Tag Archives: change

Healthcare Reform: Culture and People

I love to talk about organization culture and leadership. What I like even more than talking about it is working on it. In my experience, they are inseparable. You cannot change one without simultaneously working on the other. What happens when we are talking about changing the culture of an entire industry?

Healthcare Finance Management Association (HFMA)

One of the best conversations I’ve had in a long time about culture and leadership took place last week. I was interviewed by researchers from HFMA and McManis Consulting about the Value Project.

HFMA is in its second phase of an ambitious effort to help healthcare organizations prepare for the monumental changes that are occurring in (or, “to”) the industry. The result of this research will be a series of recommendations and road maps to help healthcare organizations navigate the structure, reimbursement, and organizational changes that will be required as a result of healthcare reform. In the end, healthcare organizations are going to have to change, and deliver more value to their patients and their communities.

What I found interesting is that I was one of few Chief HR Officers to be interviewed in this project to date. I’m glad that I was given the opportunity, and I had a few suggestions and opinions to share regarding the project’s focus on “Culture and People.”

Managing Conflict

After a robust, high-energy, and 75-minute conversation, one of the researchers summed up my “radical” rant like this: ”Building the culture to drive this change must include building the leadership capacity to manage conflict.” My response was, “Yes!” I’ll take it one step further: this work is going to require healthcare leaders who thrive in a world of continuous conflict.

Change is Not a Program

One mistake that we often make in leadership and organization development is that we try to reduce the change work that we need to accomplish into neatly defined programs and initiatives. We develop strategies, timelines, and metrics to fit into our strategic plans and organization dashboards. Trying to codify change elements into concrete business deliverables sometimes comes at the cost of really understanding the human side of change. It is difficult to plot the steps of behavioral evolution onto Gantt charts.

Radical change will always be rooted in messy and emotional people issues. Conflict is inherent in change work. But, it is in this conflict where human innovation, strength, and diversity lie. The answers to our problems will be found in the conflict and debate that hasn’t yet occurred. Leadership is about creating this conflict where it doesn’t exist, and effectively leading people to contribute where it does. Change is not a program, it is a set of relationships and social structures. Changing an organization, or an industry is a contact sport.

Back to Reality

As much as I like to debate theoretical constructs, it still comes down to the day-to-day actions of leaders to move their organizations (or industry) through change. Here were a couple of my recommendations about the Value Project:

Involve more CHROs in the research. There are some smart, radical, and strategic thinkers in the HR profession and the industry;
Do not underestimate the importance of organization development and social science research on change. The real work of healthcare reform lies with the people who are providing care to our communities; and,
Challenge traditional business logic and assumptions. As one of my colleagues often says, “Rearranging the deck chairs on the Titanic will not change the outcome.” Focusing exclusively on re-aligning the financial incentives and payment systems will not in itself drive the behavioral changes necessary to create value in our country’s healthcare system.

What are your thoughts about healthcare reform, and the people side of the change necessary to address it?

It’s Not You, It’s Me

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Before you dive into this post, I want you to pause and place your fuzzy, warm thinking cap squarely on top of your melon. Think about the most pathetic breakup line you’ve ever heard? Perhaps it is a line that YOU have used to end an intimate relationship? A line that boggles my mind is the proverbial, “It’s not you, it’s me.”

Now think about the most pathetic breakup line you’ve heard in an employee-employer breakup. Please tell me that it is not one of your’s. The most pathetic termination line I’ve heard of – outside of anything discriminatory – is, “we are going in a different direction, and your services are no longer required.”

Photo Courtesy of nuttakit

In either case, the breakup lines say absolutely nothing! We’ve ended relationships with people who have been an important part of our lives/organizations, yet have managed to give them no feedback, reasoning, rationale, or explanation for our decision. In a word, this is “cowardice.” But, what if it is true?

Employer Breakups are Easier to Do

When the decision to end an employment relationship is our’s as employees, we tend to sing a different song. How many disgruntled employees do you know who have written, “it’s not the company, it’s me” in their bitter letters of resignation? When we leave a job, particularly out of anger or frustration, we almost always put the blame squarely on our employers. In fact, we are quite effective at rationalizing why the sour relationship wasn’t our fault. It is clearly ________’s fault.

