The quote from W. Edwards Deming above should be a sobering reminder for us. In this time of increasing competition and regulation, and growing public expectations about the level of care that hospitals, health systems and clinicians should provide, we need to change how we operate so we can survive. A hospital that has served a community for a hundred years will be lucky to survive for another five years if it’s not keeping up with the best clinical practices and top-percentile patient satisfaction numbers of the new hospital across town. These things require innovation, and that means change.

Fear and resistance must be overcome in managing change. In instituting the magnitude of changes that are necessary in healthcare today, fear and resistance will inevitably be encountered, no matter how noble the intentions of the change or how much we as leaders try to sugarcoat it. As Robert F. Kennedy once said: “Progress is a nice word, but change is its motivator, and change has its enemies.”

So how do you ensure as a leader that positive changes occur and, most importantly, are sustained over the long term? It starts with knowing and acknowledging that change is needed, and communicating what the changes will be. Leaders should recognize that all people have different reactions to transitions—from those who dive into new opportunities with reckless abandon, to those who meet any uncertainty with anxiety. Leaders also need to accept that these people will all be on the same team. 

Leadership development and communication consultant Randell Jones says that there are three types of change styles: Conservers, Pragmatists and Originators, and they all go through cycles of change differently. It’s not as important to know the specifics of these change styles as it is to recognize that the effective change leader will be the one who can ease the tensions among people who handle change differently.

According to noted change-management consultant Rick Maurer, there are three basic reasons people resist change: 

• they don’t understand it
• they don’t like it or are afraid of it
• they don’t trust their leaders to make the change

In dealing with the first two—a lack of understanding and fear of the change—leaders can go a long way toward curbing this resistance by aggressively and effectively communicating the change and how it will be accomplished. The last one is a little tougher.  People are usually mistrustful of change because of a history of failed change initiatives in your organization or in others in which they have previously worked. With these people, you may have to find out why they believe previous efforts failed and get their input as to how they believe you can avoid those failures in the future.  So in all three cases, effective communication can be the key to success. 

Jones says that at the beginning point of the change process, leaders often struggle over how much information they should give out. The need to withhold some information at the beginning could be considered a valid argument, because this is usually the point where people have the most fear. However, Jones says that laying it all out on the table at the beginning is important because doing so brings more of a sense of reality to the change. I would add that the last thing people need when they are resisting change is an unexpected or unpleasant surprise in the middle of the process.

I would also recommend this at the beginning of a major change—start with the positives. Let’s say your goal is to decrease wait times and improve throughput in the emergency department. By doing this you can greatly improve the bottom line and patient satisfaction at the same time. This is a huge undertaking that requires everyone involved to move far out of their comfort zones for the sake of long-term improvement.

After announcing this change, a good place to start might be to meet with everyone and say: “What is working with our processes here in the ED? What are some of the good things that we’re doing right now to get patients to a doctor quickly, get their tests done and back right away, and get them admitted for the care they need or on their way back home with a prescription?” Give them some time. Maybe give them a few days or a week to go back and talk about it among themselves and then come back with a list.

Using this method, everything starts on a positive note and moves forward the same way from there. Once this information is fed in on the front end, then you can start talking about how things can be done even better, and you can talk more naturally and comfortably about what is not working so well. 

In environments of change, leaders sometimes make the mistake of trying to rid the environment of any resistance. Those who show initial resistance are often excluded from teams or given lesser responsibilities. Don’t be so quick to dismiss resistance. You don’t necessarily want your whole team of people blindly jumping off a cliff into the ocean with you. You might want a few of them standing on top of the cliff yelling “shark!” if there happen to be a couple of them in the water at the time.

Those who resist often do so because they are aware of some of the pitfalls of past efforts, and they know how to warn you where the sharks are. It can be very valuable to get their input into the change process, learn what they know about past failures and why they happened, and use that information to more effectively manage the change process. It can be a great way to involve them and make them feel more ownership for the effort, thereby easing their resistance. That being said, they still need to move past resisting the change, or eventually they will erode the entire effort, and that may mean you will have to remove them from the team at some point.

It’s important to realize that you as the leader are leading the change, but that managing the change is a huge undertaking that no single leader can accomplish. If you try to do it all yourself, you will fail. You need to complement your strengths with the abilities of others. For example, you may not be the greatest facilitator (I’d advise you to work on that), so you find someone in your organization who is a great facilitator and put that person on the team to help manage collaborative efforts in the change. The same goes for communication, which is key to the change process. You also need a great communicator to help manage the constant informational aspects of managing change, even if communication is one of your great strengths.

Finally, as the leader, you need to embody the change. If you decree that everyone will be communicating information via the intranet, then that’s how you must be communicating. If one of the requirements is that everyone at the end of each day write a one-sentence report about at least one thing they did to get us one step closer to the goal, your report should be the one they see first, and they need to see it every day.

As Mahatma Ghandi once said, “You must be the change you wish to see in the world.”

More about this in the next newsletter.

Betty Till

• Identify the opportunity

• Place a value on it in both organizational and human terms

• Determine the scope of the changes needed

• Develop a vision for the change

• Communicate that vision completely and give it a sense of urgency

• Form a core team and empower them to make decisions

• Accentuate the positive

• Use resistance to your advantage

• Constantly measure to improve performance

• Continuously communicate, reward and celebrate

• Institutionalize successful processes

• Never let the effort lag or die