Guiding health care providers during redesign
By Greg Laskow, PhD
Senior Consultant, Client Manager
Farr Associates
Greensboro, NC
(Editor’s note: One of the most important elements to a successful restructuring program is gaining the support of staff. It is also the one element frequently ignored during planning. To ignore the human side of change invites staff resistance and potential failure. Resistance to change is human nature, but it does not have to be lethal. By addressing the human element, you can limit opposition and smooth the transition. In this column, psychologist Greg Laskow opens with examples of conflicts you could face during restructuring, then explains how to manage them.)
In the hallways of a traditional health care institution which has the reputation for the state-of-the art medical technology, equipment, research, and residency training, along comes an obviously irritated and animated physician wanting some definitive answers from his favorite hospital administrator.
He asks: "What did you call that patient of mine?"
"A customer," the administrator replies.
"How so?" the physician asks "Why are we calling them that now? What happened to the term patient’? Where did that go?"
"Nowhere, the administrator says. "They simply have been renamed customers’. This way health care providers and institutions can direct their strategic marketing campaigns and selling efforts to those that will make a difference to us."
"Oh, yeah? That’s ridiculous," responds the physician. "They are my patients. They aren’t silly customers. I have been treating them for a long time. In fact, I have been treating many members of their families."
"Well," the administrator says, "They don’t necessarily belong to you, nor do their families. And what’s more, we now have to be concerned that a recent utilization review process seriously questioned the extended care plans your practice typically calls for your patients and for their family members."
"What?" the physician says. "What is this utilization review process have to do with sound medical decision making in the interest of the patient?"
"Well," the administrator says in an attempt to remain calm and logical. "This is a way of influencing and slowing down the spiraling costs of health care."
"Wrong," the physician says heatedly and not so logically. "It will never work. It simply is a travesty of good medical care placing these decisions in the hands of someone ill trained. I have been told that a nurse practitioner is now making these decisions. How inappropriate. Quality will suffer. Patient care will be compromised. Customers? Indeed."
In another setting of this hospital, a decision has been made by the executive group to conduct a re-engineering process to reduce and minimize wasteful and redundant practices in the health care provided to inpatients within the facility. In fact, a preliminary study conducted by the external consultants contracted for this process initially suggested that the nursing resources may be maldistributed and not positioned in a functional and sensible way, and should be decentralized. In response, the chief nurse immediately fires up a memorandum of protest. He cites an array of possible compromised patient care if this decision is implemented and notes how abuse of patient care, along with attendant critical incidents, likely will occur.
In today’s health care marketplace, the time-honored doctor/patient relationship, while unequivocally still preferred, is clearly not the only variable of consideration for a prospective patient in deciding which provider or institution to select or to maintain. Other matters such as provider listing, health maintenance organization vs. preferred provider organization, preexisting conditions, capitated costs for conditions are deciding points for the "customer" along the spectrum of events surrounding an episode of care, acute or chronic, immediate or anticipated.
It truly requires a substantial shift in thinking, prioritizing, and decision making for all parties involved, but especially, for the health care providers, administrators and all of the necessary ancillary support for the allied professionals.
They simply have had to undergo a radical change in their minds and have had to do so in a slow and sometimes painful process. But that is precisely what it takes: a slow change in minds.
Whereas the primary target of health care previously was the competition arising from disease process — the pathogens and unhealthy lifestyles — that competitive field now is extended to include other health care colleagues and institutions. As evidence, how many billboards did we use to see on the highway promoting a particular health care maintenance organization or hospitals ten years ago? And how many mergers of hospitals and health care institutions did we witness in the early 70s? Virtually none or minimal in both instances? Today, however, this is quite commonplace, as is the health care market industry itself as a viable investment tool in a financial portfolio.
Sadly, there are so many instances where, in a panic to remain competitive, health care organizations have jumped aboard in-vogue strategies such as re-engineering and downsizing of the health care structure and work force, while unintentionally omitting a change plan for the most crucial component: the human mind. The re-engineering process itself may be well intentioned and a strategically smart direction to move toward. Its success, however, rests largely on the not-so-logical patterns existing within the human system of the organization. This system is the principle key to organizational change.
