Steve Gordon, MD

Change is a fact of life. Yet the degree to which change is occurring in healthcare is astounding.  From Affordable Care Act requirements to the array of medical research and new treatment options, providers have been overwhelmed by the pace of transformative change. So, when change needs to occur at an organization or medical practice, how should leaders approach it?  

Whether that change requires embracing new technology or the adoption of new policies, leaders must communicate the reasons behind the change and connect people to strategy in order to help them assimilate the change and understand the benefits and impact on the business. Implementing change management best practices facilitates this process and helps staff more easily and quickly make a personal transition from a current to a future mindset.

Change efforts among physicians and providers falter when leadership stumbles into some common pitfallsincluding:  

Failure to describe and communicate the problem; its personal impact on physicians, providers, and staff; and what exactly individuals are being asked to change within their daily workflow

Failure to determine the root cause of the problem before working to solve it 

Delaying engagement with providers until after the solution has been decided 

Solution bias and over-confidence in the chosen approach

Inadequate support through the change; failure to address the communication and training needs and provide at-the-elbow experts during implementation and additional staffing to maintain productivity 

Failure to recognize the personal investments made by physicians and providers and their successful adoption of the change benefitting the organization or practice

Failure to consider and align with other concurrent organizational changes 

The first step in engaging your employees in the change process is the recognition that change is required. Leaders should assess practice culture, including the history of change in the organization, enablers or barriers, and whether stakeholders expect to be asked or told to determine the best way to initiative the change process among your employees.

The following tips can help you take your organization or practice through any change: 

Identify the specific problem you are trying to solve. 

Frame it in a way in which people will understand and agree on the problem and convey what will happen if the problem goes unaddressed. 

Create open dialogue and show empathy. Affirm that you understand the myriad challenges they face and ask for their advice and partnership in trying to solve this issue. Solicit their engagement in finding the solution, becoming experts in it, helping the rest of their colleagues adopt the change as it happens, and understanding resourcing needs afterwards.

Use proven data-informed techniques, such as Lean or 6-Sigma, to guide improvement and thoroughly review technology products with a large group of physicians, providers and other relevant end user staff. All time spent choosing the right solution to the problem is invaluable and saves your organization exponentially down the road. 

Clarify each person’s role in the change process

. Prepare an inventory of roles and customize a change plan for each. Participants without workflow change can nevertheless be impacted secondarily, so awareness matters.

Select which changes to bring to physicians and providers for input or decision making.

 Develop a tailored approach, focusing on how much and what information to bring forward, and each specific audience group.

. Seek out individuals who have the most influence and ensure your messages are resonating with the right team members who can help drive change.

Provide specific action item lists that inform staff of what will be needed, and when. Custom checklists for leaders, physicians, and other staff roles are helpful to support each employee through the change experience for their job.

Break large initiatives into smaller projects that are most likely to succeed. Any plan should be achievable from start to finish in three years or less.

Determine how success will be measured. 

Success measurements should be agreed on by all impacted group leaders and transparent to everyone.  Adjustments to the solution may be needed, so set expectations to be flexible and to monitor and track performance as the change processes and becomes the new normal.  

Align and partner around change with other individuals and groups inside and outside your practice, 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. 

Remind others that change is the new normal.

 Regardless of your specialty, position, or function, changes frequently emerge in healthcare, especially with external market forces such as MACRA or adopting new value-based payment models. Emphasize that these programs are likely to change over time but are not going away.

Acknowledge the uncertainty with any change

. Shadow people in their daily work, solicit their reactions to the experience, understand their pain points, and offer assistance or support when you can.

All progress is good and should be recognized. 

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 short-term goals and be sensitive to overlapping demands for change.

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.

Above all else, 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 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, MD, is a principal consultant with Point B, an integrated 

 firm. Steve has nearly three decades of progressive healthcare experience as a clinician, educator, executive, and board member. He has worked with providers, payers, and policy makers on a range of initiatives including care model redesign, pay for performance, change management, IT adoption, physician engagement, strategic planning, and effective governance. 

Keely Killpack, PhD, is an independent consultant and expert change management strategist. She holds a PhD in Organizational Psychology and has more than a dozen years of experience supporting diverse client organizations through transformational changes from business strategy, technology adoption and operational performance initiatives. Keely is known for her highly collaborative approach to large-scale change adoption in healthcare systems, pharmaceuticals, retail, government agencies, energy and transportation. Beyond consulting, she is also a founding member of the only global change management professional association, has presented at international and national conferences throughout the last decade, and taught courses in change, communication, and leadership and her first book about change management strategies, 

Articles

Change isn't easy, but the following tips can help you guide your organization or practice through any transition.

Embracing change in healthcare: Tips for getting your team on board 

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is one of the biggest shifts in physician payment in decades. Yet for such an industry change, the impact on most physicians will be modest and incremental. Take stock now of the challenges facing physicians and then scale an effective and lasting approach for your group or organization.

