Don't Be a Dodo: Three Crucial Steps to Evolving Your Healthcare Organization (Part 3 of 3)

David Birdsall , MD

Chief Operations Officer

Published July 22, 2014

Welcome to my third and last article in this series on change management for healthcare leaders.

Part 1 started with a reference to the dodo and the need to change or risk extinction. In Part 2, we touched on getting our wings and prepping for change. Specifically, that means doing your pre-work, picking your team and developing your timeline.

Step 3: Stay the Course

Now it is time to take flight and embark on making your change. This flight can be a bit tumultuous at times. But fortunately we have a map: namely, Quint Studer's 5 Stages of Change, to guide us.

These stages are universal, consistent, predictable and help the leader navigate the journey. Those stages are:

1) The honeymoon phase
2) Reality sets in
3) The uncomfortable gap
4) Consistency
5) Leading the way

Let's look at them more closely.

1) The Honeymoon Phase

You have your goal, you've got your team, you've done your prep and you have a roadmap, metrics and timeline. Now you set out. You are happy, you are excited — and you should be.

This is the honeymoon phase. Maybe you have a kickoff party: get t-shirts, make signs, bring balloons and cookies or whatever. What is necessary at the onset, is that there needs to be an acknowledgement of the journey you are embarking on. Think of it like breaking the bottle of champagne on a ship's maiden voyage or a ribbon cutting.

This is the sendoff party that overcomes the inertia. It is the "big push." You, as a leader, will need that push in order to build momentum and prepare you for stage 2.

2) Reality Sets In (The First Hurdle)

This is where folks realize that what they are doing is really hard. One day it is fun to get up and go to the patient's room to discharge the patient with the doctor, and then the next day, it just seems like one other thing you need to do on top of all the other things.

As a leader you need to prepare for this stage. You need to expect this "gut check" to occur and to look for the signs of this in your team members and in yourself.

In my opinion, managing this part of the journey is the most important step. As a leader, you need to have unflagging optimism. You need to be supportive and encouraging. You need to lead by example, and you need to help people get through this and help them realize that the difficulties will pass.

This is where you earn your keep as a leader.

3) The Uncomfortable Gap (The Second Hurdle)

That first hurdle, when reality sets in, is the hardest, and it really clarifies your team.

Some members will identify themselves as unofficial leaders and take initiative to coach teammates through this change. For others, overcoming a difficult phase strengthens their resolve and gives them a proud sense of ownership. ("I did it!" they say to themselves.)

However, there will often be team members who never quite get past the "gut check." As time goes by, these people stand out, and you begin to see a growing separation between the high and low performers. You recognize that people start falling behind and an "uncomfortable gap" develops.

When there is inconsistency in performance among team members, the progress of the journey is slowed. High performers start complaining about the low performers, and they look to you, the leader, to deal with it.

It is your job to help people along, to bring them up to the group's overall performance level, to coach and encourage them through this. However, you will realize that some team members will require more help than the group can provide, that they are holding you back and that you need to cut them loose.

It is a fact that not everyone is equipped to make the journey or is meant to make the journey. Some will share your realization that they aren't made for this new team and will choose to go elsewhere, but some you will need to cut loose for the betterment of the team and its goal. If you do not, these holdouts will continue to hang on and actively try to drag the team back to the "old ways."

4) Consistency

The fourth stage is consistency. This is also a tough one. It requires leadership to prevent backsliding.

Once someone reaches a goal, it is natural to let up on effort, and people will find themselves slipping back into their old ways. You can't let them. To prevent backsliding, you need to keep the pressure on. You will need to find a way to track compliance and give continued feedback. You will have to hold people accountable. If you are trying to be consistent with RN and MD team discharge, you could call up patients to see if it happened. You can also perform leadership rounds and visually watch to see if team discharge is happening.

Even though you have reached your goal, you can't take your foot off the pedal. You need to make this new change part of the norm, to instill the feeling that "this is how we do it here."

5) Leading the Way

Once change is accomplished, you will realize that in many ways, your job is just beginning. Success will cement your reputation as a leader and a doer, so you and your team will need to be prepared, motivated and hungry for even more change.

If you are successful, it's likely that people outside of your team will ask you for help. Don't forget that you were in their position once, and that you now have the responsibility to spread and nurture this change.

So there you have it. Change management in three short posts. If only it were that easy. However, reaching a great goal is never easy, but always worthwhile. And in our healthcare industry, we need to attain great goals in order to survive and to meet the "triple aim" of better care for the individual, better care for patient populations (our community as a whole) at a lower cost (so that we don't bankrupt the individual or the country).

You are a leader. Go out and lead the necessary change. Realize that you are not alone. There are many like you working for the same goal. Reach out to them so that you can help each other. We need you and we need your leadership.

I would love it if you would comment below to voice your thoughts, experiences, successes and initial failures. We are all in this together and we should help each other.

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