Foundation for change built on four cornerstones
Changing organizations share basic qualities
(Editor’s note: The first installment of this Q&A feature appeared in Healthcare Benchmarks’ June 1999 issue.)
Consultants Mary V. Gelinas and Roger G. James work daily with clients such as Kaiser Permanente, Levi Strauss & Co., Intel Corp., Vanderbilt University Medical Center, Coca-Cola Co., and Duke University Medical Center to help them implement change. Their consulting firm, Oakland CA-based Gelinas James Inc., has also helped health care clients to deal with issues such as creating a stronger customer focus and reducing costs and bureaucracy.
Gelinas and James are authors of a recently published book, Collaborative Change: Improving Organizational Performance. In it, they provide answers to questions about what is necessary to successfully implement organizational change, such as these:
Q: What are the "four cornerstones of the foundation for change?"
A: The four cornerstones are key agreements and conditions that need to be in place to create a strong foundation for any change initiative:
1. Clear purpose and balanced goals. The purpose and goals of a change effort must be clear, results-oriented, concrete, and connected to the business. Specific goals give clearer meaning to the purpose and give people results they can work toward achieving.
Also, an initiative is more effective if it addresses the needs of the business and the people who run that business. Including goals that consider employee growth and development, customer satisfaction, and process efficiencies as well as sales and profits creates a more balanced picture of what goes into improving organizational performance.
2. Sponsorship and leadership. Leaders can make or break a change initiative by their level of demonstrated support and involvement. By directing their attention to a change effort, leaders communicate a powerful message to the organization about the importance of the initiative. Most importantly, their leadership makes all the difference when the rubber meets the road — when it is time to implement change. To successfully sponsor a change initiative, leaders have to set goals for the initiative, build a compelling case for change, define the change process, actively participate in the effort, and ensure implementation of changes.
3. Customer-focused, comprehensive, collaborative, user-friendly process. Change initiatives are more successful when all key stakeholders understand and support the process that will be used to create change.
That means building agreements on the major elements of the change process — the purpose and goals, scope and focus, degree of change needed, boundaries and givens of the initiative, decision-making process, time frame, and roles. It also means keeping people informed and involved throughout the process, so they can maximize their contributions.
4. Commitment and capability to change. Building organizational support for change is as important as figuring out what changes must be made. Building this support with a "critical mass" from the very beginning helps prevent the invisible wall that many change initiatives hit before and during implementation.
However, commitment without capability is not enough. Successful organizations today invest heavily in developing the skills and knowledge — at all levels — that will allow them to anticipate, recognize, and respond to challenges and opportunities. They see their mastery of change as a major source of competitive advantage.
Q: Why are these important in achieving change in health care organizations?
A: The rate of change in the health care field is extraordinary, and it continues to increase. Also, health care organizations are experiencing extreme pressure to cut costs while maintaining quality. This means that for health care organizations, the ability to change effectively and efficiently is an absolute necessity. They cannot afford to waste time, money, and energy on change initiatives that are poorly focused or that fail to achieve the desired improvements in performance. Because of the high cost of failure, leaders of health care organizations need to pay particular attention to establishing a rock-solid foundation before undertaking any change initiative.
Q: What is "customer-focused" organizational change, and who are the customers with respect to health care organizations?
A: Organizations survive only if they understand and respond to the needs and requirements of customers, both internal and external. So organizational change initiatives must have a laser-like focus on customers’ current and future needs. This presents a unique challenge for health care organizations, because they have a number of equally important customers: patients, families, payers, and physicians. Each of these customers has different needs and requirements, yet all of them must be satisfied. This is complicated further by the fact that those who receive health care services are not the ones who pay for them.
Q: What steps can a health care organization take to make the change process more user-friendly, and why is this important?
A: The importance of a user-friendly change process is simply this: When people understand and effectively participate in the process, they are more likely to support the outcomes. This, in turn, reduces the time, money, and energy leaders have to spend selling the necessary changes. There are several things health care leaders can do to make the change process more user-friendly.
They can make the process more understandable and manageable by organizing it into phases, with clear outcomes and time lines for each phase. They can make sure that everyone knows his or her role in the process, particularly in making decisions. Finally, they can keep everyone informed about the progress of the change initiative. Honest communication — particularly face-to-face communication — is critical to the success of any change effort.
Q: How can leaders best build support for change within their organizations?
A: To gain employees’ support for change, leaders can use the following approaches. Initiatives tend to be more effective when the approaches are used in combination:
• Education and persuasion. People cannot support what they don’t understand. Leaders need to ensure that they are building the "intellectual capital" of their organization by educating employees about all aspects of the business (e.g., strengths, weaknesses, opportunities, threats) and the change initiative (e.g., purpose, goals, process, roles, time frame). They also need to build a compelling case for change — why it is necessary, how the organization will benefit, and what the consequences are if the organization does not change.
• Rewards and recognition. Providing incentives can be effective if those being asked to change value the rewards and recognition and the incentives are explicitly linked to the desired changes. The challenge is to define the desired changes clearly and to assess whether the changes have been implemented.
• Participation and conversation. The most consistent and compelling lesson about change is that people support what they have helped create. Thus, participation is the hallmark of the most effective change initiatives. Here the emphasis is on creating change and commitment through conversations, learning, and building agreements.
The emphasis is on engaging people’s hearts, minds, spirits, and bodies in the process of determining whether to change, what changes are needed, and how to implement change.
[For more information, contact:
• Gelinas James Inc. at 6114 LaSalle Ave., Suite 442, Oakland, CA 94611. Telephone: (510) 339-4322. Fax: (510) 339-4324. Web site: www.gelinasjames.com.]
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