Chances are, you are or will be involved in some organizational change campaign. “Everyone agrees” that change is needed in our healthcare system, and many endeavors toward improvement are no doubt begun every day.
Indeed, the business book shelves are packed with volumes espousing empowerment, learning organization, Total Quality Management, the Balanced Scorecard, Blue Ocean Strategy, and so on. Initiatives regarding reducing errors, evidence-based medicine, and patient engagement are familiar examples of such efforts in the healthcare field.
The efforts to implement such programs generally meet with mixed success and frequently with failure. There can be many reasons for that, but the most important one is that the changes to be made require altering the organizational culture, whereas the effort was framed not about that culture but about some idea, function or reform. True, such campaigns often include a “change management” component of some sort but these are often a sideshow and do not drive or control the overall process.
You can’t change the way things are without changing the organizational culture, any more that you can reform someone’s health without changing the way they think about it. It is in fact very difficult to change organizational cultures, just as it very difficult to change the habits of people with an unhealthy lifestyle. Still, it can be done and there is body of knowledge (organizational development and change management) that can help such attempts to succeed.
Here are some suggestions that may help you if you are leading, participating in, or just swept up by such change. Whatever your level of involvement, understanding the principles will enable you to be more effective.
1. Everyone must be involved.
Everyone contributes to the organizational culture (even if unawares). So everyone needs to be involved if it is to change.
If you are fortunate to be in an organization where everyone’s opinion is respected and considered, you will find that change efforts are relatively easy, because everyone contributed to the decision. If, however, the change is being imposed by an elite at the top or outside consultant without the input of “those of us actually do the work,” then greater difficulty can be expected.
2. Don’t underestimate the effort and resources needed.
In his book Leading Change, the best ever written on that topic, John Kotter says that you have to “overcommunicate by a factor of ten”: estimate how much communication is needed and then do ten times that amount. The same can be said of almost every other aspect of culture change!
Recently, Cleveland Clinic won justified praise for conducting a training program that brought all employees together in mixed groups (i.e., a surgeon might be sitting next to a janitor) for a half-day session on patient service. Commentators noted how difficult it was to get that much time for all hospital workers to be off-site. But really half a day’s training is hardly like to change organizational norms: it would take ten times that much!
3. Be honest about it.
Are people going to be laid off? What’s going to happen to me? Such questions are endemic in change efforts and needed to be answered honestly.
If you are leading the change, you must resist the temptation to temporize and to sugarcoat. If you are caught up in the change, you must insist on your right to honest information, just a patient has the right to the truth.
4. Trust and respect are foundational.
Anthropologists say that culture change is very difficult, but if the culture does value change, then it can be done rapidly. The same applies to organizations: those in which staff and leaders trust and respect each other will find change relatively easier.
In a good organization, people can discuss all subjects openly and honestly. If that is not the case, then any change effort toward, say, teamwork between doctors and nurses or empowering patients, is doomed: First there has to be a culture change to an environment where people can speak their minds without fear and trust one another. For example, it can’t be expect that a program to eliminate bullying can succeed if people cannot openly discuss how they are being treated.
Moreover, organizational change usually has to be incremental rather than revolutionary. Organizations usually can move from one level to another – good to great, say, rather than from bad to excellent.
Another important point: Don’t overwhelm people with too much information all at once! Bearing that one in mind, we will take a pause here and continue with the rest of our tips later. As always, your comments and reports on your experiences are most welcome.
–Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium. His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices. Having produced newsletters for several organizations and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching. www.manage2001.com firstname.lastname@example.org