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Overcoming Organizational Barriers to Change in Healthcare

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Within the healthcare industry, some of the most successful systems have focused heavily on the cultural side as they adapt various management strategies and process improvement techniques. Success is measured by the organization’s ability to demonstrate system-wide improvement year over year. Carolyn Pexton explains how to identify and avoid the most common barriers to change in healthcare.
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Change is more than today’s hot topic – it’s an absolute imperative for a growing number of organizations struggling to survive in a faltering economy. Even in the best of times, however, management must be willing to steer the ship away from the false safety of the status quo shore.

Every organization will experience change over time. The question is whether it will be thrust upon them, or whether they will be the leading force proactively moving the organization in a better direction.

Most executives concede the importance of transforming their capabilities or culture in order to survive in a competitive environment. Significant time, energy and money are typically invested in efforts to reinvent a portfolio of offerings or redirect the organization through new systems and structures.

Unfortunately, however, there is often an inverse correlation between expectations and end results.

Studies conducted by Harvard and other venerable institutions have shown a failure rate anywhere between 60 and 80 percent. In addition to being demoralizing and counterproductive for the organizations involved, failure to successfully implement change can also be incredibly expensive.

The 2008 IBM Global Making Change Work Study examined a diverse range of projects at companies representing 21 different industries. According to the study, the percentage of CEOs expecting substantial change rose from 65 percent in 2006 to 83 percent in 2008, but those who felt they had effectively managed change rose from just 57 percent to 61 percent during the same time period. Analysis revealed that the gaps were primarily related to organizational or cultural issues.

Within the healthcare industry, some of the most successful systems have focused heavily on the cultural side as they adapt various management strategies and process improvement techniques. For the purposes of evaluating change management, success is not measured in terms of a health system’s size, annual revenue or ranking on one of the many top 100 lists. It is measured by the organization’s ability to demonstrate system-wide improvement year over year.

To make sure a major change initiative stays on track, learn how to identify and avoid the most common barriers:

  1. Cultural complacency, resistance or skepticism. Expect and prepare for a certain level of dissent. Change is hard, and there may be pockets of resistance throughout the organization. While you may clearly see the need to change, others may be quite satisfied with the status quo. Some may feel the proposed initiative encroaches on their territory and threatens to upset the way they have always done things. Others may be skeptical because they have lived through past initiatives that were eventually abandoned when they didn’t yield the expected gains. You’ll need to take the time to demonstrate why this particular effort is different, and one way to do this is to focus on delivering a few quick measurable wins. If you can, seek objective outside experts to help work through resistance, uncover the real issues and build a plan to reach your goals.
  2. Lack of communication. Putting a strong communication strategy together will help avoid the misunderstanding that can ultimately thwart your best-laid plans. Start by defining your goals and vision. For this purpose, think sound byte rather than dissertation. If you can’t clearly articulate what you’re doing and why within a few minutes, keep honing the message until you can. Next, create a stakeholder analysis to make sure you have considered all groups and individuals you’ll need to communicate with, what their various concerns might be and the best way to communicate with them. The most common communication mistake is thinking you’ve got it covered when you really don’t.
  3. Lack of alignment and accountability. This aspect will be vital to your long-term success. If a project is not part of an individual’s goals and objectives and they’re not being held accountable in any way for the results, then it will not command the necessary level of attention. It’s amazing how many organizations plough ahead without making sure there is clear alignment between performance and goals and that people are actually being held accountable for results. This requires putting the right management systems and structures in place and not skimping on the planning phase of your project. Assess and leverage the strengths within your organization. Make sure people are appropriately aligned, and if not, be prepared to make some changes.
  4. Passive or absent leadership support. Leadership engagement is crucial to success. You can’t just flip a switch and put your initiative on autopilot. The most successful efforts have had unequivocal support and involvement from the CEO and executive team. This may include personally attending report-out sessions to review project results, publicly recognizing success. Walk in the footsteps of your team members to understand what they’re doing.
  5. Micromanagement. This is the other end of the spectrum in terms of leadership. It’s important to champion the cause without overly scripting the team as they seek to carry out your vision, and to share the spotlight when goals are attained. Allowing a command and control approach to prevail in your organization is the fastest way to stifle innovation and engagement from team members. Leaders should establish the vision, empower the team and help to remove barriers – including (if necessary) an overbearing, autocratic manager.
  6. Overloaded workforce. A heavy workload and a shortage of resources are common complaints when a company tries to introduce a new change initiative. People will say, “We’ve got too much going on, this will just take extra time away from our work. “The smart change leader will communicate to the team that the initiative they’re embarking on is designed to make their lives easier – not add more to their workload. Demonstrate the benefits of rethinking workflow and using new processes or technologies to reduce non-value-added steps.
  7. Inadequate systems and structures. You will greatly increase your chance of success if you ensure there are appropriate systems and structures in place to support the initiative. This may include providing the right computer systems and software, having the right performance management structure and introducing the best approach to leading change. The framework for transformation should contain basic core principles that support it, but there should also be some flexibility built in to adapt to different situations and evolving needs. For example, not every problem requires the rigor of Six Sigma. Create systems and structures that are based more on desired results rather than on the tools being used.
  8. Lack of control plans to measure and sustain results. There are many examples of great planning and implementation when it comes to introducing something new like a quality improvement program. The problem seems to be in making sure the results stick. Develop mechanisms to maintain the results you’ve worked so hard to achieve. Some organizations choose to hire or train master change agents to steer and oversee the change initiatives. Others have different groups that all report into a central program office. Still others rely on system-level dashboards, control charts or balanced scorecards to keep a finger on the pulse of the project and the impact on the organization. Having a control plan in place will help to catch issues early before they derail your project.

Deciding to implement a new strategy or solution is the easy part. The hard part is implementing that solution and making it stick. Whatever form your change initiative takes, it will benefit from a large dose of advance planning along with caution in sidestepping the most common roadblocks.

Having a formal process to accelerate change has been especially helpful when used in conjunction with other improvement efforts like Lean Six Sigma to make sure you’ve gotten acceptance for the path you’re laying out for the organization. After all, the best strategy will run into invisible brick walls if you haven’t adequately addressed the acceptance side. And you can’t lead change if nobody is following you.

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