Managing performance improvements in a hospital full of patients can seem daunting, but it’s a skill that can be learned. You will make mistakes, but the secret is to learn from them and correct how you implement changes. As we have seen from the experiences of Virginia Mason Medical Center, Cleveland Clinic, Mayo Clinic, and Memorial Hermann, it can take years to transform a culture. You can’t do it overnight, but you can do it over time. Deming would say, “Maintain constancy of purpose.”
I think we can agree that even the best of changes meet resistance during implementation and sometimes fade away within a few months. The reasons for these failures are varied, but often it’s a simple lack of change management.
THREE STAGES OF CHANGE
On the surface, change management is pretty simple. There are three stages of change:
- Current state. Where are we now?
- Transition. How do we get from current state to desired state? How do we make sure that we align strategy, process, organization (i.e., people) and technology to get to the desired state?
- Future state. Where do we want to get to? What will it look, sound and feel like when we have achieved our goals?
It doesn’t matter if the change involves implementing Lean Six Sigma or some other change, getting from here to there is never a straight line.
Ask yourself: “What percentage of results depend on people changing how they work?” If you’re implementing a medical records system in a hospital, the answer is probably 90 percent. If you are changing an information system to prevent a certain kind of input error, the answer might only be 5 percent. The more the change depends on people, the more thought needs to be given to the care and feeding of the change. Everything depends on how the culture accepts, adopts or adapts the change. It doesn’t matter how great a change might be, if the culture doesn’t accept it, it is doomed.
KEY COMPONENTS OF MANAGING CHANGE
While it would be impossible to discuss cultural transformation and change management fully, here are a few key insights on how to proceed:
- Plan. Engage the stakeholders. Identify the sponsor, champion, and process owner.
- Inspire. Paint a convincing picture of how the change will be beneficial for everyone—patients, families, clinicians, payers, etc.
- Launch. Initiate the change. Engage the stakeholders.
- Support. Sustain the improvement.
PLAN
First, identify the stakeholders and their readiness to implement the change using the QI Macros Stakeholder diagram (Figure 12.1). I have found that successful implementation of change requires three levels of support: sponsor, champion, and process owner (Figure 12.2).
FIGURE 12.1
Stakeholder diagram.
FIGURE 12.2
Sponsor, champion, and process owner diagram.
Leverage Your Centers of Influence
In The Tipping Point (Little Brown, 2002), Malcolm Gladwell argues that any idea “tips” into the mainstream when sponsored by one of three informal leaders: connectors, mavens, or salespeople. They may not have the top job, but they do have the ear of the people. They can make or break your success. Everyone comes to the maven for their encyclopedic knowledge of the business or technology. The connector knows everyone and succeeds by connecting the right resources. It would be a good idea to engage your connectors and mavens in the change team.
Seth Godin calls these people “sneezers” because they sneeze the “idea virus” in ways that get it into the minds of everyone. Godin separates sneezers into two categories: the powerful and the promiscuous. Powerful sneezers do it because it enhances their status. Promiscuous sneezers (i.e., salespeople) do it for the money.
Connectors connect people with other people they know. Think about your own hospital. Who is the center of influence who knows everybody and introduces everyone to everyone else?
Mavens connect people with new ideas. Who is the center of influence in your hospital who gets everyone on board with all the new changes in methodology and technology (e.g., Lean Six Sigma, statistical process control, protocol changes, etc.)? I think of myself as a maven because I’m trying to connect you with the powerful ideas in Lean Six Sigma.
Salespeople do it for money. If you do get CEO support for any change, these folks will show up like vultures to a carcass. Beware.
Teamwork Is Hard
Those of us who have been around Lean Six Sigma for a while know that the methods and tools are easy. It’s the people and culture stuff that’s hard. This is one of the main reasons that I recommend that people focus on the 4 percent of the business that’s causing over 50 percent of the delay, defects, or deviation and engage only the employees involved in that 4 percent.
I also recommend that the teams be no larger than five to nine people. Make sure that you have sneezers on your team. When focused on the 4 percent of the hospital causing over half the delay, defects, or deviation, a handful of people usually make dramatic headway in a few days, whereas a wider focus and more people often ensure failure.
Teamwork is important to the success of the team, but as they say, it’s “like getting rich or falling in love, you cannot simply will it to happen. Teamwork is a practice. Teamwork is an outcome.” And teamwork leverages the individual skills of every team member. What can you do now to maximize your team’s success?
INSPIRE THE TEAM
Teams need a reason why they should implement change. It has to be good for the members as well as the hospital and patients. Give some thought to how to frame the change so that it fits the needs of everyone involved. You might even go so far as to develop a voice of the customer (VOC) matrix to determine what will motivate and inspire the team.
Creating a Sticky Idea Virus with SUCCES
Dan and Chip Heath wrote an excellent book on making ideas sticky, Made to Stick (Random House, 2007). They found six key principles of sticky ideas (acronym SUCCES):
Simplicity. Ideas must be stated simply and also be profound.
Unexpected. Ideas must be surprising.
Concrete. Ideas must be stated concretely in ways that you can see, hear, feel, smell, taste, or touch. Sadly, medicine is full of jargon.
Credible. Ideas must be believable.
Emotional. Ideas that stick invoke a feeling or emotion that acts like Velcro in the mind.
Stories. Stories, especially mysteries that reveal the solution at the end, are especially powerful for helping ideas stick in the mind. In each of Don Berwick’s speeches, he tells a tale of one or more patients who experience some sort of medical harm. He then ties his message to the patient’s experience. You can too.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
