Change Management: Focus on Who

Many health care organizations develop great ideas for streamlined workflows, new programs that improve patient health, and new contracting mechanisms that promote value.  A small, specialized team develops model pilots, reviews research studies, carefully considers metrics and data, and determines who will do what in the new workflow. Leadership has signed off on the new idea.  Resources are allocated to build data capture elements into the electronic health record.  The pilot has a go-live date, but it keeps getting pushed back.  A year later, the pilot leadership was excited about ends because of low volume.

What happened?

Any number of things could have gone wrong with the project.  Do you know what proportion of change efforts fail?

70%.

With all the demand that “healthcare needs to change,” it’s understandable that healthcare leaders may be averse to change given a statistic like that, creating tension.  “We know we need to change, but change has a high failure rate, and it is hard.”  An important aspect of change that often goes unnoticed or gets deprioritized is change management.

What is change management?

Prosci defines change management as “the discipline that guides how we prepare, equip, and support individuals to successfully adopt change in order to drive organizational success and outcomes.”  We believe change management principles are the consistent undercurrent of successful change, especially in healthcare delivery organizations.

One basic idea behind change management is that people do the work of change. Whether it is a new program or a new workflow, if you don’t set people up for success, the change won’t succeed.  It’s an easy, relatively obvious concept to read, but it demands time, attention, and resources to execute.

What does successful change management look like?

We’ve already said that people are the key to change management, so it is important to consider the “who” in any change scenario. 

• Who will be required to change in the new program?

Change will not succeed if it rests on one person’s shoulders.  Bring multidisciplinary teams in from day 1 to develop the new program.  You may have a subject matter expert who can read the literature and speak to what is evidence-based, but if the medical assistant and nurse practitioners at the clinic who will have to change their day-to-day work aren’t involved in shaping the change, it may not succeed. 

• Who will the new program serve? 

Often, new models of care in healthcare are designed to improve care for an important group: Patients.  As a result, any change initiative must consider how patients will interact with the change and what it will require of them.  The new program may require your patients to come to clinic less often, which may initially seem like a great idea, unless you fail to consider that patients used to regular reassurance and interaction from their medical team may become more anxious when that regular interaction changes. 

• Who else will be impacted by the change?

We’ve thought about the front-line healthcare staff.  We’ve thought about the patients.  Who else may our project impact? If we add a new program, how will we bill for it? Colleagues from revenue cycle and finance can help to inform.  How will the EHR need to change, or who needs access to the EHR, to accommodate the program?   What are the legal and compliance implications of the change?  If we make a change in specialty care, what implications does it have for our patient’s medical home?

In our introductory scenario, bringing together a team of front-line staff, patient representatives, leadership from the clinic and service line areas, subject matter experts, analysts, developers, and others identified through the line of questioning above would be more likely to drive successful change.

Identifying everyone needed for the change is critical, as is figuring out how best to set them up for success.  Prosci developed the ADKAR® model to guide change and, when used, it can help you meet people where they are in the change process.  If clinic staff are not aware of the need for change, showing up for skills training on the new model of care is likely to be a low-attendance training.  Alternatively, clinic staff may be very aware of the need for change and may support it but not know exactly how to bring it about.  In this scenario, providing tools and resources to make the change would be more beneficial than a meeting to discuss why the change is needed.

Focusing on people is a key element of successful change management.  Genesis Health Consulting has deep experience in change management principles and in co-creating smart, effective, and sustainable systems change in support of child health and wellbeing.  Email us at [email protected] to learn more about our work in this area.