Access 2000: A road more traveled
By Mike Monahan
Healthcare Resources Associates
Evergreen, CO
Jeff Jones
Stockamp & Associates
Lake Oswego, OR
American business and the world in general are in the midst of the greatest change since the Industrial Revolution. All rules for success in organizations have been superseded by new rules that are still poorly defined.
Highly structured, multilayered provider organizations are having particular difficulty respond ing to rapidly changing market forces. The emerging successful organizations tend to be customer-focused, decentralized, highly interconnected both electronically and culturally, and with a seamless access system for patients.
The health care industry has been remarkably resistant to market forces for the past 50 years. Unlike any other industry, health care professionals and organizations have been the sole determiners of:
· What should be done?
· How much should be done?
· How well should it be done?
· Who should do it?
· Whom should they do it to?
· How much should it cost?
The result is a $1.3 trillion-a-year industry under tremendous pressure to respond to market influences. Health care economists, government agencies, and private commissions have studied the state of the industry and conclu ded that massive changes in organizational structure and traditional roles of personnel and finan cing are certain.
We are seeing evidence of this in such changes, strategies, and predictions as:
· consolidations - seeking economies of scale and reducing expenses;
· role shifting - changing the requirements for licensure, training, and utilization of health care professionals;
· bed and/or facility closure - responding to the marketplace;
· increasingly pervasive managed care strategies - controlling the cost of health care delivery by changing financial incentives;
· widespread organizational redesign - seeking effective and efficient organizations;
· increasing government regulation - trying to protect the federal budget and regulate quality;
· changing practice patterns - reacting to changing demands of patients, employer cost initiatives, and advances in medical science.
It is essential that individuals responsible for access to these changing health care organizations be adept at:
· developing a clear picture of the changes in the industry with an emphasis on discerning the difference between market forces and the results of personal decisions;
· increasing the ability to see trends and make better decisions;
· becoming masters at process redesign, systems management, and change leadership;
· understanding the intrapersonal forces associated with change and exploring one's abilities to adapt;
· understanding the group forces associated with change and how organizational success is affected by organizational adaptation;
· recognizing individual responsibility and accountability as a requirement for both personal and organizational success.
When planning for the redesign of processes, these will serve as a useful checklist for determining your role in the process as well as the readiness of the organization and staff for change:
o What is to be changed?
o Why is it to be changed?
o What will be different after the change?
o When and how fast should change occur?
o Will the change really work?
o Who is for the change?
o Who is against the change?
o What kind of support will you get?
o How will the change be announced?
o Will everyone understand the change?
o Is your timing for the change appropriate?
o Will the change be perceived as beneficial?
o How will you monitor the change?
o Will the final outcome be worth the effort?
o Is there another path you should take?
In managing the change itself, there are some principles that, when observed, produce fewer surprises and greater cooperation; when ignored, they practically guarantee vigorous resistance and increase the likelihood of failure:
o Change is inevitable; resistance is natural.
o Maximized involvement means minimized resistance.
o Don't create losers - they'll get even.
o Make sure the changes support the process redesign efforts and goals.
o Seek alignment among the purpose of your organization, the processes in your department, and the utilization of your staff.
o Promote engagement of your staff in adapting to the change and looking for improvement opportunities.
o Measure to improve.
o Be prepared for dysfunctional and dependent behaviors - strong, positive leadership is the antidote.
o Separate from the past with a symbolic "ending" to the old way. Celebrate the new way.
o Remember that change requires more and more intense communication and follow-up than you might expect.
Working successfully through change
The reality of the health care environment today is one of change, financial responsiveness, and the perception of conflicting forces such as quality vs. cost, productivity vs. worker satisfaction, patient demands vs. plan restrictions, and patient satisfaction vs. access system restraints.
Reactive changes to the continually changing environment will not do anything to lessen these conflicts. Instead, you must design an access system in your facility that is based on processes that will secure sponsorship and maximize revenue as well as seamlessly ingress, process, and care for patients. Proactively seeking a process-driven, seamless access system and careful attention to the change principles to enhance staff acceptance and support will benefit patients, providers, and payers. This is the road we must travel!
[Editor's note: Mike Monahan is managing partner of Healthcare Resources Associates in Evergreen, CO, a consulting and training practice that helps changing organizations deal with human issues, promote healthy workplaces through enhanced leadership and management skills, and coach individuals and groups for enhanced performance. Telephone: (800) 759-2881. E-mail: [email protected].
Jeff Jones is a director at Stockamp & Associates in Lake Oswego, OR, a national health care consulting firm. He leads the practice group specializing in systems integration with a seamless access system. Telephone: (800) 260-0452.
Next month: Monahan and Jones will look at the necessary steps for leading change by developing and implementing effective process redesign in health care access services.]
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