This is the first of a three-part series, “Keeping anchored in the twirling seas of healthcare.”

Martie L. Moore

As long-term care providers face the many changing industry regulations, I have seen a growing number invest in new technology to improve their processes and get ahead of requirements. I also, as a healthcare leader, implemented technology and initiated major change to meet performance requirements.  I will admit that I thought I was doing the right steps when implementing change, but in hindsight, there was more needed to be done. 

Change management, defined by the Health Information Management Systems Society as “… process, approach and a set of tools for managing the people side of change so that business results are achieved, on time, and within budget,” can make the difference between acceptance or rejection of improvement processes. Sounds so simple — right?

Envision the last time you — with open arms — said, “I love change. Bring it on.”  It is the rare individual who asserts that type of reaction, and when they do, we label them as Pollyannaish or seeing the world through rose-colored glasses.  

Change Management Theory has been rooted in several theories on change. Kurt Lewin describes it as three stages: Unfreeze the organization, Make the changes needed, and Refreeze the organization.  Certainly, behind the three stages are deep tangible actions and outcomes that managers take to move their organization forward. The challenge is that many of the changes never really refreeze.  My personal experience is that I am not sure that some of the changes that I have led, ever thawed in the first place.

A theory from John Kotter, Ph.D., has been a model that I have personally utilized with success. The following table gives a good overview of the model and steps.

Stone crumpling isn’t part of Kotter’s theory, but it is reflective of the current healthcare environment where performance metrics are measuring the degree of sustained change. What is missing in most leaderships’ actions is actually the pre-work needed for sustainable change.

Gregory Shea and Cassie Solomon in their book, “Leading Successful Change,” address the pre-work needed to make sustainable change. “They contend that change efforts fail for two reasons: Leaders present vague and abstract change objectives, and leaders underestimate the power of the work environment to precipitate or stall change. They assert that to create successful change, leaders must consider focus on the behaviors you want from people and design the work environment to foster those behaviors.”   

Many times when we create a sense of urgency, we focus on the external forces that are driving the need for the change. We build our strategy on the “why” the change is needed. Often overlooked is stepping back to map out the behaviors needed to rise to meet the changing environment, and then working through what the work environment would look like to support and promote the behaviors.

In a recent study published in the Harvard Business Review, employees were found to be far more open to change and more adaptable than leaders gave them credit for. Employees just wanted to know what behaviors and actions were expected for the future and how to be successful in their work environment. Maybe giving thought to the behaviors and work environment is not pre-work, but the actual work needed for a rapidly changing healthcare environment.

Next month’s column, part two of this series, will look at A3 problem solving and how the methodology creates sustainable performance needed for today’s healthcare environment. Building on how to lead change, next month I will give tangible tools for leaders to help elevate performance.  

Martie Moore, RN, MAOM, CPHQ, is the chief nursing officer at Medline Industries Inc. and a corporate advisory council member for the National Pressure Ulcer Advisory Panel.