Getting the People Part of Change Management Right
by Craig Deao, MHA, senior leader and national speaker, Studer Group and David Marshall, managing director, Huron
I can’t do all that patient experience stuff!” nurses sometimes say when leaders try to engage them in improving the patient experience. They think it’s fluffy stuff…stuff they don’t have time to deliver on.
In an age when the healthcare industry has engineered world-class clinical solutions with complicated healthcare robotics and transformed the flow of medical information through widespread adoption of digital medical records, the people part of care delivery remains elusive.
Other Industries Excel at High Reliability
And yet, nearly every other high-risk industry—from oil/gas and nuclear power to commercial aviation and the military—have successfully adopted high reliability strategies to dramatically improve operational efficiency, quality, and safety. They too function in high-risk, high-stress conditions under extreme time pressures, face a complex regulatory framework with economic pressures, and need to operate at high capacity during peak demand.
If the problem is that to err is human, how can we design processes and collaboration among healthcare teams that are harm-free? Imagine the possibilities if we could hardwire zero patient harm and medication errors through reliable systems to prevent, intercept, and mitigate the harm that human error causes.
What if we could also use the same skillset to reduce any variation in human behavior for consistently excellent results in things as diverse as HCAHPS performance across different nursing units or monthly revenue collection? Wouldn’t we face fewer unplanned readmissions if we explained medication side effects to every patient every time? The principles of high reliability apply to all of our goals across the organization.
High Reliability Defined
High reliability is the science of achieving efficient, error-free operation. That means that a High Reliability Organization (HRO) is an organization with predictable and repeatable systems in place that allows for the consistent execution of operations while catching and correcting potentially catastrophic errors.
It’s all about reducing variability. When it comes to clinical variation management, the goal is to decrease unwarranted variation in the delivery of care while improving clinical results and reducing costs. To achieve that, organizations must stop chasing averages and focus instead on variations. An HRO is focused at every level on creating predictability and process consistency.
Without a dedicated and reliable process improvement engine, organizations will continue to achieve average results…at best. A culture of excellence and high reliability includes a strategic commitment to continuously strive toward predictable, repeatable behaviors and reliable, consistent processes.
A Successful Change Formula
The reality is that across the healthcare spectrum, more than 70 percent of change and transformation initiatives fail. Why? For starters, 80 percent of the work in managing successful process improvement has nothing to do with tools and everything to do with perceptions. There’s a slow drift away from the norm towards catastrophic failure with workarounds, short cuts, and organizational pressure…especially when workers feel forced to make decisions without support from leaders.
So what works to ensure that front-line staff consistently embrace the agreed-upon process…even during a busy shift? It’s a comprehensive approach to high reliability that includes: (1) a shared vision; (2) skills and training; (3) incentives; (4) resources for support; and (5) required action. The absence of any one of these five ingredients puts lasting change in jeopardy.
The Engine for High Reliability
At the heart of a successful HRO strategy is a solid foundation of leadership development and accountability. Studer Group’s Evidence-Based Leadership provides the foundation by modeling, creating, and sustaining a culture where alignment, accountability, and standardization are at the very heart of the organization’s high reliability journey. In essence, it provides the “chassis” to bolt on specific HRO initiatives.
Because goals cascade to every level and department, high reliability no longer risks becoming a project on the quality side of the house. So many efforts at high reliability in healthcare have failed because they focused on process improvement—like Lean or Six Sigma—at the expense of examining the habits of people who need to implement such processes when time or staff are in short supply. Conversely, Evidence-Based Leadership systematizes process improvements through goals and skill-building to address variation through role modeling to sustain consistency over time.
Engagement Is Essential
Leader, clinician, and employee engagement are also critical. As noted in Craig Deao’s recent book The E-Factor: How Engaged Patients, Clinicians, Leaders, and Employees Will Transform Healthcare, the research confirms the importance of unlocking the team’s potential and building the capacity of front-line staff in the high reliability journey.
When you engage your team, you build efficacy and self-confidence in speaking up. Likewise, engaged leaders have an important role to play in supporting the team through continually improving processes and ensuring sufficient resources to deploy to provide excellent care without exception.
In the end, high reliability is about providing the kind of care we would demand for each of our own family members. Healthcare needs to restore trust that we will get it right for every individual every time…just as we trust that when our plane drops during turbulence at high altitudes, the odds of something bad happening are almost non-existent.
The good news is this: There are already HRO trailblazers succeeding in our industry today. High reliability is increasingly well understood and efficient to apply. It’s a great time to embark on the journey.