Recently, my daughter wrote a school report on Charles Darwin. The title of the report was "Evolve or Die," which I thought was a bit harsh and certainly too fatalistic for a middle schooler. My parental concerns not withstanding, as I thought about our current healthcare environment, I realized we are in an "Evolve or Die" situation in this country.
Take for example reimbursement. No longer will we be paid simply for what we do but how we do it and how happy our patients are with our service. It is clear that if folks don't make a change (like focusing on delivering higher quality and more patient-centered care), they will go the way of the dodo.
Unfortunately, change is hard and involves a number of steps.
- First, you must have the environmental awareness to determine which way the wind is blowing and connect the dots that a change is critical.
- Second, you must be able to determine what change is required.
- And third, you must bring about the change (a process known as "change management").
It is the third step that is the hardest for most organizations and has created a number of pricey new consulting firms and a multitude of business books focused on change management.
While I am certainly no expert in this field, I have learned a lot from these consultants and organizational self-help tomes as well as my own personal successes and failures. As such, I am adding my two cents to the change management vault, and we will explore the topic in a three-part series over the next few weeks.
For the first installment, I'll focus on rallying key players in preparation for change.
Step 1: Create Believers
The first step towards bringing about big change is to get people on board. Then to dramatically increase your odds of success, you need to get these folks not only to go along with the change, but to truly believe that this is the right thing to do.
Kennedy accomplished that in the 1960s when he convinced the country to marshal our resources and go to the moon. He created a "sexy" goal (just the idea of going to the moon in those days excited people), and he locked Americans in by adding that we had to get there before the Soviet Union. At that time in our history, the Soviets were on the rise and threatening our perception as the greatest country in the world. Plus they had just beat us to space with Sputnik.
Kennedy not only created an exciting goal, he also created a compelling reason for people to get behind it. A reason that stirred something deep inside them and motivated them to act — not because someone told them to, but because they wanted to. This is the definition of leadership as described by Eisenhower:
In our healthcare world, we have many goals: improving patient satisfaction, implementing a sepsis policy, developing a palliative care program and so on. We also have extremely compelling reasons to do these things.
These reasons are called patient stories.
Take palliative care for example. Most people have heard of it, and some know that it is a program to help people at the end of life. Once you explain to them the benefits of the program (decreased ICU admissions, decreased readmissions, better symptom-focused care leading to better patient comfort and satisfaction), these same folks would probably agree that this type of program would be beneficial.
However, where you get people to truly buy into it — to be motivated not only to create such a program but also to go out and be disciples and active participants in change — is through patient stories.
Here's one such story about an elderly woman with advancing dementia who was in a skilled nursing facility. She was living out a relatively healthy and happy existence, but her life sadly ended a year later in an ICU after multiple hospital admissions, bedsores, device-related infections and many painful procedures.
This was a patient with a loving family, but unfortunately no advanced directive. After her death, the family stated that she always expressed the desire to die at home, and they wished that she could have ended her life in a more comfortable and compassionate way. This could have been accomplished through a palliative care program.
Does this sound familiar? Haven't we all seen a similar case and said to ourselves, "Why are we doing all this to this poor patient? Why isn't she a DNR?"
In contrast is the story of an elderly man with advanced lung disease, who understands that his condition is progressive and will ultimately be fatal. He is adamant that he will not die in a hospital but in his own bedroom looking out on his prize roses. He is referred to palliative care by his physician, and this helps him better understand the dying process and the resources available to him to die with dignity and without suffering. Even though the patient visits the ED multiple times over the next few years, he's not admitted. Thanks to palliative care, home health and eventually hospice, he receives symptomatic care at home and eventually dies quietly in his bed with his family and his roses.
Upon contrasting these cases, one sees the overwhelming benefit of palliative care. I also believe that one is subsequently motivated to advocate strongly for bringing such a change to their hospital. They say to each other, "We don't have to keep doing this to our patients. There is another way, a much better way."
It is clear that change is occurring all around us, and our means to survive and flourish is to adapt and evolve, to change ourselves. However, change is hard, and change is resisted. To quote a funny t-shirt I saw recently, "Change is good. You go first."
As leaders (and whether you are an "official" leader or not, you can still lead), we must drive the change, and we must motivate people to change because they want the change. In the healthcare environment, you do that by using stories to tap into providers' deep-seated values of patient-centeredness.
If we are successful in creating believers, then our providers become the engine of change, and we as leaders become the captains navigating the ship to our end goal.
If only the dodo understood change management…
Tune in soon for Part 2 of our change management series.