Managing Change in Health Care Organizations

The Greek philosopher Heraclitus said that the only constant in life is change. In health care, organizations and providers are constantly navigating shifts in policy, payment models, new scientific findings, and consumer needs and demands. Navigating change can be confusing, even exhausting; or it can be exhilarating as new opportunities to improve the health and well being of clients and communities present themselves.

Change management is the systematic approach and application of knowledge and tools to deal with change. As a strategic health care advisory firm, much of our work at Third Horizon Strategies boils down to helping clients manage change effectively and chart a course for success in the future.

In my experience, effective change management starts with strong communication. Leaders of organizations need to clearly define a unifying vision for change (the “what”), articulate the “why” so teams understand the importance of the change, involve staff in designing the “how” so they feel bought into the process, and provide the resources needed for teams to succeed. Organizations should design a communications strategy to convey key points in simple terms, use consistent messaging, and invite bidirectional communication between staff and leadership through multiple forums or communication modalities.

Without strong communication, it is much harder to create staff buy-in. For example, I worked with one clinic that was integrating primary care and behavioral health. The changes were impacting everyone from front desk staff who were being asked to share new screening tools with patients when they walked in the door, to medical assistants or nurses who were asked to collect new health measures, to providers who were expected to start making warm hand-offs to behavioral health clinicians when warranted. The clinic leadership had a great vision of improving the health outcomes of patients, while reducing overall health care costs. Yet, they failed to convey this vision to the staff and met a great deal of resistance. I helped them build buy-in by communicating the expected benefits of integrated care, and engaging staff in defining new workflows and processes to support integration. The clinic developed data dashboards so staff could see the impact of integration on a regular basis and be held accountable for key performance indicators.

Multifaceted change needs to be appropriately scoped, resourced, and coherently tied together. In other words, organizations taking on multiple change management initiatives simultaneously need to demonstrate how these initiatives are linked, and ultimately help achieve the same guiding vision.

John Kotter, a Harvard Business School professor, developed a well-known and widely-adopted approach for managing organizational change called “Eight steps for leading change.” I have found these steps provide a strong foundation and guiding structure. In summary, the steps include:

1. Create a sense of urgency: Leaders need to convey why the change is imperative to the organization, whether it be in response to an existential threat (e.g., if we do not change, we will be put out of business) or an opportunity (e.g., we will significantly improve the health of our patients through this change).
2. Build a guiding coalition: Organizations should establish a multi-disciplinary team from across clinical, operational, and administrative functions to guide the change management process. In every organization, there are change leaders or people who embrace new ideas and ways of doing things. Leaders need to identify these team members and foster their leadership. They also should ensure that adequate time is dedicated for the group to meet and plan.
3. Form a strategic vision: The coalition crafts a guiding vision that others will find motivating or even inspiring.
4. Enlist a volunteer army: Additional staff at all levels of the organization should be engaged in the change management process.
5. Enable action by removing barriers: Leaders need to ensure that formal structures support, rather than inhibit, the change, make additional training and resources available as needed, and remove identified obstacles.
6. Generate short term wins: Incremental changes may be required as organizations work towards larger system transformations. It is essential that small wins be made visible, and celebrated along the way.
7. Sustain acceleration: Until major changes are institutionalized, or embedded in the organizational culture, leaders need to sustain the momentum. Change management efforts can be reinvigorated by engaging new volunteers or rotating the guiding coalition leadership/facilitation.
8. Institute change: Embed the changes in organization policy, protocols, and norms.

As health and behavioral health providers experience increased demand for client care, yet severe workforce shortages, it is more important than ever that leaders develop change management plans that are driven by a guiding vision and implemented through inclusive processes. Third Horizon Strategies has experienced first-hand the importance of developing a change management plan that supports organizations achieve their goals and ensures employees, board members, and other key stakeholders are actively engaged. As such, the firm builds change management advisory services into many of its consulting engagements and provides policy analysis, strategic planning, data analytics, change management coaching, implementation assistance, and other strategic advisory services to help health care organizations succeed in a constantly evolving health care landscape.