Implementing Change

The CEO was thoughtful. “In my experience,” he said, “the three greatest barriers to performance improvement are culture, culture and culture.” His observation was absolutely on target.

As would-be change agents have learned—often at great cost—organizational culture ultimately determines whether or not performance improvement initiatives will be successful. Culture defines the work environment. The hospital can design the most efficient possible work processes, acquire the very best management information systems, and employ state-of-the-art medical technology, but unless the culture is prepared for change, improvement efforts will fall short. Management teams that must reduce costs and improve performance are immediately confronted with a daunting challenge that they will ignore only at their peril: how does one go about changing the organization’s culture?

Understanding Change Management

It is axiomatic that constructive change cannot be imposed from the top. The Dannemiller-Tyson change formula elegantly explains why this is true and points the way to successful change implementation.

The Change Formula:

C = V x D >R

Where:
C = Change
V = A positive vision for the future
D = Dissatisfaction with the status quo, and
R = Natural human resistance to change

If you have ever put forward a great idea only to have it rejected or ignored by the very people whom it would most benefit, you will appreciate the change formula. The formula says that constructive change will occur in an organization only when a positive vision for the future multiplied by dissatisfaction with the status quo (the relationship is not linear) is greater than the natural human resistance to change.

The hospital’s culture is defined by the beliefs of its governing body, executives, managers, staff and physicians; the assumptions upon which those beliefs are based; and the behaviors that rest upon those assumptions. Human beings are creatures of habit. Because established routines help us order our lives we naturally resist threats to those routines. By definition, cultural change requires large-scale modification of routine-based behavior. It may require re-evaluation of long held and deeply cherished beliefs. No matter how great an idea is, if the people who would be affected by it are reasonably satisfied with the current situation, they will not voluntarily change their routines. Conversely, no matter how dissatisfied people are with things as they are, unless and until they believe that change will materially improve their circumstances, they will not change either, preferring less than ideal conditions over the unknown.

Positioning for Healthcares Next Era

The ability to make and implement sound decisions quickly in a rapidly changing environment is critical to financial survival and mission success. The problem is that the traditional hospital organization and the culture it has fostered are utterly inadequate to deal with these emerging challenges and opportunities.

Clearly, health care providers must adapt by developing new structures and operating methods if they are to survive and prosper. What will tomorrow’s leading health care organizations look like?

• Governance – Boards will possess unprecedented sophistication on issues affecting reimbursement, ethics, technology, law, regulation and management. Board orientation and continuing education will assume increasing importance.
  
• Organizational Culture – The classic concentration on uncoordinated department agendas will be supplanted by a dynamic, synergistic hospital focus.
  
• Management – Department managers will function less like chief technicians and more like entrepreneurs. They will possess the mindset and training to perform in a new era of high expectations.
  
• Decision Support – Technology-savvy managers will routinely consume and act upon incredible quantities of financial and management information, including market intelligence and benchmarking data.
  
• Planning – Hospitals will operate from and manage against integrated results-focused business plans with a one-year time horizon.
  

Making this organizational transition has become “job one” for progressive governance and executive management teams and many hospitals have made significant progress. However, ultimate success requires a significant continuing organizational development effort. Successful change will occur only when a positive vision for the future and dissatisfaction with the status quo combine to overcome the natural human resistance to change.

How ready for the future is your hospital?

Can You Really Flex Staffing?

Many hospitals attempt to "flex" staffing; that is, department managers are encouraged to adjust employee work schedules to match workload. This often amounts to little more than cajoling employees to go home early during "low census" periods or when workload is light. The problem is that full-time employees expect to earn full-time pay, a reality that makes sending full-time people home a short-term tactic at best.

What is surprising is how few hospitals have explored the extent to which workforce structure ties department heads' hands and drives up labor costs. Here are steps that the hospital can take to facilitate real "flex" staffing that will reduce costs, optimize quality, and improve employee relations.

• Analyze department workload patterns by time of year, day of week, and by shift. Compare current workload patterns against current employee work schedules by job class. If the structure of today's employee work schedule was determined long ago, do the assumptions upon which it was based still hold?
• 
  To what extent does the department schedule its work? Many departments either do not attempt to do so or employ dysfunctional scheduling systems. Yet a fairly significant portion of most departments' workload could be scheduled. That is, it is either not "time critical" or can be done at times that would allow the department to schedule it to optimize use of department staff time, vastly improving department productivitiy.

• As a side note, evaluate routine day shift tasks (particularly clerical and other "paper work" tasks) that are not "time critical" to determine whether some or all of these could just as easily be done on other shifts, particularly shifts that may have a lot of "stand by" time. If there is no real operational reason not to do so, consider the effect on workload of redistributing some or all of these tasks to other shifts.

• 
  Start with the assumption that employees who are hired to work full-time deserve to work full-time. Based on your analysis of workload patterns, what is the optimum mix of full-time to part-time employees by job class on each shift? Let's call that optimum mix your "target staffing structure."


• 
  Now, how does your "target staffing structure" compare to the current staffing structure? Develop a plan to get from where you are to where you should be. Take into account the realities of the labor market but don't let labor market difficulties prevent you from developing a plan and working toward it.


• 
  Develop staffing matrices that project required staffing by job class to match observed workload patterns by time of year, day of week, and shift. Identify "trigger points" (changes in workload) that will prompt management action to consider sending part-time employees home or bringing part-time employees in. Remember that staffing matrices are a tool designed to augment, not over-ride, professional judgment.

Effective scheduling of work and staff can produce productivity gains in the range of twenty to twenty-five percent. This is an opportunity that should be aggressively pursued by every department manager.

About Us

We provide decision support benchmarks and change management assistance to hospitals

More than 600 U.S. hospitals of all sizes, missions, and ownership types throughout the U.S. as well as major medical centers in Europe and the Middle East have relied upon Brady & Associates for decision support benchmarks and change management ssistance.

We are resources to the American Hospital Association (AHA) and to the Healthcare Financial Management Association (HFMA). We serve as consultants to consultants and have worked with The McKinsey Group, The Lewin Group, and other internationally-recognized firms.

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