In today’s economic and healthcare environments, managers face unprecedented challenges and uncertainty. This changing landscape was summed up by Nathan Kaufman in a recent article titled Changing Economics in an Era of Healthcare Reform.Kaufman (2011) noted that few organizations have the expertise to implement the changes required by current economic trends combined with the impact of healthcare reform. Due to current demands to redesign the overall U.S. health delivery system, the competencies (i.e., specific knowledge, skills, and abilities) required for tomorrow’s healthcare leaders will need to be reassessed. The question posited is, “for the future, which competency area(s) will healthcare managers need to excel to successful lead their organizations?
To meet the challenges of healthcare reform, many leaders will need to focus on developing their organizations into innovative, cost-effective, integrated systems. This will require exceptional change management skills since most organizational change efforts will be met with resistance. Kotter (1995) identified eight steps for managers to follow for successful organizational change:
1. Establish a Sense of Urgency: Management needs to establish a sense of urgency about the required change by examining market and competitive realities and discussing crises, potential crises, or major opportunities.
2. Create a Powerful Guiding Coalition: Management needs to create a powerful guiding coalition/group (including non C-suite members) that spans both the functions and levels of the organization.
3. Develop a Vision: Management must create a vision to direct the change effort and develop strategies for achieving that vision.
4. Communicate the Vision: Management must use every vehicle possible to communicate the new vision and strategies, including teaching new behaviors by examples from the guiding coalition.
5. Empower Others to Act on the Vision: Management must eliminate barriers to change and encourage risk taking and creative problem solving for changing systems or structures that undermine the vision.
6. Plan for and Create Short-term Wins: Management should plan for visible performance improvements including recognizing/awarding employees involved in the improvements.
7. Consolidate Improvements and Produce More Change: Management should use the credibility achieved by short-term wins to create more change. This may include hiring, promoting, and developing employees who can implement the vision and reinvigorate the process as change agents for new projects.
8. Institutionalize New Approaches: Management must reinforce changes by highlighting connections between new behaviors and organizational success, including ensuring leadership development and succession.
Many entities are successfully implementing change management to transform their organizations in delivering high-quality patient care. VanDeusen Lukas et al. (2007) examined twelve high-performing healthcare systems and identified five interactive elements critical for the successful transformation of a healthcare organization:
1. Strong impetus to change – Impetus to change can be external or internal to the organization. In most cases, external pressures are the strongest (i.e., political, IOM reports, declining reimbursement, etc.)
2. Leadership commitment to quality – Leadership is critical for organizational transformation. Leaders must demonstrate authentic passion for and commitment to quality and steer the change through the organization’s structures and processes to maintain urgency, set a consistent direction, reinforce expectations, and provide resources and accountability to support the change.
3. Improvement initiatives that actively engage staff in meaningful problem solving – Improvement initiatives must actively engage staff across disciplines and hierarchical levels in problem solving around objective, meaningful, urgent problems (i.e., surgical infections). These initiatives, such as, clinical redesign and improved operations, must be built into routine workflows that are more visible, reliable and efficient.
4. Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization – Changes must be aligned with the organizational mission and strategic direction, and consistent with plans, processes, information, resource decisions, results and analysis to support key organization-wide goals.
5. Integration to bridge traditional intraorganizational boundaries among individual components – For success, change initiatives must be integrated across intraorganizational boundaries to improve coordination and continuity of care (i.e., patient flow, case management, EHRs). Extensive integration is needed to breakdown departmental silos so that the system operates as a fully interconnected unit to support organization-wide goals.
The primary objective of change is to ensure the future competitive sustainability of an organization. For successful implementation, healthcare managers need to take into consideration the various barriers that will create resistance to the required change. Successful healthcare managers need to develop exceptional change management skills so they may develop their organization’s capacity to adapt and change to environmental needs.
