Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 39 From Sprints to Marathons: How to Help Hospital Leaders Cope With Continuous Change By Quint Studer, Founder of Studer Group I 've spoken to dozens of hospital associations so far this year, and by and large, leaders are all too familiar with the big changes facing their organizations. Most everything is in a state of flux: reimbursement, market competition, physician employment and pricing transparency. Of course each of these issues impacts employees, but what's really interesting is that they they're all part of a larger trend: the shift in the very nature of change itself. By far the biggest and most profound challenge facing hospitals and health systems is the shift from episodic change to continuous change. No hospital or health system is immune to this fundamental shift, which is thoroughly explored by John Kotter in his book A Sense of Urgency. When I mention this change to hospital leaders, I see lightbulbs go off immediately. It may sound self-evident, given how often the term "continuous change" is cited these days, but we should not underestimate how much this jump has changed what we expect from healthcare professionals. Moving from episodic to continuous change creates an enormous and unfamiliar demand on our leaders and causes a great amount of pressure in an organization. If your hospital culture is struggling, it's because people are expected to lead like never before. What we need from leaders today To survive and thrive, healthcare organizations must create and maintain a culture of high performance. What does that look like? Research shows we expect different skills from high performers today than we did only a few years ago. I compared the skill sets of high-performing organizations in 2004 with those in 2013-2014, and I found some big differences. In 2004, high-performing organizations were relentless in achieving desired outcomes and did not accept excuses. They used objective evaluation tools, invested in leadership and made concerted efforts to communicate with employees. Today, the five traits of a high-performing organization pertain to its alignment, readiness for change, self-awareness of performance, consistency and accountability. These traits are more continuous in nature and are more difficult to measure. "Readiness for change" is a particularly huge demand that requires a different perspective from leaders than before. Non-stop preparation Continuous change means leaders have to always be ready. This takes a wholly different mindset, muscle set and emotional set than what our supervisors, managers, directors and employees use when managing episodic change. Think about it this way: when you have a houseguest visiting from out of state, you plan ahead and ensure the house is clean and comfortable when they arrive. You know when they will arrive and when they will leave. But what if you only knew your houseguest was coming into town — but didn't know the precise date? You would need to take time every day to clean your home on a continual basis and ensure it is prepared for the surprise visitor, whenever he or she decided to show up. This is a new demand on your time and energy, and you would have to adjust your workflow, schedule and behaviors. Healthcare providers face a similar scenario. The Joint Commission used to tell a hospital or health system that an official would be stopping by for a visit. Now, they show up unannounced. The way hospitals prepare for these visits has changed from an episodic routine to continuous readiness. This change is a good thing for healthcare organizations, as it requires excellence all the time, but it's also stressful for staff. They may feel like sprinters running their first marathon, navigating a change in pace and course that takes different types of muscles and a different endurance level than a 60-meter dash. The shift from episodic to continuous change stirs stress throughout all levels of the organization, but directors and supervisors really feel the squeeze. They've been trained to sprint. They are accustomed to running hard for a couple of months, but there used to be an end in sight — whether it was a deadline, event or quantifiable goal. Not anymore. Take the annual budget process, for example. Preparing the budget was always tedious and grueling, but at least when it was finished the hospital had a solid game plan for the next 12 months. Given the current external changes — performance-based reimbursement, unstable patient volume and increased consolidation, to name a few — a hospital's annual game plan can actually change very early on in the new fiscal year. Budgets have become guidelines that require continuous monitoring and change. Quint Studer I know of an organization that was halfway through the year when they experienced a dramatic change in their reimbursement. The change was so extreme that if all of the leaders achieved their goals in expense management and even received good performance reviews, the organization still would have suffered a severe financial loss. So the organization had to review six months into their fiscal year and change its leader evaluations. They gave credit for the first six months of results, but changed the goals for the next six months to match the reimbursement change. Another continuous demand is for integration, or having as many providers on a single asset sheet as possible. Politicians often refer to integrated systems when describing how to improve healthcare. They may indicate that all providers have to do is copy a particular system, but politicians don't understand that it has taken years and years to make integration work in these organizations. Trying to get everyone on the same page and the same team, either through employment contracts or another type of agreement, is a drastic change that can take years. It is hardly episodic. How to help leaders in this time There is one constant in healthcare, though, and that's an eagerness to learn. I continue to see a hunger to learn in today's hospitals and health systems. The key question is whether an organization provides learning opportunities for managers, supervisors, directors and staff.

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