BY JOSH MATHIS
Two doctors at Great Ormond Street Hospital for Children (GOSH) in London were watching television during a break when they saw Formula One racing crews change a tire in a matter of moments.
The hospital had been struggling with high mortality rates during surgical handovers, and it occurred to the two physicians that there had to be something they could learn from the pit crew’s seamless interactions. What was their method? How were they able to work so quickly and collaboratively? More importantly, how could the doctors institute similar concepts into their handovers from surgery to intensive care?
The GOSH doctors visited and observed the pit crew handoff in person, learning process mapping, process description, and task delegation. Reinventing this handoff, they reduced errors at the hospital by more than 40 percent. In doing so, these leaders at GOSH set their organization apart in an industry better known for its intractability in the face of change.
Long-shielded from market forces by legislation and regulation, healthcare is ripe for innovation. With new entrants disrupting the industry with radically different business models, it will need to adapt to survive. ZoomCare, for example, takes a consumer-centric approach that utilizes a flat-fee model and leverages mobile technology for everything from appointment scheduling to accessing lab results. Other models competing with traditional healthcare industry players include venture firms and health plans, which are investing in organizations such as Iora Health and Qliance, and onsite workplace clinics.
Change is uncomfortable. It can be awkward and it can create serious damage if done incorrectly — which is often the case.
Shift within an organization, while challenging, can be transformative if driven by committed individuals and unyielding leadership support. To move a healthcare organization successfully toward an improved future, change leaders should focus their efforts on five key tactics: 1) start from the top; 2) understand the goal; 3) set the stage for input; 4) effectively look for solutions; and 5) ensure a smooth handover to operations.
Start from the Top (It’s Not Necessarily the Executive Team)
When Aetna was struggling in the early 2000s, one of CEO John Rowe’s earliest and most important networking efforts was to identify a core group of “key influencers”—potential leaders who could offer insight regardless of their level in the hierarchy. Rowe began with about 25 influencers and within a few months had expanded the group to nearly 100. These conversations helped Rowe rethink his approach to the company’s successful turnaround – between May 2001 and January 2006, Aetna’s stock price rose steadily, from $5.84 (split adjusted) to $48.40 a share.
It’s common for change management theories to focus on executive buy-in as a critical component in getting momentum behind any major initiative. In healthcare, however, more so than in many other industries, leadership isn’t always concentrated in the executive team. Key medical staff, such as physicians and nurse managers, are likely to be the key drivers of change in this setting, as or even more important than the CEO.
Leadership rarely thinks as a single unit, though. It’s helpful to identify the thought leaders both within this group and outside of it. There’s a good chance that there is someone who has been thinking about the need for change, and possible solutions, longer than you have. It might be someone who has seen this type of change happen at another hospital, someone who has been following the latest thinking on the subject, or both. These thought leaders can help not only inform your efforts but also influence others within the healthcare organization – a critical component of effecting lasting change.
Understand the Goal (There is No Single Solution)
Organizational change is generally a change in process, behavior or both. To facilitate, the goal must be clear. Break it down into its most basic parts. Identify who is involved. What feeds into the process? What is expected?
Hospitals – and organizations outside the industry as well – too often fall into the trap of thinking there’s a single solution. In reality, change is more likely to involve little steps, each of which are a part of the larger system. What’s more, each change is going to have a corresponding effect on something else in the system.
Transition in healthcare is also hampered by a common misperception that changes need to happen on the processes that have been identified within the system. Just as often, it’s connectors between the points along the patient process that need to be changed, as the physicians at GOSH found. Mapping existing processes or diagramming the system that’s changing can help eliminate assumptions and provide a full picture of what is going on.
As a change manager, consider witnessing and participating in what’s happening in the organization as much as possible, legally and ethically. This firsthand experience will allow you to deepen your understanding of the situation and build credibility with the teams doing the work. It also will provide you with real-world examples and stories that are critical tools in helping you influence and inspire people to act.
Set the Stage for Input (Create a Safe Environment)
When Rowe was leading wholesale change at Aetna 15 years ago, the organization conducted a series of “safe space” discussions with thoughtful people at different levels of the company to learn what behaviors were most affected by the current culture, both positively and negatively.
These types of safe discussions can be as simple as a weekly team meeting to identify issues, devise solutions and create plans. Because hospital workers are in a very stressful, fast-paced and unforgiving environment, it’s not uncommon for these discussions to be marked by passion and emotion. Setting and sticking to ground rules can help focus this intensity.
Look for Solutions (Turn Inward and Outward)
When identifying possible solutions, a good place to start is to ask the boots-on-the–ground folks what is keeping them from being able to accomplish the goal in front of them. Looking at other hospitals too will allow you to identify the gold standard within the industry. It also allows a change manager to avoid repeating others’ mistakes – a simple phone call to the administrator can reveal what worked for that facility and the pitfalls to avoid.
Consider also looking outside of healthcare for benchmarks, like the doctors from GOSH did. In a similar vein, Gene Lindsey, former president and CEO of Harvard Vanguard Medical Associates and Atrius Health, told Forbes that the healthcare industry should look to carmakers’ use of lean process management: “This is what saved the automotive industry – allowing them to create better cars and manage suppliers more efficiently and minimize waste,” he said. “The healthcare industry can learn from these same techniques and thought processes.”
Ensure a Smooth Handover (Don’t Overlook the Transition to Operations)
Change managers in the healthcare setting often underestimate the importance of setting up successors to serve as operational leaders of the work. By teaching these key people the tactics above, and the measurement and communication tools they will need to keep the momentum going, you can greatly increase the chance that your change initiatives will succeed.
Healthcare doesn’t have to be a dinosaur. More so than ever before, change in healthcare is possible – not to mention necessary, if hospitals and clinics want to stay competitive in a changing industry. Whatever your role within the organization, be open to change, because it’s time. By taking a fresh look at your organization, you can effectively manage transition and foster true innovation in healthcare.
Insightful and direct, you can count on Josh Mathis to quickly get to the essence of a problem. With a talent for finding the best ideas and the sharpest minds in any organization–and encouraging them to work together to examine the issues at hand–he won’t hesitate to champion a course of action once he’s positive it’s the best path forward. Whether solving a business challenge or converting a basement into an accessory dwelling unit, Josh does not stop until he is moving in the right direction, even if it means doing things differently than they’ve been done before.