Spare any change?

The Oregon Health Forum sponsored a summit recently and it's subsequent write up started with "The health care industry is outdated because it hasn’t kept pace with change."

I also met with a senior leader at my organization who noted that the health care industry has been just admiring the scope of the problem around our large aging population for about 2 years. However, we haven't moved past admiring the problem.

Both approaches were different ways of describing how health care organizations have not changed in terms of keeping up with trends or addressing chronic problems. Change is hard and someone has to really be motivated to change. The health care industry has had little incentive to change until recently. Everyone usually got pay increases above inflation. No new disruptive forces emerged as concierge medicine or retail clinics didn't really displace any large players. The market kept growing as demand showed no sign of abating. If I got continually rewarded for doing the same thing that I always did, I wouldn't change either. Health care was living in a world where marginal return hasn't change as the 82nd slice of pizza tasted just as good as the first slice.

Now we're fighting for pizza with other countries with medical tourism and realizing that our pizza buffet is no longer being paid for by someone else. Change will be coming and it won't be any easier.

Changing organizational behavior is one of those things that every MBA needs to know how to do but you really can't teach in a class. I've recently had some success in my organization with promoting change. After years of debating on whether or not to enter a new line of business that would change the nature of our health plan model, I pushed us over the edge and we made a decision to go forward with this change. The committee that I led which made the change recommendation celebrated with a bagel fest and I will further the celebration with my blog post of how I created change. We're going to need a lot of it soon.

If you don't get the answer you want first, ask at least 4 more times. Our provider contracting team was a key piece. They had heard about this idea for a while, they didn't see how it would work, and would repeatedly ask for answers to their questions. While their concerns were legitimate, a lot of change efforts have been stalled under the weight of endless questions. I answered all their questions, gave them numerous white papers to share with providers, and kept checking back with them. They realized that I wasn't going to stop asking until we drove the question to its final conclusion about whether or not providers would participate.

I saw answers to the provider contracting concerns. However, answering their concerns once or twice or even three times was not enough to address them and move down the change process. Four times was the magic number. I'll admit that four times was also my limit.

Bring in senior leadership early and involve them. Senior leaders need time to digest change because they will be on the front line if anything goes wrong. They need to be involved to be comfortable and your team needs to see that they are engaged to realize this is important. As I outlined above, they need to hear about it 4 times to be convinced.

Talk to the customer. Nothing trumps any concern like saying, "I talked with our end customer and here's what they said".

Set a schedule for milestones with a hard deadline. Nothing can delay change like having yet another meeting to double check with one more group of stakeholders or gather another piece of information. I made the milestone decision schedule clear and that deciding not to make a decision was in fact a No decision. Inaction was not a part of the process or part of the feasibility but another way of saying no. To help cut off the inactivity route, I answered all questions and also had a deadline for requesting new information.

Change is a humbling experience so this might be the last time that I can happily chronicle a successful change project. For any readers who care to comment, what have been your change success stories and what do you think the key factors were?