In our change management consulting, we work across many industries and organizations that are in the throes of transformation. The healthcare industry may well be the leader in transformational change. In addition to the implementation of the Affordable Health Care Act (also known as Obamacare), healthcare is experiencing a myriad of other changes, including:
- expansion to a customer base of individual consumers in new retail-based organizations
- acquisitions designed to maintain the organization's competitive position in the marketplace
- streamlining of operations to reduce costs
- re-structuring and leadership changes
- compliance-based changes such as ICD 10 that lead to major changes in processes
- new and upgraded technology led by the explosion of Epic implementations
The impact of these changes is complex, and transformational in scope, especially in an industry that is historically and culturally cautious (even risk-averse) and slow-moving. As one healthcare exec recently stated, "We've got to be smart and be quick...In the past we've been slow and hanging out."
But while it may make intellectual sense to move at a level of speed heretofore unknown, there are lots of barriers that must be overcome to get to value realization!
Our change management consultants have been working on the ground on healthcare transformational change for more than two decades. Here are the most common barriers we see to achieving sustained adoption of the transformation:
9 Barriers to Healthcare Transformation
1. Projects are poorly defined, and metrics for success are not commonly understood. It is surprising to see how many major changes are well into implementation but have not been well-defined. Key Sponsors all have a different "definition of what success looks like." If you don't know where "there" is, the likelihood of getting to it is significantly diminished.
2. Users don't adopt new processes fully; they use work-arounds rather than accepting new tools or methods, and as a result, operational efficiencies are never realized. Most organizations today put a strong emphasis on a financial business case for an investment, but the business case lacks the definition of the "human objectives" for the change. In other words, what will people be doing differently as a result of this new system or process. Unless this is well-defined, with associated metrics (see #1 above), you won't get to adoption and value realization.
3. There is weak accountability in the middle layers of the organization for implementation success. Most changes fail because there is a lack of demonstrated commitment to changes at the mid to director management levels. This lack of commitment can only be addressed by a level-by-level cascade of rewards and consequences that is driven systematically and systemically. Hence the need for a structured, repeatable process like the Accelerating Implementation Methodology (AIM)!
4. Resistance generated from the degree of work disruption created by the transformation is covert, unmanaged, and ultimately slows down the change. Transformational change requires an explicit "resistance management plan" that provides management personnel with specific tactics to manage resistance with their direct reports. Tactics and strategies for managing resistance must be broadly shared and used, and not limited to a small team of HR or Change Management Professionals.
5. Old reinforcements are applied, and don't match new expectations. Given that transformational change is radical, it always has a cultural component. The only way to drive the new culture into your healthcare organization is through a systematic and systemic inculcation of new and radically different reinforcements. As Don Harrison says, "If you are not reinforcing transformation differently, you are reinforcing staying the same."
6. Leaders at all levels don't take an active role in the implementation of the transformation. Transformational change requires leaders who are actively "expressing, modeling, and reinforcing" the change with their own direct reports, day in and day out. Too many health care leaders are there for the strategy and the launch, but fail to "show up" for the hard work of implementation. The visible, active role of leaders throughout the entire lifecycle of the transformation is the single most important factor in getting to value realization.
7. Use of multiple approaches to enterprisewide change reinforces a "silo" mentality. One of the best examples of this barrier is in the implementation of shared services. When a change goes across the vertical power structures of the organization, as is the case with shared services, you need one implementation process that reinforces the desired behaviors of the future state. Otherwise you are giving your organization mixed messages.
8. Organizations are seduced by the frenetic activity of project teams. One of the most difficult messages for healthcare leadership to hear is that the pace of the transformation is controlled by their own behavior and actions, not by the activity of the project teams assigned to the hundreds of workstreams!
9. Healthcare organizations confuse the "installation" of new processes, systems, and structure with "implementation", and therefore, declare success too early. Your organization won't achieve sustained adoption of new behaviors unless there is a planned process for getting there. If you haven't changed behaviors, you haven't transformed anything.
The business case for a systematic and systemic framework for healthcare transformation is apparent in the thousands of dollars being invested, often without the expected return. Healthcare organizations need a cohesive, repeatable process to get to the anticipated value realization for the transformation.