In This Issue
Message from Your HCAT President
Management Innovations Poster Session at the 2017 Congress on Healthcare Leadership
Forum on Advances in Healthcare Management Research at 2018 Congress on Healthcare Leadership
IFD, ACHE Alliance to Expand Healthcare Internships for Diverse Individuals
ACHE Call for Nominations for the 2018 Slate
Your Career is a Marathon
Announcements from the HCAT Membership and Advancement Committee
Thank you! 2016 Sponsors
Change Management: Supporting Transitioning Teams
New Degree Programs at Eastern Virginia Medical School
HCAT Tidewater Communications Committee
Change Management: Supporting Transitioning Teams
Written by: Mark S. Gornitzka, MBA

Have you ever worked for a healthcare system where an employee is fragmented from the future direction of the organization?  Does the employee consistently push against leadership when change is communicated and implemented?  Have you heard them say or said yourself, “Why should I buy-in to this new change?  How does this benefit me?  My voice is never heard and when I think it is, the leadership never follows through with what they say will happen.” 

It is unfortunate that these statements have become common within the working environment.  These faults, if not properly handled, can lead to a dissatisfied work force comprised of employee’s that find themselves disconnected with their professional environment. This is a direct result of forced change, communication barriers and little to no involvement in the change process.  So why is that we (leadership) find ourselves inundated with these frequent challenges regardless of the scope of the change being made?  Most of it simply boils down to human psychology, misunderstandings of leadership and change management, and the importance of the Voice of the Customer (internal) for effective change to happen. 

What is Change Management and Why is it Important?
Let’s look at change management as a passage through time that moves an individual from current state to a transition phase and then a reincorporated future state.  A great example that many can relate to is human development through life changes (adolescence, adulthood, marriage, parenthood) (Prosci, 2016).  As we grow and mature, transition is an important part of change and a necessary process to ultimately achieve the end goal. The stressors imposed on change were not the focus or part of the business vernacular until the mid-1990’s.  This is when we started to see the “[…] employee-employer relationships change with the increased recognition of how important the human side of change was” (Prosci, 2016).  This idea set into motion, new business practices that would start the transition of organizations into the next millennium.  It is important to mention that during this era, leaders and managers recognized the following observation: “The first steps were taken to show that individual change does not happen by chance, but can be supported and driven with thoughtful and repeatable steps” (Prosci, 2016).  Now we start to see the development and importance of how changes are implemented (structure and human element), not when or if it will happen.  In the 2000’s, we saw the formation of change management discipline shift from concept to reality as organizations recognized the value and effectiveness of strategic change elements.
Change is inevitable and is happening on a consistent basis.  It is not about the actual “change”, it is about the management of processes and structures that ensure its ability to be seamlessly incorporated into an organizations culture, which ultimately leads to transitional success.  The root purpose of change management is to prepare, guide, equip and support transitioning teams to a future desired state.  As healthcare systems continually grow and redevelop their vision for the future, it is important that effective strategies for planning and execution are developed into a coherent plan of action in order to achieve a successful transition.

The Psychology of Change Management:  Common Barriers and How to Build Trust in the Employee for Effective Change to Happen.
Understanding human behavior is complex and frustrating.  The majority of us can probably relate in the fact that we know enough to get us through the human psychology to get us through daily interactions.  This is probably right, but what happens when you find yourself in a management or leadership position?  How much do we really know about human nature other than through experience and the occasional book?  When it comes to change management principles and engineering a specific work-force behavior, one must assess the complexity of the performance project or desired change. It is about adopting new processes and or changing an existing mind-set to reach the goal.  Emily Lawson, McKinsey & Company, poses this question: “[…] what if the only way a business can reach its higher performance goal is to change the way its people behave […]?” (Lawson, et al, 2003).  This could be viewed as a necessary shift in organizational culture from reactive to proactive with a sense of pre-occupation for failure. 

So, what things should be kept in mind to make a transition smooth?  First, it is necessary to determine the purpose of the change.  This change must be communicated effectively to affected employees to gain buy-in.  We can reference Stanford Social Psychologist Leon Festinger and his research on cognitive dissonance.  When employees find themselves in conflict with their beliefs and actions, personal behavior and change do not happen.  Making the agreement between the change process and overall purpose allows the employee to engage and develop a willingness to alter their individual behavior to serve the purpose (Lawson, et al, 2003). 