The Grass Isn’t Any Greener Over There

I have hit the wall a few times in my career. These are times when I become profoundly frustrated by my inability to get things accomplished. While I am as happy as anyone with swimming in abstract ideas, and visioning grand plans to solve employee engagement issues forever, in the end I need results – that’s what I get paid to deliver. I always expect to accomplish that which I set out to do. I take pride in delivering measurable organizational results. And, when I am unable to deliver results, I become frustrated.

Like many, I have been quick to blame others for the barriers and resistance that have prevented me from achieving my goals, and initiatives. I have broken up with employers. The funny thing is that given enough time, the same frustrations inevitably appear in subsequent roles.

Hindsight is Always 20/20

The common theme in my times of frustration is that they occurred during times of change. Conspicuous organizational changes (e.g., mergers, CEO changes, organizational structure redesigns) have always precipitated my periods of frustration. I’ve blamed organizations, leaders and colleagues for creating these unnecessary barriers. I am a master of narrating elaborate stories to justify my vilification of these good people – privately, of course.

What if my frustration had less to do with outside changes, and more to do with my inability, or unwillingness to change my leadership approaches to achieve results in a new environment?

That Question Just Sucks!

What if it really isn’t them, and it is me? Simply asking a different question forces our brains to search for a different answer. If it is done honestly, we sometimes won’t like the alternative answers that we realize. I’ve learned that just because I am an HR leader, experienced in organization change, and knowledgeable about helping others through change, it doesn’t mean that I am personally exempt from the same change experiences. I now understand that many of the times I have blamed organizational dynamics for my woes, it was really about me.

I would love to hear some of your best breakup lines!

Photo Credit: nuttakit at freeddigitalphotos (dot) net

HR Antiques Road Show

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If you are a history buff, or just a hoarder, then you might be a fan of the Antiques Road Show on Public Television. While I’m sure that many of you are familiar with the program, the premise is as follows: the show brings together a variety of experts to a single location where locals can have anything they own appraised, from attic-junk to family heirlooms. Every once in awhile you see a person who made a five-dollar purchase at a garge sale years before with an item that appraises at tens-of-thousands of dollars. Of course, virtually every item that is brought to the Road Show has personal value to the owner; the question is whether that value translates to monetary value for others.

Healthcare Value Network

I spent a couple of days last week in Appleton, Wisconsin with 17 other healthcare HR leaders to learn and share how HR systems and processes can drive real change in a Lean organization. The only things we knew going into the session is that our organizations were part of the Healthcare Value Network, and through some pre-planning we surmised that we were all struggling with similar HR, organization development, and leadership challenges. Our brief time together confirmed these assumptions.

I left the land of the Green Bay Packers with a bag of cheese curds, and a number of key takeaways. However, there is one simple concept – although not a new concept – that has stuck with me more than others: The development of HR systems and processes in a Lean organization occurs in the Gemba, and not in an HR conference room. In non-Lean language, we need to develop our HR approaches with our clinical (operations) leaders and employees. In the end, our work must be redesigned to support what is really needed on the rapidly changing front lines of healthcare.

Get Out of the HR Attic

Our traditional approach to HR administration is that we have done the bulk of our process work and planning behind closed doors, or in the attic. We are the experts in regulatory and compliance matters, organization development constructs, and we have the unrivaled talent to create reams of forms. When we were feeling more “strategic,” we might have included, or sought real input from others outside of the HR kingdom.

When our new systems were defined, and the ink was dry on the new forms, we took the process/system on the business version of the Antiques Road Show. What we often discovered was that the heirloom-quality HR process that we had masterfully created was appraised by operational leaders (experts) to be of little or no value to them, or the work that they were doing. It was easy to become that person on camera at the end of the Antiques Road Show who whined about how unappreciated our process was – at least it was highly valued by us, and we are going to hang onto it.

