Prof. Mathias Goyen
University Medical Centre
The way hospitals address and manage change can substantially influence employees' willingness to commit to the process.Today, the question is not whether to change, but how we manage the transformation in a way that also motivates employees and unifies the healthcare organisation. On the one hand, change is demanding and stressful. On the other hand it provides an exciting and challenging area that is responsible not only for the existence of but also for the enjoyment of our jobs.
How should we implement change? It is a simple enough question; surely there is a simple answer – especially since we do it so often. Every time we implement a new system or install a new process, we are implementing change. Therefore, surely there are some things that work, and some things that fail?
The Only Person That Likes Change is a Wet Baby
When change is considered or promoted, there will always be a conflict between those supporting the status quo and those supporting change. Among the supporters of change there may be conflict as to the extent and the nature of change that is desired. There is an assumption that there is a clear solution and the process is only a matter of finding that solution. The progression follows a linear process, namely deciding if change is necessary, and if so, what change will be made. Healthcare is an area in which change is characteristically slow. In addition, healthcare organisations often look at issues in a very narrow, short term way. However, in healthcare there may not be a clear, single solution or best choice. There may be as large a group that supports the status quo as there is promoting change.
Views on Change Management
Change management can be viewed from two perspectives – from those implementing the change and from the recipients of change. Your view of change management varies dramatically if you are the executive demanding the change versus the front-line employee who may be unsure why a change is even needed.
In many cases at the onset of a new change, neither the executive nor the front-line employee is knowledgeable about managing change. Executives want the change to happen now; employees are simply doing their job. It is the project managers, consultants or members of the project team that first learn about the necessity for change management. They are the first to realise the two dimensions of change management: the top-down managers’ perspective and the bottom-up perspective.
The result is a potentially dangerous mix of different priorities, different knowledge sets and different driving forces. If the change is not managed properly, these different values and driving forces clash, resulting in unfortunate outcomes for the business. Many healthcare organisations learn the hard way through failed projects. They learn that change management is not something addressed after the fact. Change management must start at the beginning of the project and be integrated into all steps. Both perspectives of change management must be addressed: the managers’ and the employees’.
The Managers’ Perspective
The managers’ perspective on change is results-oriented. Managers are very aware of the issues facing the department or institution and are accountable for its financial performance. When a change is deemed necessary, quick action is required. Primary concerns include:
• When can the change be completed?
• How much will this improve the processes of the hospital?
• How will this change impact financial performance?
• What is the required investment?
• How will it impact participants within the process (e.g. patients, referring physicians, etc.)
The Employees’ Perspective
Now consider the perspective of front-line employees in hospitals. They are the ones who must ultimately implement the change. In general, they do not have an overview of the department’s or institution’s strategic goals. Serving patients and getting the job done on a day-to-day basis are their primary areas of interest. When changes are made, many employees lack the broader context or knowledge base of why the change is being made. They also do not share the same accountabilities as managers. They question, therefore, how the change will impact them personally.
Six Steps for Implementing Change
Given the above-described model or framework for change management, you can break down the required elements to effectively manage change.
I - Understand Status Quo
Creating something new is always an act of destruction. When implementing change you replace the old status quo known to everyone, with a mere vision of a goal in the future. Having respect for the existing status quo builds respect for you. Some status quos have been around for only a few months, others for years. The older the status quo, the more likely it will be difficult to remove. The older a status quo, the more it has been proven as being valid. Let us respect the status quo, but not be afraid of change.
II - Understand the Need for Change
Before you implement change, it is crucial that you understand all the reasons for it. You must become an expert in the change being proposed or reacted to, because people will look to you for answers. They might even look to you for guidance. At the very least, "Is the change necessary?" will be asked by everyone impacted by it. It would be nice to have an answer.
III - Create Desire to Change
This phase draws on all your management and leadership abilities. The more people who come to believe that the change is necessary, the easier the change process. Imposing on them what to believe is not the answer. Describing the problem, creating a vision of the future, and allowing them to contribute to the details of what the solution might be, creates a common ground for support and commitment to the change.
IV - Get Operational
The move takes place, the layoffs happen, the new system is made live. Getting the operational details to go as smoothly as possible, through good management practices, adds to the ease with which the change is assimilated.
V - Reinforce New Behaviour
Most attempts that are prepared well and implemented properly will result in sustained success. Not all attempts will result in failure. Each one of those successes should be rewarded. Employees initially hesitant to the respective change need special attention to guide them to appreciation.
VI - Celebrate
Celebration is both personal and peer recognition that you are of value to the progress of our department or institution. People like to be appreciated, and a celebration is a powerful way to communicate that message. Celebrating does not require a huge financial budget. It does require an attitude, however, that people work better when their efforts are appreciated.
Implementing a support structure to assist people through a significant change is not just a matter of overcoming your reluctance to leave the comfort of the old status quo; it is an attempt to support and promote the determination and courage necessary to move towards the next one. Especially in healthcare organisations, change management approaches are often rather random instead of strategically driven. However, a strategic management of change for healthcare organisations is needed to face the challenges of the future.