MACRA, a related but distinct legislative byproduct of the Affordable Care Act (ACA), seeks to incentivize improved outcomes and overall quality of care. Centers for Medicare & Medicaid Services (CMS) created guidelines that tie provider reimbursement to cost-effective, high-quality care. MACRA replaces the unpopular Sustainable Growth Rate (SGR) and provides incentives to physicians for the quality of care they provide. Physicians who outperform their peers on measures of quality, health record interoperability, care improvement, and cost may see higher payments, while under-performing or non-reporting physicians will be penalized. These changes will be incremental and take several years before fully implemented. Physicians and groups participating in Medicare Advanced Alternative Payment Models (APMs) are exempt from MACRA incentives.

Most physicians are not yet familiar with MACRA, according to the 

Deloitte Center for Health Solutions 2016 Survey of U.S. Physicians

. The survey revealed that 50 percent of physicians have never heard of the law, and 32 percent recognize it by name but are not familiar with its requirements. The study found employed physicians were less likely to be familiar with MACRA than independent physicians.

The impact of MACRA on individual physicians and groups

MACRA’s impact on individual physicians and groups is variable, as the law mostly affects physician practices who care for seniors and who bill Medicare under traditional fee for service. The law has limited or no impact on providers who care primarily for children and younger adults, and who provide services predominantly to patients insured under Medicaid and commercial health plans. Managed Medicare Plans are not affected by MACRA, although this could change in the future. 

Practices most likely to benefit from the new law are those that previously invested in EHR, quality measurement and reporting, care process improvement, and providing low cost care. MACRA also rewards practices already participating in demonstration projects with quality and cost incentive programs, such as advanced medical homes and Accountable Care Organizations (ACOs). 

Physician impact is not limited to reimbursement. MACRA builds upon and refines existing quality incentive programs (Meaningful Use and the Physician Quality Reporting System PQRS). Some specialists will want to take advantage of new and more pertinent quality metrics. New options exist for group rather than individual reporting, reducing administrative burden for many practices. Physicians who see fewer than 100 Medicare patients annually or less than $30,000 in annual charges are excluded. Most importantly, performance on quality scores will now determine whether physicians are financially rewarded or penalized. Physicians need to expect their quality scores will be reported publicly and integrated into star ratings. When communicating with physicians, be prepared to describe specifically how each physician and group will be measured and what choices face the practice about selecting quality metrics.

It may seem ironic that a program intended to reward physicians for doing the right thing – providing higher quality care at a lower cost – might not be perceived positively. Providers are increasingly burned out and frustrated by issues such as EHR adoption, administrative burden, and inability to provide patients the quality of care they need. When it comes to pay for performance programs, the devil is always in the details. 

To help keep physicians engaged with the process:

•Create open dialogue and empathize with your providers. Don’t just tell them what needs to happen to succeed under MACRA, but affirm you understand the challenge and ask for their advice.

•Use proven data-informed techniques such as Lean, 

 to guide improvement. Seek out providers interested in being involved with these techniques and learning more about improvement. 

•Break large initiatives into smaller pieces that are more likely to succeed.

•Celebrate progress and express your appreciation. Recognize providers not just for succeeding under programs like MACRA but for providing compassionate, high-quality care every day.

•Shadow your providers, understand their pain points, and offer improvement assistance when you can. 

•Recognize the signs and symptoms of burnout and support at-risk providers.

•Don’t assume that every physician and group can or should be a top performer under MACRA right away. Pushing too hard or too fast may jeopardize long-term success.

With repeal and replacement of the ACA in progress, many are concerned about what that means to initiatives already underway. MACRA will evolve, as does any new federal program, but repeal is unlikely. MACRA passed with broad bipartisan support. Secretary of Health and Human Services Tom Price supports MACRA with more flexibility and less burden on physicians. 

•Acknowledge the uncertainty, but also that MACRA is current law and in effect now.

•Agree to make a plan together and commit to adjusting the plan if and when the regulations change. 

•Describe the steps you will take to monitor and track any changes to the rule. Many physicians receive information on MACRA and other policy matters from professional associations and other outside organizations. Ask them to forward and share this material to help keep one another informed. 

MACRA is complex, and understanding the detailed final rule is just the beginning. Communication and engagement with physicians and providers must be tailored and succinct.  Be specific about the impact and ask for help designing and planning change. Be empathetic to other challenges affecting the current practice environment, and stay flexible to adapt as the environment continues to evolve.

Steve Gordon, M.D. is a national principal healthcare consultant with Point B Management Consultants. Steve has three decades of progressive healthcare experience as a clinician, educator, executive, and board member. Steve trained in internal medicine at Massachusetts General Hospital and attended Harvard University for his Bachelor, Master in Public Policy and MD degrees.

Uncertainty about the future of the ACA means continued concerns about initiatives already underway.

Author | Steve Gordon, MD

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Embracing change in healthcare: Tips for getting your team on board

Addressing Physician Concerns about MACRA and APMs