Strategic HR: Solving Other People’s Real Problems

Strategic HR today, particularly in a Lean sense, means that we are solving our customers’ problems through the ongoing, real-time design of better HR processes and systems. By better I mean: they are intentionally designed to add value to clinical (operational) people and processes, as their needs evolve; they are not mired in meeting the strictest interpretations of government regulations; they are not derailed by an unreasonable aversion to business risk; and, they accomplish what is most needed by the people in the Gemba, and ultimately our customers.

It seems that the only way to accomplish the strategic work of HR in a Lean organization is to design it with the people in the Gemba. So while the “what” is settled in my mind, and the minds of many other Lean healthcare HR leaders, the “how” is an entirely different challenge.

What have you done to engage your operations leaders in redesigning HR systems to meet their needs?

[Photo Credit: anankkml via freedigitalphoto.net]

Transformational Change Management and Organizational Culture

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This is a guest post by Maryanne Wanca-Thibault, Ph.D. Maryanne is an organization development and leadership strategist, and an executive coach. She uses a communication-based methodology to help her clients effectively navigate the complexities of change and align business strategy, culture, structure, and people with change initiatives. You can contact Maryanne at her website www.creativeintelligenceinc.com (under a little construction at the moment); on Twitter (@wanca_thibault), and on LinkedIn. Her email address is creative intelligence (at) q (dot) com.

As forward thinking and strategically savvy as the leadership in an organization may be, when it comes to implementing change, some level of resistance must be anticipated. This is supported by statistics that show about one third of corporate initiatives are successful. Even when the need for change is recognized and goal of the initiative is clear, people naturally avoid the uncertainty that transformation brings. The costs associated with failure can be high – not only financially, but also psychologically. Leaders need to recognize and plan for this inevitability. They are not without a tool that can be used to support long-term change. Building and maintaining a culture that values and promotes change is in fact one of the most underutilized advantages leaders have.

Culture can be interpreted in a number of ways, but most commonly it is defined as a specific worldview that results from a set of commonly held values, beliefs, and norms. Culture can be explicit or implicit, but in either case it drives the behaviors of the group. When new or inconsistent behaviors are required in an otherwise “status quo” environment and those behaviors are not supported by the current cultural system, resistance to change is the outcome.

Understanding an organization’s unique culture is a first step in determining how to shape change. However, the assumption that leaders must change the way that people think before they can change their behavior is a misnomer. While awareness and education can change how people think, this approach takes a great deal of time and the effort doesn’t guarantee a long-term change in behavior. In fact, it is actually easier to change behaviors first with the intention of “pulling” the culture in the direction more consistent with the desired change. Once those behaviors are put in place and reinforced a new set of supporting values, beliefs, and norms (i.e., culture) results.

Leaders interested in managing change using this approach should focus on using communication to instill the behaviors that can lead to cultural change. Consider taking the following steps:

Clearly define the behaviors that will lead to the desired change and translate them into processes that are specific and concrete enough to be meaningful to the audience. While it is important for people to understand the overall goals of a change initiative, leaders cannot simply ask people to change without a strategy that outlines the day-to-day impact the new behaviors have on the way they perform their jobs.
Clarify the costs and benefits of the change so that people understand the need for change. Provide specific examples. People are more likely to buy-in to the change when they understand how it impacts them directly and fits into the bigger picture.
Lead by example. Change comes from the top and employees look to their leaders to guide the cause. Modeling behavior not only has a positive psychological impact on people, but also opens the opportunity for dialogue that can reinforce the desired behaviors.
Create metrics and a performance system that align with the desired change and build accountability into the new system. Often the behaviors that leaders look to change are not supported by existing reward systems. In addition, people are not easily moved out of their comfort zone without good reason and clear consequences.
Finally, leaders must continually provide people with the skills and support to maintain change. New behaviors are best reinforced with feedback and coaching. Cultural change is more easily achieved when people are reminded of what they are doing well and how their behaviors reflect the overall values, beliefs, and norms of the organization.

Change is an ongoing part of an organization’s evolution. As such, finding a strategy that minimizes uncertainty and perceived risk can increase the success of the change process. Successfully meeting the challenges associated with transformation requires adaptive leadership and a clear understanding of the ways in which instilling new behaviors impacts cultural change in the organization.