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Digital Health – A Practical Model for Change Management

Becoming a digital health system requires self-directed evolution, the deliberate act of transforming from the traditional model of care into a digitally enabled model.   To be successful on both a personal and organizational basis, you need a practical change management framework that can assist both the change agents and those who must change.  It must be simple and memorable.  That’s the easy part.  The hard part is getting both individuals and the organization to change – at the same time.  If you or your organization don’t, won’t, or can’t change, you and your organization will not survive.

One of my favorite book titles is “Change is Good…You Go First.”  The subtitle of this truly short read, “21 Ways to Inspire Change”, certainly offers encouragement given that so many options are available.  Why is it difficult to get a healthcare worker to change?  A healthcare worker’s identity is tightly coupled to their role in healthcare.  Good, motivated healthcare workers believe the processes they use are what’s best for their patients.  When you introduce change in a healthcare environment, you are not just changing what the healthcare worker does, you’re very likely challenging how they think about themselves.  You’re also impacting the patients for whom they care.  Effective change management requires social engineering which involves careful planning, clear, concise communications, and a study of the impact on a worker’s workflows and a patient’s lifeflows.

The first step in planning for change is understanding where the individuals and organization are in their thought processes.   Though there are many to choose from, my favorite and recommended framework is the simple, yet practical and pragmatic transtheoretical model (also called Stages of Change Model) described by Prochaska and DiClemente in 1997.  It’s easy to remember because there are only 5 primary elements that are logical and based on our shared life experiences.  Here is my annotated diagram based on a variety of sources for the transtheoretical model:

Many other users of this framework show a diagram where the steps are arranged in a circle and suggest that one can enter or exit at any stage.  Regardless of when someone enters or exits, there is a time progression that one should follow from left to right in the order above.

To be an effective change agent, meet your target or audience where they are.  Your change playbook must have chapters with messaging you can personalize for each stage.  In the text under the stages in the diagram above, there are some tips on how to deal with individuals and organizations in the various stages.  Perhaps the most difficult challenge is moving from precontemplation to contemplation.  In healthcare, evidence and precision messaging can be amazingly effective for even those most resistant to change.

Remember as you craft your communications, you’ll be more successful if you can get emotional and logical buy-in.  Emotion and logic, however, are not always in sync.  When someone is skeptical, or I suspect they might be, I try to use non-challenging probing questions instead of making declarations about the logic or benefits of change.  Rather than, “We have determined a better way to do things and it’s time to change what you’re doing.”, I’d suggest you start with these questions: “We’re thinking about the future and how to improve our care across the board.  Are there some things you or others are doing that you think could be done better.  If so, what are they and what would you suggest?  Would you be willing to talk about and see if it might work for you and others?”  Listen without judgment.  Sometimes the answers help show flaws in logic,  and sometimes reveal a better approach.  The goal of the questions is to get the individual to become an observer and judge of their own behaviors, to understand the logic behind the change to improve the chances for buy-in.

Occasionally, underlying technology(ies) may need to be changed in order to instantiate the improved processes.  Be prepared to advocate for technology changes, but only as a last resort.  Leveraging existing technologies or using them in novel, innovative ways is a great way to save money and minimize the timeline for change.

If you encounter resistance (and you will) or don’t have the time (and you won’t if you try to talk to all individuals in an organization) provide evidence to your audience for how and why you’re making the proposed changes.  Provide a mechanism for feedback – a real or digital suggestion box.  Create and share FAQs.  Be open about the challenges and the benefits.  Listen to your critics and worriers.  Acknowledge that even if the change will be good and the benefits are substantial, the transition may be difficult.  My short, direct message is, “Change is good; transition sucks.”

Get broad representation in your committees promoting change.  Include thought leaders who often are the line workers.  At the bench or bedside experience is invaluable.  The goal is to minimize risk, lower anxiety and stress, and accelerate realization of benefits.  Ideally, enthusiasm and excitement will replace worry and concern.  Make sure you’re getting input from as many affected stakeholders, including patients and families, as practicable.  You’ll benefit from the diversity of ideas.

The Kubler-Ross model for stages of grief is also an important change management framework.  If you’re making major sweeping changes, such as implementing an EHR or ERP, and even for some smaller changes, get familiar with the mourning process.  Even the most despised systems I replaced in my career were never so popular as the day before the replacement system’s go-live event.  Users often grieve when they have to give up familiar systems and processes.  Healthcare workers are great at helping their patients and families through a grief process, but not so good at helping each other through grieving.  They don’t always recognize they are grieving.  When change happens, be as compassionate, merciful, and patient with your coworkers as you are with your patients and families.

Becoming a digital system will involve transformation at both the individual and organization level.  If individuals are ready to change but the organization is not, you’ll fail.  If the organization is ready for change but the individuals are not, you’ll fail.  To succeed individuals and the organization must get in sync and change together.  The transtheoretical model can help you the change agent and your target audience ascertain where individuals and their organizations are in their thought processes at the outset and throughout the change management process.  Monitor progress with all participants.  An individual’s and organization’s awareness of where they are in the transformation process will help them deal with both the emotional and logical progression toward change.

Digital health transformation is underway.  We all want to do better, get better.  Change is the means by which that happens.  Manage your own evolution.  Change is good!

This blog is the 8th in a series.  The other seven are:

  1. Digital Health – Is Healthcare Ready? Are You and Your Organization Ready?
  2. Becoming a Digital Health System
  3. Digital Health – Governance in a Digital Health System
  4. Digital Health – The Role of Empathy and Understanding
  5. Digital Health – Language and Comprehension
  6. In a Digital World, The Human Elements are Essential
  7. Digital Health – Planning for the Virtual Campus

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