The effectiveness and change process in the health care industry, as in any other industry, will be potent and sustained only insofar as the planners address and plan for the fact that the human mind of the provider work force is constructed along patterns and processes that very rarely make any logical sense, but rather are imbedded in a form of psycho-logic, a person’s unique thought process reflecting needs, values, and beliefs systems.
Changes in the structure, numbers, processes, and protocol will realize efficient impact on health care services and consequent cost containment with maintenance of the highest quality of health care only as a function of the management of the human minds of that culture in which those changes and modifications have been put in place. That is the challenge.
Most intelligent executives, managers, or providers of health care can manage things such as structure, numbers, and methods. The true challenge of the health care leaders of today is the process of managing minds. Now what is meant by that?
Maintain the survival mode
The mind is a wonderful conglomerate of activity as the center of all behavior and operates in behalf of the many programs that reside in its neuronal structure. The programs are set up in the first place to assist survival and thereafter, to maintain that survival mode, as well as a high level of satisfaction and pleasure. Those programs that work are considered as "right" and those that don’t, as "wrong" in the person’s belief system. More importantly, the belief systems are usually so automatic that we don’t have to "think" about them, much less challenge their legitimacy. It is very much like the automatic behavior involved in the mechanics of driving a car by an experienced driver. In a competently, unconscious fashion, he or she does not have to be "aware" constantly of the changing of the gears.
In a situation where an experience out there fits our psychological programs or beliefs, then we get to conclude "it must be right"; when it does not, "it is wrong" and often rejected outright. This process is the principle function of our Ego. It accepts what is right and rejects what is not.
Challenges to the system meet resistance
The more it becomes a "time-honored" mind set, which in some circles might be referred to as unconscious, the more likely violations will be actively resisted unbeknownst to the individual. As importantly, the programs did not get there overnight in the first place. They were fashioned and reinforced throughout a multitude of experiences.
For example, when I, as a doctor, am asked to see my patient as a customer, that does not fit my program and, in fact, conjures up all sorts of additional associations for me, such as customer satisfaction, malpractice, loss of the customer to another provider or plan. Therefore, the concept must be "wrong." Or, when I have to submit a business plan when the entirety of my practice’s success heretofore has rested upon comprehensive, clinical treatment plans, that notion, too, must be wrong, and I resist it or reject it.
Principles to manage change
So, as a provider, manager, or executive involved with providers in a competitive health care industry, how do I manage this change process for them? A number of principles are operative:
1. There needs to be a desire, or "I have to want to change my mind on this matter." After all, the beliefs held by the provider were also put there in the first place based on a complex array of needs. Thus, their modification or alteration will also need to be needs-based.
2. Understand that the resistance is simply a function of the Ego, even though it may not be logical. Most often, this resistance is ignored and worse yet, countered through organizational edicts.
3. Understand that the reactions of the provider base — the physicians and RNs and other health care deliverers — will, in all likelihood, not make logical sense since they are in support of a survival maintaining mechanism. What is likely to occur at first is an impressive effort on the part of the targeted change agents (the physicians, RNs, and other providers) to devalue or disprove the efficacy of the proposed change.
4. Health care executives are more likely, over the long haul, to realize success with change interventions, if they act in ways to minimize automatic resistance to change. Tactics, such as getting the providers and the work force to play a significant role in the determination of the change events and strategy, can be employed. Get them to examine what are the needed possibilities out there to support the future requirements.
5. Leaders need to be committed to exploring the mental terrain of the health care staff through formal and informal process such as interviews and objective data collection. This process not only conveys to the provider that the leadership is committed to knowing what is on their minds, but puts them at the advantage of understanding what is the pulse of the organization preceding the anticipated change of evens. The interventions can then be shaped accordingly rather than simply implemented as the program of the month.
Address the provider base
As a manger, leader and executive in health care today and in an industry that is truly in a learning, living and growing mode, given the business components vis-a-vis the medical and clinical policies and protocols, tools are needed to address the minds of one of the most critical populations affected by the change process — the provider base. While restructuring and reformation will create an optimal environment to respond to the ever-changing demands imposed by governmental, legislative and managed care influence, the institution of plans, of necessity, has to embrace the mindsets of the providers, those who are expected to execute the new policy.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content