Following a proven path to success

Physician Executive, May-June, 2005 by Edward J. O'Connor, C. Marlena Fiol

If you leave one component out of a chemical process, you are likely to get a different result than the one you anticipate.

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If you leave a step out of a healing process, such as rehabilitation, you are also likely to get a different result than the one you desire.

Similarly, if you leave a key component out of a change process, you will typically get outcomes that are different than the ones you hope for.

As noted in a prior edition of this column, change is difficult and failure rates for change initiatives are high, often exceeding 65 percent. (2) Health care is no exception, and the cost of unsuccessful initiatives--such as patient safety, physician relations, new information technology--may well be beyond our ability to pay in either dollars or lives.

While there is no single right approach to tackling change, following a systematic, sequential process developed by others who have effectively traveled through similar territory increases your likelihood of success. Attention to three components is essential.

1. Energizers -- Where you are going and why?

2. Barriers -- Who and what are blocking your progress?

3. Action steps -- When and how you will move forward? (3)

Energizers

Planes, trains, and ships all have a familiar inertia when they are at rest. An energy source is required to begin their forward motion. The same is true of organizations moving into change.

The energetic support for taking future, often unpopular, actions is built throughout this phase (where and why). People develop a sense of increased urgency, a change team starts to effectively work together, a vision is clarified and communicated and people begin to demonstrate behaviors that show buy-in. (4)

Barriers

Just as water resistance increases as ships begin to move forward, individual and organizational barriers (who and what)--in the form of non-supportive people, systems and structures--also become more evident as leaders begin to move toward their objectives. Identifying, altering or removing barriers is important to communicating a leader's commitment to change as well as making it easier for those who are energized to shift their behavior. Generating visible short-term wins to diffuse cynicism, reduce pessimism, and confront skepticism is important to building momentum during this phase. (4) Relying on the energized support developed in earlier phases, leaders can begin to take the actions required to change systems and structures to facilitate movement toward their desired vision. (5)

Action steps

As currents press upon a moving ship, steering adjustments may be necessary to maintain a desired course. Likewise, as organizational barriers become evident, plans for when and how to make adjustments to remain on course must be developed and redeveloped on an ongoing basis.

It is important to create wave after wave of action to maintain hard-won momentum while confronting difficult implementation issues. Ensuring that people continue to act in new ways despite the natural pull to return to "tried-and-true" is important to consolidating gains while solidifying the new foundation for future actions. (4)

This is the time to build a culture that supports desired results through further changes in policies, systems, structures, and people. (5)

Researchers and practitioners have identified several components that distinguish change leadership success and failure. (6,3) An overview of these is presented in Figure 1.

Have these components been consistently in place during change initiatives in your health care organization?

The change process goes through a series of stages. Skipping stages
creates only the illusion of speed and never produces a satisfying
result.
--John Kotter, 19961

Figure 1: Characteristics that Separate Winners from Losers

Describe your organization's change initiatives using the following
statements.
Answer each question on a scale ranging from Never (1) to Always (5).

Leaders effectively Energized support by developing and communicating:
__ WHERE each change is designed to take the organization.
__ WHY each change is important.

Leaders effectively identified and addressed Barriers blocking progress,
including:
__ WHO will resist each change and the actions that will be taken to
   minimize negative consequences.
__ WHAT systems and structures exist that block change and the actions
   to be taken to alter their impact.

Leaders effectively implemented Action Steps to move forward,
clarifying:
__ WHEN the change initiative will begin and end, as well as the pace of
   the planned transition process.
__ HOW strategies and tactics will be implemented toachieve desired
   results.

How does your organization look when compared with this list of winning
practices? If some, but not all, of these components are in place,
results are likely to be inconsistent and the process of change highly
frustrating to many of your people.
  Giving people clarity about Where they are going and Why provides a
basis for getting people moving in support of the outcomes of a change
initiative. Under pressure for rapid results, however, leaders often
focus on barriers and action steps before energizers are effectively
addressed, leading to little progress, many meetings and fruitless,
repetitive discussions of the same topics--over and over.
  Once people are energized and interested, discussions of What and Who
must change are more likely to be successful. Lastly, developing,
implementing, and altering a plan regarding When and How steps will be
taken to carry out a transition provide the relentless waves of action
required for reliable results.
  Each of these critical change components that separate winners and
losers will be described more fully in future editions of this column.
In addition, examples and questions will be provided to assist you in
applying these materials in your organization.