The degree of change in healthcare over our careers is astounding. Electronic health records (EHR), HIPAA, ICD-10, value-based care, ACOs, and MACRA are just a few examples, superimposed on an explosion of medical research, evolving treatment options, and a major shift by physicians towards employment in large groups. How should healthcare practice leaders approach initiating change and improvement? What can be learned from the experiences of others, especially when change efforts go sideways? What does success look like? And how do you manage change when change fatigue itself is recognized as a cause of professional burnout?
Change efforts among physicians and providers falter when leadership stumbles into some common pitfalls including failure to describe the problem and explain the impact on physicians, providers and staff, leaping to solve a problem before determining the root cause, confusing the measure with the aim, solution bias and overconfidence in the chosen approach, inadequate support and failure to align with concurrent organizational changes.
These pitfalls collectively represent the under-appreciation of the emotional impact of change and the importance of adopting a change management mindset at the outset. Successful change management begins when leaders first recognize that change is required. Acknowledge the uncertainty with any change. External market forces such as MACRA and other value-based payment models may evolve over time but are not going away. Before proceeding, leaders should consider practice culture, including the history of change in the organization, enablers or barriers, and whether stakeholders expect to be asked or told.
Additional steps include:
•Identify the specific problem you are trying to solve. Frame the problem so people understand what will happen if it goes on unaddressed.
•Select which changes to bring to providers for input or decision-making. Develop a tailored approach: clarify each person's role, focus on how much and what information to bring forward, determine who the information would be tailored to, break large initiatives into smaller, more digestible pieces, and help alleviate concerns by providing specific action items that address what will be needed, and when.
•Create open dialogue and show empathy. Don't just tell providers what needs to happen – affirm that you understand the myriad challenges they face and ask their advice.
•Don't go it alone. Align and partner around change with other 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.
•Address burnout issues. Change cannot occur in a practice rife with burnout. Implement policies aimed at alleviating burnout such as paid sabbaticals.
However you approach change, 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. Celebrate progress and express your appreciation. Recognize individuals not just for the change at hand, but also for providing compassionate, high-quality care every day.
Change is now a constant in healthcare 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.
Steve Gordon, M.D. is a principal consultant with Point B's healthcare practice group. Steve has more than three decades of progressive healthcare experience as a clinician, educator, executive, and board member.
Keely Killpack is an expert change management strategist and technology adoption expert devoted to supporting diverse client organizations through transformational changes. Keely is known for her highly collaborative approach to large-scale change adoption in healthcare, retail, government agencies and transportation.