The Australian healthcare industry is always in a state of change.
This year alone we are likely to see major changes to Primary healthcare, Medicare rebates, private health insurance, prescription medicine payments, mental health care and electronic health records. Add to that the opening of new facilities across the country, mergers and organisational restructures, models of care changes and the introduction of new technologies.
This level of change can feel overwhelming for consumers and employees alike.
When change occurs in a Health Care setting there is an imperative to continue to provide quality care or quickly return to the provision of this care with little to no downtime or the chance to deal with the normal emotional reactions of human transition and the expected and emerging challenges that change creates.
So how do our essential healthcare staff cope and how can we help them manage with the ongoing change happening within the industry?
Over ten years of Organisational Change in Healthcare has provided me with some insight into the key ingredients that promote effective human transition in times of significant change within the healthcare system.
Here are my learnings:
1. Provide support for people transitioning through times of change
‘Transition is the state that change puts people into. The change is external (the different policy, practice, or structure that the leader is trying to bring about), while transition is internal (a psychological reorientation that people have to go through before the change can work).’ Quote from William Bridges.
Without people (employees), the system that provides Healthcare can’t exist… therefore change in healthcare is also not possible without actively engaging our healthcare employees.
Ensuring that change plans incorporate a dedicated focus on human transition is fundamental. These plans must include overt strategies to raise awareness and normalise the emotional reactions and challenges people experience in times of change.
The change itself is not the hardest piece – it’s the human transition that creates the largest need for support before, during and after the change has occurred in the workplace. William Bridges in his transition model talks about the need to let go of the old and the associated grief that often results. The impact of the grieving process is often underestimated as people move away from what they know through an often ambiguous and emerging change process to re-establish themselves in the new context.
2. Patients and families are often grieving as well
It is important to acknowledge that patients and families are also impacted by healthcare changes. How patients and families access healthcare when there is significant organisational change can mean that they are experiencing some sense of loss and the associated emotional responses. How, when and where they access services will often change while they are already overwhelmed with their own/family health concerns. This leads to a range of reactions that are intensified in times of change and are regularly experienced by frontline staff in healthcare settings.
Raising staff awareness of their own reaction through change and transition has parallel applications to patients and families who are going through change.
Customer service skills and building staff capability to de-escalate and manage customer aggression are core skills in any context but it is important to boost or revisit these skills when there are changes that will impact patients and their loved ones.
What to do:
- Increase awareness of the psychological process of change and transition for employees
- Build or revisit customer service, de-escalation and customer aggression capability especially in front line staff.
3. Inclusive access to support throughout the Healthcare System
If there is a gap in the support required to assist employees transition through change, the system will be impacted. For example, Administration and Operational Services are going through the same psychological process of human transition as the clinical staff. If there is a breakdown in effective functioning through a lack of support it will impact the systemic nature of healthcare provision and impact on patient care, experience and often the reputation of the service.
What to do:
- Ensure the provision of support mechanisms are available and accessible throughout the workforce.
4. The leadership capabilities of people managers are imperative in times of change
As a people manager (Team Leaders, Supervisors, Directors and Executives) the ability to support staff in holistic ways to achieve individually and collectively is fundamental in the workplace to reach high performance.
In times of change, the impacts of human transition on the emotional and psychosocial wellbeing of staff is heightened. Managers are often required to lead staff through the transition journey whilst experiencing the emotional turmoil of the change themselves. People managers benefit from both group and individual coaching when it comes to leading through change. They also require foundational leadership and management capability, including how to set and hold teams to behavioural expectations, reframe negative thinking and coach staff through challenging times.
Leaders need a safe space to make sense of the changes for themselves in order to position the changes in cohesive, positive, meaningful and healthy ways for their staff and the organisation more broadly.
What to do:
- Provide coaching for people managers to help them effectively lead their team through change.
5. Have the conversations that matter
What we permit we promote. Change is an opportunity to define and shift towards the culture required for the provision of great healthcare. What often happens is that the need for getting outcomes and results in the new context is all-consuming and unacceptable behaviours can go by unaddressed. The unintended consequence of this is that unhelpful behaviours can establish as acceptable due to busyness diverting managers away from addressing them.
What to do:
- Provide Leaders with capability in a strength based approach – coaching for high performance and building the skills and confidence to have the conversations that matter in a timely manner.
6. Lateral integration
An amplified focus on our own area of responsibility in times of change is required, especially with the imperative of quality care. This can inadvertently reinforce silos, increase rework, inhibit the sharing of learnings and create disconnects in the healthcare system.
