Making Work Place Changes That Last

The ancient Greek writer Diogenes said it succinctly: “Change is the only constant.”

In healthcare, the rate of change seems to be exponential. Physicians can and should play a critical role in implementing change in their organizations, but only if they take steps to acquire the necessary skills needed to manage change. Given that the estimated failure rate of change initiatives is 70 percent,¹ it is imperative that a leader understand how to increase the probability of success. While the change may be relatively small, like a new appointment scheduling process, or relatively large, such as the implementation of an electronic health records system, there are six skills a physician is required to have in order to successfully implement a change initiative.

First, the physician needs to be able to effectively analyze the organization’s current environment, determine the desired future state, and identify the major drivers of change. Change drivers are typically categorized into external drivers (regulatory pressures, market competition, customer demands) and internal drivers (service delivery enhancement, improvement of quality control processes, operating expense reductions.)²

By identifying the major change drivers, the physician can gather relevant facts to support the need for change. Another critical piece is determining the employees’ readiness for change. Organizational change experts believe that the level of change readiness is one of the main reason initiatives succeed or fail.³ Will employees believe that the change is necessary? Do they believe that the change will be successfully implemented? Will employees believe that top leaders are committed to the change, or do they think the initiative is just another program in a string of failed change attempts?

Second, the physician needs to be an excellent communicator. Once a clear case is built for the change and employees’ readiness for change is determined, the physician needs to develop a compelling vision of the future state.⁴ The vision needs to be clearly communicated to everyone who will be impacted by the impending change, and a sense of urgency should be established.

The rationale for change has to be explained in a manner that employees understand and believe. Additionally, their readiness for change should be addressed by communicating the employees’ role in the change effort, by articulating leadership support for the impending changes, and by outlining exactly how these changes will address the underlying change drivers.

Different forms of communication need to take place, including formal communication via newsletters, quarterly reports, and emails, and informal communication during performance reviews, hallway conversations, and meeting sidebars. In the midst of change, one cannot over-communicate; a preponderance of people need to “get it.”

Third, the physician must have several influential tactics in their skill set. Rational persuasion, or the presentation of factual evidence supporting the change, is a compelling way to initiate and propel readiness for change. This is the influence tactic that physicians most frequently use, but is usually not robust enough to overcome employee resistance.

Bargaining, or the exchange of benefits, is another popular influence and can smooth the way for change. However, it is typically not feasible to employ this tactic on a large-scale. Consultation brings key players into the planning stages and is very useful for creating buy-in for the change. Inspirational appeals that arouse enthusiasm by addressing employees’ values and aspirations can also help build support.

There may be situations were relying on coercive pressure is necessary, particularly when a resistant individual jeopardizes the success of the change initiative. However, over-reliance on negative influence tactics usually results in short-term compliance without long-term attitude change. The physician who uses positive influence tactics (persuasion, consultation, and inspirational appeals) is more likely to engender compliance and attitude change, which are both necessary for the change to stick.

Fourth, the physician must be persistent in the face of opposition. Change is not an event, but a process — a process that can take months or even years depending on the extent of the change. Successful change entails not only altering strategies and the way of doing business but also people’s thoughts, feelings, and actions.

People are inherently reluctant to change. They fear the unknown and worry about how the change will impact their job, their social relationships, and their compensation.⁵ Just because the physician is excited about the impending change does not mean that anyone else will be enthusiastic or buy-in to the process. If people can get away with the status quo and avoid having to do anything differently, they will. Successful change implementation takes much longer than most people imagine, and the physician needs to be unrelenting in his or her push for change.

Fifth, the physician must effectively manage conflict. If a physician avoids directly addressing opposition, then the change initiative is doomed to failure. Opposition to a change is a given, and the physician needs to be adept at analyzing and discussing the underlying reasons for the resistance. Here’s where those strong communication skills again come into play: active listening is the key in getting individuals to clarify their viewpoints and in understanding how they believe the change will negatively impact them.

Only when the physician has a complete understanding of the situation can conflict be effectively negotiated. If the physician is hesitant to address a conflict, he or she should pose the question, “What’s the potential outcome if I don’t intervene?” On the flipside, the physician should think carefully when choosing which battles to fight. Not every disagreement needs to be won if they are not critical to the success of the change initiative (Gebelein et al, 2001).

Finally, physicians must view the organization from a systems perspective. That is, change does not occur in a vacuum, and all the various systems and processes in the organization need to support the change effort. For example, if a customer satisfaction initiative is underway, it is highly doubtful that sustained behavior change will take place if customer satisfaction measures are not used to assess employee performance. Only if the organization’s performance management system rewards the desired end state will the change become sustainable.

Analytical skills, communication skills, influence tactics, conflict management, persistence, and systems thinking: these are key skills that a physician must have before beginning a change initiative. With these prerequisites, a physician’s vision for the future of healthcare has a better chance of coming to fruition.

Kate Atchley, PhD, is the director of leadership development curriculum for the University of Tennessee's Executive MBA programs.

Reference

Armenkais AA, Harris SG. Crafting a change message to create transformational readiness. Journal of Organizational Change Management, 15(2), pp. 169-183. 2002.  

Balogun J, Hailey VH. Exploring Strategic Change, 2nd edition (London: Prentice Hall), 2004.   

Dent EB, Goldberg SG. Resistance to change: A limiting perspective. Journal of Applied Behavioral Science, 35(1), pp. 45-47. March 1999. 

Gebelein SH, StevensLA, Skube CJ, Lee DG, Davis BL, Hellervik LW. The Successful Manager’s Handbook. (Minneapolis, MN: Personnel Decisions International Corporation). 2001.

Kotter JP, Cohen DS. The Heart of Change: Real-Life Stories of How People Change Their Organizations (Boston, MA: Harvard Business School Press). 2002.

Oakland JS, Tanner S. Successful change management. Total Quality Management, 18(1), pp. 1-19. 2007.

Todnem RB. Ready or not... Journal of Change Management, 7(1), pp. 3-11. 2007.

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