Thought Leadership

Leading and Managing Complex Change

Change is the new normal for leadership

In today’s competitive healthcare environment, you are constantly dealing with change – both expected and unexpected. Some of these changes you can control (like quality improvement initiatives) and some you cannot (like regulations).

Any organization that doesn’t change risks being left behind in this ever evolving market. The good news is that the ability to manage change is an advantage you can give yourself over your competition.

But it is not easy.

The reality is that the majority of change efforts end in failure. The question is – why?

Though some will say having the right technology is the key factor that determines successful change, our work has repeatedly shown us that there is more to it. In fact, technology is just one of five core competencies that are required to make lasting, meaningful change.

The five core competencies are:

Let’s take a closer look at each area.

Bad things happen when you ignore one of the competencies

Looking at the five core competencies, you can probably think of times where your organization didn’t account for one or more of these areas, and you probably want to forget the frustration and challenges associated with those experiences such as cancelled projects, schedule delays, cost overruns, or staff turnover.

The truth is, without these 5 competencies, your change efforts will be fraught with problems.

As the visual shows, if you have all five competencies covered (the top row), you get the change you are looking for. However, if you are missing one of the five competencies, you end up with problems.

For example – if you don’t have proper Governance, you get Confusion among your teams. No defined processes? You get sporadic change where some people are able to make the change, but others struggle.

Looking at technology, you can see why it usually gets the blame – lack of proper technology causes anxiety and frustration, which quickly mask all of the other issues. Once people are frustrated, it’s tough to understand why they are resistant to change.

Now let’s look at some of Afia’s experiences with each competency.

Governance – Confusion

Governance is the vision and direction. Leadership needs to convey a clear vision of the future that generates action and inspires change.

Building a shared vision is a critical factor in managing change. Without it, we find confusion and lack of cohesion in teams. As evidence, let’s examine two of Afia’s clients. In both situations, no changes were being made to their EHR for many months. At one of the clients there was a clear vision for, and communication of, this lack of progress. At the other, there was no communication:

  • Client without governance – the lack of change was due to a lack of available technical resources. There was no prioritization of what those limited resources should be working on and no communication about the lack of progress. Staff who submitted requests were confused about why their requests were not being handled and started making one-off workarounds to solve problems.
  • Client with governance – the lack of change was due to a new EHR. Based on Afia’s guidance, leadership communicated that even though they knew users would want changes immediately, that no major changes would be made to the system for at least six months after go-live so that we could see which changes were truly needed. During the “system freeze” period, there was certainly impatience about not changing the system. But, staff knew the plan and ultimately agreed it was the right approach.

Execution – False Starts

Once you have a clear direction in place, your organization needs the resources that will take the steps towards this future and make it a reality. Without adequate execution resources, an organization will experience “false starts” because it will be managing via trial and error rather than having a proven process to deliver.

Afia has come into project situations where there is a clear vision, but the project is stuck in limbo for years (ten years is the current record). The problem in nearly every case is that the execution team didn’t have the time or skills to tackle the project correctly. Sometimes that means a lot of talk and no action. Sometimes that means picking the wrong vendor and having to start over. In every case, the lack of execution was an expensive mistake for our customers.

By contrast, once an execution team from Afia was properly engaged, the wheels of progress started turning and the client started seeing results. Everything else was the same, the only thing that changed was that the client brought in the needed execution resources from Afia.

People – Resistance to change

In order to create change, your organization needs the people who will live and breath the change – to make staff stakeholders and champions of change. On top of that, the organization needs to enable staff to make the required change. This may include developing their knowledge, expertise, and requisite skills to effectively move the change forward.

Without this commitment, organizations will find resistance to change and staff may actually work actively against the change.

Before hiring Afia, one of our clients embarked on a new EHR implementation without addressing staff skills and uncertainty around what impact the new system would have on their jobs. They struggled to get their project live because staff raised issues (without any corresponding solutions) at each turn. Nothing seemed like it would work for staff.

By contrast, in another situation, Afia encountered staff resistance (and even conspiracy theories!) and determined that more staff training was needed to make the project a success. By engaging staff more frequently than usual and providing more support, they were able to develop a comfort that allowed them to successfully rollout and adopt a system within an accelerated time frame.

Process – Sporadic change

Processes are the workflows and incentives necessary to smoothly and effectively operate an organization’s day-to-day. When change is expected, it is of the utmost importance that organizations spend time thinking about (and documenting!) how the work of every group in the organization will be impacted.

Otherwise, decisions on how to change workflow will be left to every individual person and team. This means that every person and team could choose to change their workflow in a different way! Some will find great ways and others will not. In other words, the change will be sporadic.

Typical EHR implementations see drops in productivity at go-live of anywhere from 10-30% for a period of months to a year after go-live. But one of our customers focused so heavily on their post-live processes that they saw a ZERO drop in productivity when they went live with their new EHR. Everyone knew what to do across the organization. (We’ve seen other clients implement this same EHR vendor, but neglect the necessary workflows only to see a drop in productivity post go-live.)

Product/Technology – Anxiety and frustration

Lastly, we have product/ technology, which are the tools and equipment needed to facilitate change. Without the right products and technology, organization cans expect their staff to be filled with anxiety and frustration.

Our best example of this comes from two similarly sized customers who implemented the exact same system.

One of the systems was hosted on an infrastructure provided by the vendor and the shared resources ended up resulting in extremely slow response times. Staff would attempt to document their services collaboratively with the client/patient, but the system was too slow. They were filled with anxiety and frustration that they couldn’t keep up. They were not happy!

In the other situation, Afia provided a locally hosted, dedicated infrastructure for the client. The performance of the two systems was night and day, and the staff in the Afia example were much happier with the system. They were able to focus on quality improvement efforts while the other customer spent time migrating to a new data center.

Go forth and change!

In the ever-changing, competitive world your organization exists in today, you are dealing with change on a daily basis. As economic, political, social, and technological change continue to accelerate, competitive pressure will grow. And your organization will need to change the way it does business in order to stay competitive.

Ultimately, change is NOT the problem – actually making change is the problem! And while change is difficult, it’s easier once you know what to look for.

Time and time again, our experience shows that a lack of focus on the 5 Core Competencies of Change spells trouble for a project. By properly accounting for the five competencies and planning for them from the start, you will set your organization up for success.

Remember that it is critical to look at people, processes, technology, governance AND execution. If you only focus on one or two, problems in the remaining areas will still be there under the surface – like an iceberg ready to sink a ship!

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