It is really worthwhile thinking about how to purposely focus leaders on integrating laterally as leadership teams at all levels of the healthcare system. This will increase connectivity, create peer support and learning opportunities, and increase the likelihood of providing employees with cohesive messaging in times of change.
What to do:
- Purposefully create lateral leadership networks to keep sight of the systemic nature of healthcare
- Provide regular connection opportunities for leaders to establish both multidisciplinary and professionally specific ‘leadership teams’
- Regular leadership meetings in times of change to determine cohesive key messages and identify emerging needs is essential.
7. All hands on deck
A healthcare system requires people focusing on and working at strategic, tactical and operational levels. What can happen at times of significant change, when there is a very real demand for operational quality, is that leaders throughout the system of care spend lengthy periods of time diving into operational mode. Spending excessive time assisting operationally can become an expectation and then quickly become the norm.
The risk of this occurring post change implementation is that leaders are not functioning at the level required of their position nor delegating to raise the level of staff to enable appropriate tactical and strategic functioning.
What to do:
- Ensure leaders have an awareness of the need to work at the strategic and tactical level for the majority of the time
- Ensure that leaders have the skills to delegate effectively and manage expectations.
8. Provide foundations to effectively develop new teams
Teams take time to develop and the pressure of new membership and different working environments and processes can manifest in less than positive team behaviours if left to occur organically.
As newly formed groups change from being a collection of strangers to a united group with common goals there are identifiable stages. Bruce Tuckman’s Forming, Storming, Norming, and Performing model describes these stages.
Understanding these phases can help leaders and team members more efficiently reach required performance levels. Including team members in strategies to fast track the stages of team development is a critical investment when considering new teams in a Healthcare environment.
What to do:
- Include team members in processes dedicated to accelerate healthy team development and provide the scaffolding for successful and speedy return to high performance
- Communicate expectations and ensure agreement and commitment around workplace behaviours that will assist team development in a healthy trajectory.
9. Public confidence and reputational risk
The majority of healthcare happens in public and is observable. Examples include the admin staff who haven’t had a break and are navigating through new systems requiring expert customer service skills with distressed patients, parents and loved ones and nursing staff who are having a chat in the corridor (or even to a patient or family member) about how unpredictable the staff in pharmacy are. Healthcare workers interactions are often observable and have a direct impact on consumer confidence and service reputation
Encourage employees to be aware that they are representing the broader healthcare system that they work within. Divisive language that pits one service against another is not acceptable from an employee perspective but completely intolerable when done in front of patients and loved ones as it raises doubt in the minds of people at often incredibly vulnerable times. All the little ‘plus ones’ make a difference. Each individual’s behaviour in the workplace contributes to how the patient experiences the provision of healthcare especially in times of change.
What to do:
- Promote awareness of the significance of language and behaviours in the healthcare setting that have potential impacts on reputation and confidence
- Provide support mechanisms where health workers can discuss and synthesise change outside of the patient care environment.
10. The political media magnet that is healthcare
The impact of the media in healthcare can be a distraction that defers energy from the core purpose of high quality care. Senior staff in healthcare can be required to spend time responding to negative media campaigns that could be utilised elsewhere to better effect. Negative media also impacts the morale of amazing staff who are going above and beyond for their patients and colleagues
What to do:
- Educate staff on the media and the expectation that there will be a focus on the negative when opening a new facility or implementing a politically driven change
- Educate and build resilience in staff to manage their own reactions to the media as well as having appropriate scripts or responses to the public reaction fuelled by potentially skewed reporting
- Raise awareness of staff that their workplace behaviour and the language they use at work does have impacts and consequences.
11. The perceived inequity of attention, resources and funding
Organisational change in healthcare does not happen in a vacuum. When there is change in one area it usually impacts others. Within a Local Health District or Hospital and Health Service the opening of a new facility will impact other facilities and community or primary health services.
Perceptions of employees in services that aren’t part of a new facility opening is that they are missing out again. It is not uncommon to hear staff outside the larger centres within a geographic area to refer to themselves as being ‘poor cousins’. This can inadvertently be reinforced if there is a new facility or a large investment in the opening of a new service.
What to do:
- Offer organisation wide change capability development when rolling out change in one area. The organisation will benefit and so with the patients and the reputation.
Change often amplifies the people and culture challenges in any organisation. We cannot underestimate the increasing demand on the critical role of leadership in guiding employees through change in a health context.
Change also represents an opportunity to reset the cultural expectations of an organisation and overtly define the expectations of the people who collectively create the culture that will enable positive workplace engagement and in turn quality care and patient experience.
Proactively building leadership capability, designing strategies for engaging staff through change and purposefully building teams that are set up to contribute to a positive culture and high performance is not a nice to have in Healthcare change. It is essential.
