In the Face of Change: Change Management as an Imperative (Part 1)
Today and in the future, successful facilities will be those whose employees can change more quickly and efficiently than those of their competitors. Yet change is difficult to manage, and most change efforts fail. Changing the behaviors and attitudes of an entire workforce is both complex and delicate, requiring a detailed framework of actions and goals for hospitals.
This article presents a framework for implementing change in a hospital environment. This framework guides and informs the hospital’s workforce change process that involves all or a significant part of the employee population. Whether that change requires mobilization of the entire workforce or just one department, this framework helps to accelerate that change by showing how to execute the change process.
To ensure a high level of relevance and application to the hospital environment, this change management framework is built from an analysis of hospital employee data from over 360 facilities and over 160,000 employees. Informed by and created for hospitals, this framework is a recipe for a successful change effort for the hospital workforce.
Change in the Context of Healthcare
Studied for decades, the process of change management is finely tuned. Over the years, many academics and business researchers have validated and applied these frameworks. However, while many detailed change frameworks produce positive results when applied in the corporate setting, the medical setting presents a different story. There remains a critical gap between “generic corporate” advice from academia or articles and specific advice for the medical setting. Bridging this gap requires several key pieces that inform change in the hospital setting. A “hospital view” understanding where healthcare organizations are unique and where they are similar to other businesses, delivering a compelling story, harnessing the employee as the center of the change process, developing competency, and assuring access to effective role models are all required in order to apply any change framework to the hospital setting.
Transparency is a Requirement
Hospitals operate in an increasingly turbulent environment, adding concern for the transparency of key outcomes. From government-mandated survey reporting to independent consumer website ratings, facilities face the notion of “being watched” by payers, patients, competitors, and even the community at large. These watchful eyes lead to real economic consequences and force hospitals to move from merely implementing new activities to actually moving the needle on those key metrics.
Many factors contribute to the harsh hospital environment. These factors are intertwined with larger health system issues as well as broader political issues and are thus hard to control. This tough environment only heightens the concerns of transparency. In addition, key health system players, including arguably the most important ones (patients), evaluate these metrics. Activities conducted on a daily basis must tangibly affect these critical metrics to improve them. These activities must provide both core patient services and sustainable business revenue.
High Cost for Failure or Delay
Every admission and discharge places the hospital’s key metrics at risk, which are influenced by the hospital’s daily activities and processes. Any failure or delay in activities to address and control those metrics is costly, especially when reimbursement and referrals depend on that success. With so much at stake, there is little room for error when implementing new initiatives and processes.
The consequences of a decline in these metrics are simply not acceptable to hospital executives, employees, or patients. The costs of failed or delayed change on these metrics are both financial and non-financial. Additionally, the hospital may lose even more momentum and bring more uncertainty to the bottom line. Hospitals simply cannot afford to draw out the process of influencing those key metrics; it must be done quickly and efficiently without disrupting the normal course of business.
Concurrent and Complex Initiatives
Flexibility and change are imperative as hospitals must adapt to a dynamic, transparent landscape. Hospitals constantly implement new processes and business ideas to improve key metrics and to remain competitive and compliant. Hospitals often have several initiatives or improvement programs in play at once. These initiatives are complex and require attention from both management and employees. Additionally, these initiatives are intertwined and leverage one another’s resources. With many moving pieces, it is easy to lose track of these change efforts and mismanage the people and activities required to achieve success.
Change is Hard for Everyone
Studies show a majority of change efforts ending in failure. Additionally, experience shows a great need for programs that help change employee behavior and knowledge. Together, this data suggests that although change is common, it is difficult to find success. Many facilities continue to stumble when implementing important, and in some cases mandatory, change initiatives. Executives are often frustrated with the wasted time and effort spent on once-promising change campaigns that ended in defeat. Although proceeding with the best intentions, management and employees continually have trouble implementing and sustaining change within their workforce.
Working without a Playbook
Change initiatives face the most difficulty when attempted without a detailed plan - a “playbook” showing the ideas and tactics necessary to plan and execute effective and sustainable change in the workforce. Data suggests that most hospitals do not use a definite playbook for implementing a change effort. They simply do what seems correct in terms of communicating, teaching, and rewarding. These hospitals often become overwhelmed and confused when the simple change effort meets the dynamic everyday environment of the hospital. Other factors causing difficulty come from both inside and outside the hospital and distract the facility from committing to that change.
Construct and Deliver a Compelling Story
Even great stories with the best intent lose steam if not constructed and delivered in the right manner. The story must be the chief motivator of the change effort and be delivered with precision. Hospital employee data reveals how to construct and deliver that story in a compelling and meaningful manner. Following these guidelines will enhance the impact of the story and those who deliver it.
Start with a Playbook
While some actions and ideas are intuitive, many are not - and it takes a solid plan to know what you should do. A detailed playbook is essential for executing a successful workforce change effort. No plan equals chaos.
However, organizations using a definite playbook see a significant increase in project success rate over those who have informal processes. They approach change implementation in a scientific manner to communicate, teach, and reward new behaviors with a deliberate process. These organizations change more quickly and efficiently than their competitors. In fact, only 36% of organizations that do not have a playbook are successful, while 52% of organizations that use a playbook are.