Second, there needs to be a clear and present reinforcement system in place.  This can come in many forms, but one thing to acknowledge is that when a goal is not enforced, employees are less likely to adopt it.  B.F. Skinner’s experiment with rats and positive reinforcement provides us with the framework to find the right incentive.  This could be team or individually driven where target goals, performance measures and financial and non-financial rewards are utilized and rewarded.  The reinforced change and its pathway must correlate with the desired outcome and follow the reward requirements.  If I was to ask for an employee to perform a task outside of the current process change and it did not move the measure, what would be the incentive?  Process outliers that are asked to be completed, but do not compute into the performance scoreboard, result in no value and employees are likely not to bother.

Third, match the right skills sets with the right position or train to desired performance levels.  Placing talented employees into a process change without equipping them with the right training and experience may result in failure.  Time and training are always necessary to develop the skill sets necessary to perform at an expected level.  If an employee is capable, but lacks the experience, pair them with an experienced leader to provide adequate time to absorb the new process, freedom to experiment, and the ability to utilize existing knowledge to build the bridge between confidence and aptitude.

Lastly, the idea of consistent role modeling is an important piece in the human psychology of behavior.  People model themselves off others and we find that behavior is engrained into the organizations culture.  Any lack of accountability in behavior tolerance can lead to organizational breakdown. This can be visualized at various levels within the organization to which they create both positive and negative effects.  I have found that people tend to model themselves off positions of influence and develop their leadership potential through behavior observation.  I also find that employees are affected not only by role models, but by the group with whom they identify.  The ultimate goal of consistency in modeling is to create an organizational culture that stays in alignment with the vision, so change is meaningful at every level, and that “[…] information flows upstream as well as down.” (Lawson, et al, 2003).

Performance Improvement with Big Outcomes: Utilizing Change Management for Change that Leads to Sustainment
Earlier this year, I was called upon to lead a high-profile process improvement project involving patient throughput for a high risk procedure department.  The immediate challenge was to build the right team with the appropriate skill sets (Subject Matter Experts) and to be the Change Manager.  Although this was a Lean project, it required significant change management utilization to get the project off the ground.  It was immediately determined early in the project, that there was no documented process or metrics to gauge the “As Is” state.  Additionally, employee satisfaction (subjective) was measured at “somewhat dissatisfied” and patient safety was of concern as improperly trained nursing staff was rendering post procedure care. 

At the start, the team was pessimistic about the project, as each team member vocalized what they believed was the root problem, all pointing a finger at various problems and stating, “Why are we doing this?  The leadership will never approve this project”.  An important fact to note was the team the structure with comprised of employees from multiple directorates and departments; each held the belief that their area was of utmost importance with little collaboration.  At this point in the transition, it is important that the Change Manager remain flexible during discussions and allow the voice of the customer to be heard, while keeping the project (change) on track and moving forward along its intended path.  It is necessary for the Change Manager to create a cohesive team environment that involves all employees at every level, and maintain constant communication.  At the first meeting, the discussion was loosely structured and focused on introductions and project goals and intentions; the subsequent meeting was when the work began.  At the very beginning, the team was not a team.  Building trust is the foundation to a successful team.  Create a culture of trust through communication and respect and listening first and speaking last.  To meet this measure, I choose to utilize the Nominal Group Technique (Focus Group).  This allowed team members to vent all frustrations related to the project. These concerns were documented, reviewed and consolidated at the proceeding meeting and addressed.  As the project progressed, team members grew into a cohesive team, with increased engagement and active communication remaining at the forefront of the management structure.  It is good practice that anytime a team member cannot attend a meeting, that the Change Manager meet with them to provide an overview of the project in its current state and allow them to provide feedback.  As the weeks turned into months, the project only became stronger in involvement and enthusiasm.

Through strong teamwork and collaboration, the root problem was discovered, metrics were collected (qualitative & quantitative), analyzed and reported, and the team perspective changed from fragmented to transformed.  Together, they were driven toward a purpose and developed a realization that their voice would be heard by leadership and that change management, if executed correctly, may perhaps create sustainment in a problem and instill purpose and confidence for future changes.

Sustainment of Change Management
Dependent upon if you plan to utilize change management practices in your organization, it is important to understanding change management, it’s prominence in organization culture development, knowing how the psychology of human engagement affects the change management process and that having a purpose that employees that get behind is vital.  Through the proper execution of the change management practices that employ the use of functional team solutions, support in change management structures create significant value in desired behavior modifications and processes which can generate sustained organizational transformations into the future.

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