTING MEANINGFUL CHANGE ACROSS THE ORGANIZATION
The degree of recent change in health care delivery is astounding. How should leaders approach initiating change and improvement in this context? What can be learned from the experiences of others, especially when change efforts go sideways? What does success look like?
Recent examples of transformative change impacting physician practices include electronic health records, HIPAA, ICD-10, pay for performance, practice consolidation, ACOs, and now MACRA, superimposed on an explosion of medical research and new treatment options and modalities. Opinions differ as to whether these changes are beneficial, but increasingly, change fatigue itself is recognized as a cause of professional burnout and a growing leadership challenge.
In our experience, change efforts among physicians and providers falter when leadership stumbles into one or more of nine common pitfalls. We use a tool called Change Curve, a conceptual model commonly employed by change-management methodologies to assess and chart people’s adoption of a change (Killpack, 2017). We have leveraged this standard tool to illustrate challenges that can occur along the way, including:
- Failure to explain the personal impact to physicians, providers and staff, and to specify exactly what each person is being asked to do
- Failure to accurately describe the problem in the first place, including the future impact if the problem goes unaddressed
- Failure to ask for help addressing the problem
- Leaping to solve a problem before determining and verifying its root cause
- Confusing the measure with the aim
- Solution bias and over-confidence in a chosen approach
- Inadequate support over the course of the change
- Failure to thank and celebrate
- Failure to consider and align with other concurrent organizational changes
AVOIDING PITFALLS OF CHANGE: HOW TO GET PHYSICIANS AND PROVIDERS ON BOARD
Envisioning a future state is often easier than working through the necessary steps to get there.
The first step is one’s own recognition that change is required. This may take the form of an extended period of consideration, or simply an instance of awareness. Willingness to change is a personal attribute and is a key change enabler, along with humility, curiosity, perseverance, and focus. Leaders should also assess practice culture, including the history of change in the organization, its enablers or barriers, and whether stakeholders expect to be asked or told what to do.
Additional steps to implementing and embracing change include:
- Identify the specific problem you are trying to solve. Frame it in a way that people understand, and agree on the problem.
- Select which changes to bring to physicians and providers for input or decision-making. Develop instead a tailored approach, focusing on how much and what information to bring forward, and determining the people to whom that information should be tailored.
- Break large solution initiatives into smaller pieces that are most likely to succeed. Don’t present 18 different initiatives, but four or five that are easily understood.
- Don’t go it alone. Align and partner around change with individuals and groups inside and outside your organization, as well as with professional societies and advocacy groups with similar values. Consider investing in expert change management support for larger, complex initiatives and when change fatigue or physician burnout is a risk. Use proven data-informed techniques, such as Lean or 6-Sigma, to guide improvement, and partner with providers interested in being involved and learning more about improvement science. Seek out the individuals within your organization who have the most influence, and ensure your messages are resonating with these team members. Describe any steps being taken to monitor and track performance.
- Market the changes to each group. Explain the problem, process, and action items to each group, along with the specific action items required of that group. Don’t provide information that is not relevant to a specific group, as that will only lead to confusion and an overwhelming feeling.
- Create open dialogue, and show empathy. Don’t just tell physicians and providers what needs to happen— affirm that you understand the myriad challenges they face, and ask for their advice. Celebrate progress and express your appreciation to individuals, not just for the change at hand, but also for providing compassionate, high-quality care every day.
- Shadow people in their daily work, understand their pain points, and offer assistance when you can. Don’t assume that every physician or group can or should be a top performer right away; pushing too hard or too fast may jeopardize long-term success. Focus on the long-term goals, and be sensitive to overlapping demands for change. Look for the signs and symptoms of burnout, and support those at risk. Implement policies aimed at alleviating burnout, such as paid sabbaticals.
- Focus, focus, focus. Competing priorities are distractions. Help alleviate concerns by providing specific action items that address what will be needed, and when. Clarify each person’s role as part of the change. Participants without workflow change can nevertheless be impacted secondarily, so awareness matters. We recommend preparing an inventory of roles and customizing a change plan for each.
- Acknowledge the uncertainty that comes with any change. Especially when dealing with external market forces such as MACRA and other new value-based payment models, emphasize that these programs are likely to change over time, but that they are not going away.
- Above all, always keep your eye on the patient. Virtually all providers and staff can agree on a change when the benefit to patient care is clear.
Change is a predictable component of health care delivery. Developing and refining an effective approach to managing change is an essential leadership skill. Recognizing common pitfalls, planning accordingly, and course-correcting effectively will help to inspire others, ensure success, and minimize adverse impact.
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Steve Gordon, MD, is a principal consultant with Point B’s health care practice group.
Keely Killpack, a consultant with Point B, is a founding member of the Association of Change Management Professionals (ACMP), holds a PhD in Organizational Psychology, and has just finished her first book about change-management strategies, ChangeRX for Healthcare.