Tailor the Story
When tailoring and adapting the story, the natural tendency is to segment by department. However, marketing methodology assists us in looking for naturally occurring demographic segments. Each segment may want to hear the change story in a different manner or through a different frame. Each hospital’s particular culture will inform this segmentation and adaptation.
However, it’s important to remember that different people respond to different types of messages. Employee data reveals three general demographic groups for which the message may be adapted and tailored to have the largest impact possible. The older, day shift usually includes about 35% of the total staff. These employees typically are already very satisfied with manager communications. The younger, night shift which usually includes about 19% of employees is typically dissatisfied with manager communications, perhaps because of their relative longer tenure at the facility. Finally, the remaining 46% of employees fall into the younger, evening shift category and fall between the other two groups, generally satisfied with manager communications.
Create a change story that resonates with these different audiences in order to capture their attention and make an impact. Consider tailoring the story to show the impact on different groups such as patients, departments, the facility as a whole, even society as a whole.
Enhance the Power of the Story with its Delivery
The story of change must come from an authoritative and respected position, such as a supervisor or upper management. However, both supervisors and upper management should follow specific guidelines to maximize their impact in communicating the story. This delivery begins the change effort and should be thoughtful and deliberate.
Supervisors are the front line of management as they have the most contact with employees. A supervisor should already have high “street credibility” and tell the story in a fair and balanced manner at the proper time, assuring all appropriate employees are updated at the same time. Delivering the change story during regular feedback sessions with employees and acknowledging both positive and negative aspects of the change are helpful strategies.
Upper management may have less contact with employees but still have a large role in delivering the change story. Upper Management should show a “soft” reputation, delivering information when recognizing employee’s accomplishments, for example. Additionally, the story should improve employees’ perception of management - especially showing their understanding of employees’ needs and demonstrating their effectiveness in running the facility. Both supervisors and upper management must deliver the story in a careful, deliberate manner.
Harness Your Most Powerful Assets
Buffeted on all sides with distractions, the employee is often overwhelmed with information and communications dealing with many job-related and personal issues. A sharp focus on the employee is required, as employees are at the heart of any change effort. With patient-facing responsibilities, the employee’s individual actions and behaviors are what determine the success of the change effort. The employee also sits between management and the ultimate outcome of improving key metrics. Everything goes through the employee, making him/her the vehicle by which change happens - or does not happen. This responsibility makes employees the true keystone of any change initiative.
Lead Employees to Choose Change
When employees choose for themselves, they feel more ownership of the change story and become much more committed to the outcome. Studies indicate that employees must perceive this ownership of change by discovering the change story on their own and then taking action using the tools at their disposal. Hospitals need to create a supportive environment for employees to take this initiative.
Two critical items to assure employees are able to discover the change on their own: job independence and appropriate equipment and other resources. Independence in a job role comes from many sources, and it is difficult and unfair to try to pinpoint only one or two items that have the most impact. In general, job fulfillment (enjoyment and challenge of the work) and personal fulfillment (feeling valued by the organization, receiving personal suport from management, feeling a sense of community) are important concepts in an employee achieving independence.
Proper equipment and resources are also keys to empowering employees to take ownership of the change. The perception of proper equipment/resources stems from both the physical workspace of the employee as well as the actual equipment used on a daily basis. And it is important to note that the employee’s perception of the equipment and resources is what is important, not necessarily the reality of the situation. If the employee perceives their workspace to be clean and that they have the tools to provide the best care to a patient, then they will be more receptive to taking personal ownership in the change.
Cultivate Positive Morale and an Inspired Workforce
The change story must effectively motivate and engage employees to change their behavior or attitude toward an idea or action. Motivation comes from many sources but manifests itself through two observable and measureable employee behaviors: morale and inspiration. Morale and inspiration are personal, emotional feelings driven by subjective factors that surround a person in both their personal and professional lives.
Professional aspects of morale and inspiration rest explain about 50-60% of overall motivation in employees. Professional morale comes from an employee’s sense of pride, job-fulfillment, and sense of citizenship at the facility. Draw on the employees’ sense of “being called” into the healthcare field and reflect that very personal belief in the change story. Inspiration is driven by largely the same factors as morale, in addition to the consistency of personal values with organizational values. To be most effective, the change story should be consistent with (and in support of) employees’ personal values.
Personal aspects of morale and inspiration rest outside the purview of the facility. They are more elusive to the facility supervisor or manager and much more difficult to influence. Personal aspects of morale and inspiration explain about 40-50% of overall motivation in employees. However, some personal aspects of motivation may be outside the facility’s influence.
Since morale and inspiration come from both inside and outside the facility, the change story must affect both aspects of employee lives. A defining moment or rallying point helps give meaning to both aspects for employees. Common external threats (such as competition in the market) often make viable rallying points around which employees can develop loyalty and dedication to the change.
This is the end of Part 1. Click Here to go to Part 2 of In the Face of Change: Change Management as an Imperative