Change is happening faster than ever before in healthcare, especially when you factor in the high percentage of change initiatives that went on pause or were delayed or amplified due to the COVID-19 pandemic. For example, consider the recent rise of a health equity focus, continued digital transformation efforts, and the major shift in the exchange of health information through interoperability and the information blocking rule.
Despite the inherent operational, clinical and financial benefits of such changes, many healthcare employees are resistant for a variety of reasons. What’s behind employees’ hesitancy toward inevitable changes in healthcare? How can leaders help their employees comprehend and sustain such changes? By understanding the most common reasons people object to changes and proactively taking steps up-front to address such resistance, healthcare leaders will more likely and consistently achieve success with change management in healthcare.
Common Barriers to Change in Healthcare.
Fear of change is a subject that scientists have studied for decades. A well-known book by Chip and Dan Heath, Switch, talks about three main types of resistance:
- Psychological/emotional — fear of the unknown
- Logical/rational — time required to adjust to new systems or new ways of doing things
- Sociological – influence of political or vested interests
Simply stated, we are neurologically hardwired to resist unfamiliar things. This resistance can be experienced at the individual level as well as an organizational and even societal level. Healthcare workplace changes — even the good kind — are fraught with unknowns. Providing employees with additional information and rationale about changes can decrease anxiety.
Reasons for employees’ reluctance to change include:
- The change isn’t really necessary
- The change is potentially going to make their jobs more difficult
- The change is going to be difficult to personally implement
- The perceived risks of the change appear to outweigh its benefits
- The change process is being improperly handled
- The change is destined to fail
- The change was tried before, and it didn’t work
Proactive actions, interventions and communications by organization leaders are the best ways to mitigate fear of change felt by employees. Rather than allowing employee anxieties to linger, grow and affect others, healthcare leaders are better served building a workplace culture of trust, transparency and engagement in which employees feel empowered to discuss the changes they’re asked to accept. Think of it as change management through employee collaboration.
Eight Steps for Change Management Success.
Kotter’s 8-Step Change Model provides a useful framework for achieving change management success with change management in healthcare. Steps one through three deal with creating a climate for change. Steps four through six are about engaging and enabling the organization. Steps seven and eight focus on implementing and sustaining the change. Here are the steps, in suggested sequential order:
- Create a sense of urgency — Immediately address and answer up-front the inevitable question: “Why change now?” An appealing way to get this information across is to share it in the form of a story so that recipients can better understand the rationale behind the decision to change. The story typically includes three components: a) the problem to be addressed; b) the solution/change that will occur; and c) the likely outcome of this change. For example: “To increase the perioperative caseload volume in a facility, a number of process improvements, procedures and training will be implemented resulting in improved patient outcomes and increased revenue for the facility”.
- Build a guiding coalition — Identify “change champions” from among a diverse set of leaders. These champions will be accountable for implementing and sustaining the desired change. Establish a visible senior leadership team that makes a point of frequently communicating the necessity of the change, demonstrating the changed behavior, and communicating expectations for others to adopt the change. This step will likely be the most important in your entire effort since the number one reason that change initiatives fail is a lack of engaged and visible leadership.
- Get the vision right — Ensure that all key stakeholders have been consulted about — and are in agreement upon — the desired change. Consider the value of getting input from stakeholders indirectly affiliated with the change; you may be surprised by how much weight and validity this outside perspective can add to your desired change. After gaining alignment around your vision, make it a part of the story that you share during the transformation.
- Communicate for buy-in — Focus your communications more on “why” things are changing versus “what” is changing. Deliver a constant and consistent stream of communications across multiple channels, as you cannot presume that recipients will see or hear your messages from a single source or understand the rationale for your change in a single sitting. Enlist a team of change agents to be responsible for helping get the word out to others.
- Enable action — Identify up-front any barriers to your desired change, remove or amend them, and build a sense of excitement with all stakeholders around the change. Get senior leaders to visibly and vocally support all barrier removals and change support efforts (as noted in Step 2). You want employees to understand how emphatically their leadership supports change.
- Create short-term wins — Set easy-to-reach milestones and break down work into small, manageable chunks that deliver value and keep your momentum going. As work progresses toward achieving your desired change, be sure people see and know about your wins along the way to keep your motivation up. The emphasis here should be on how this change is making peoples’ lives better — both for employees and those they serve. Celebrate these wins in whichever ways are culturally relevant, such as through announcements, recognition events, etc.
- Don’t let up — This is a vital and often overlooked step, as sometimes people think a change is complete when in reality, it’s only 80% there. You need to constantly demonstrate and show progress while making sure everyone does not lose focus on the end state you’re focused on achieving.
- Make it stick — Despite the merits of your change, people can and will inevitably revert to their old ways unless you repeatedly reinforce new behaviors and habits in the months following the change. Be sure to leverage your early adopters and promote plus reward desired behavior. This can be done through follow-up check-ins and refresher training.
People are at the core of healthcare transformation, and it starts with strong leadership. Achieving successful change hinges upon the right strategic plan, building the right environment for your people, and taking the sequential steps necessary to help your colleagues adopt the desired change.