Whether its leading the transition from fee-for-service to value-based care; shifting to deliver more ambulatory and less inpatient care; or leveraging big data and technology to deliver care beyond a hospital's walls, change in health care is constant.
"There's an emergence of significant forces that drastically affect children's health care," says Scott Perryman, senior vice president and administrator at Loma Linda University Children's Hospital in Loma Linda, California. "Our single greatest challenge in this environment is to continue to ensure there are resources to take care of children and their health care needs."
Uncertainty in health care creates forces a leader can feel powerless against. "There is a constant flow coming from external sources that is forcing change," says Kim Powell, leadership consultant, researcher and author of The CEO Next Door. And the onus is on leaders to frame a new direction. "A constant state of change means there's more ambiguity for everyone," Powell says. "And for many individuals that means more stress. It's the duty of a leader to, where possible, reduce ambiguity so people can focus on the job at hand, especially caregivers and those we rely on to deliver the patient experience with great outcomes."
Michelle Stephenson, DNP, RN, NEA-BC, executive vice president and COO at Ann & Robert H. Lurie Children's Hospital of Chicago, has experienced a lot of change spanning her career as pediatric nurse to her role today as an executive.
"There are a lot of people who aren't comfortable with change and find it threatening," she says. "But the better leaders are those who not only embrace change but help others live through it and try to embrace it."
Here are seven essential concepts leaders should adhere to and adopt during times of change. They may even come in handy during periods of smooth sailing, too.
Acknowledge change is hard and put the expectation on everyone they're going to have to adapt. "It's important for leaders to say, "This isn't easy, but this is the new normal. It requires everybody to be agile and open to doing things differently even though that might feel uncomfortable—we have to be willing to work through it together,'" Powell says.
Callie Dobbins, RN, M.S.N., NEA-BC, facility executive and vice president at Levine Children's Hospital in Charlotte, North Carolina, says being honest about what an organization is facing and why is crucial.
"This helps us remember our reason for being in health care—to improve the care of patients and the children and families we serve," she says. "Even for the most complicated or difficult decisions, if we start there and help people see—even if it's not a well-received change—how this could make care more efficient, effective, affordable, or patient centered, and connect it to our children and families, most reasonable individuals will get on board."
Leaders who rule with a heavy hand and don't encourage discussion or debate are not giving employees the chance to articulate why change is hard, which will ultimately slow down any change process. "Employees won't be on board because they will be frustrated, and it will erode morale," Powell says.
Eugene D'Amore, vice president, operations and chief information officer at Shriners Hospitals for Children in Tampa, Florida, agrees. "Be up front and address a challenge or an issue with leadership and with staff members, and be direct about it," he says. "Being direct is the best way to demonstrate transparency and stability as a leader."
For Stephenson, the biggest communication challenge she experienced as a leader was when the organization moved into a new facility and changed its name. These changes affected every employee—they were all facing different commutes to a new neighborhood and a new work environment.
"Everything changed with the flip of the switch," she says. "But communication and transparency worked to everyone's favor." Stephenson and her team conducted town halls, distributed newsletters and held open forums to keep everyone up to date and informed of what the benefits would be—not only to patients and families, but for employees, too.
The lesson she learned? "You can never over communicate," she says. "People don't necessarily hear you the first four or five times you say something. Sometimes you feel like a broken record, but it's in everybody's best interest to just keep communicating."
Set a vision for the future
It can be difficult to set a course and steer an organization in an environment where you don't know what things are going to look like, not just in the short term, but in the long term, too. "You can't eat an elephant in one bite," D'Amore says. "You've got to look at it from a different view and attack it from a perspective of what's meaningful today, and how over the next three, five and 10 years can you transition?"
Setting a vision and articulating it is crucial to leading during times of change. "These days, long term is one to three years," Perryman says. "The most important thing is to connect that vision to the work and lives of everyone who works with you."
With so many competing priorities, planning can fall to the bottom of the to-do list, but Powell's research indicates the more time a leader spends looking toward the future, the more successful he or she will be.
"Adaptive leaders spend twice as much time thinking about their organization over a year out," she says. They also spend one day a week with patients, clients or customers—whomever the organization is serving. This helps leaders stay ahead of changes and source ideas and best practices from not just inside the hospital but externally, too.
When it comes to looking externally for best practices, Stephenson says other children's hospitals can be great sources of ideas—one advantage of the small, close-knit community. "I know whenever I'm facing something, I can reach out because somebody has gone through something similar," she says.
Question what worked before
You know the adage: This is how we've always done it. But effective leaders say, "Wait, but why?" They're willing to question if something could be done in a new way, and they embrace the discomfort of change. For example, D'Amore says Shriners Hospitals is seeing the effects of the movement of inpatient cases to ambulatory and clinic care. "Our health system was always built around an inpatient, highly specialized orthopedic and burn care delivery system," he says. "But we're looking at things differently now."
Over the last few years, the organization transitioned Shriners Hospitals for Children Medical Center in Lexington, Kentucky, into an ambulatory surgery center and aligned it with the University of Kentucky. And at its Pasadena, California, hospital, Shriners built an ambulatory surgery facility and transitioned it from an inpatient facility to ambulatory surgery center.
"We had to adapt to a different mindset, culture and type of patient," D'Amore says. "And we made sure the skill sets for the nurses, surgeons and staff members were aligned with treating more patients in a shorter amount of time." This helped make the ambulatory and clinic environments more cost effective and service oriented with positive outcomes. It also means the organization can continue to address its mission.
Go slow to go fast
How well a leader identifies and engages with the stakeholders affected by a change is an indicator of how successful he or she will be in implementing that change. Powell's research says leaders who are effective at engaging for results are twice as likely to reach organizational goals. "This is about how you listen and interact with the parties involved to educate them on the challenge, engage in idea generation, create buy-in for what needs to happen and involve them in implementing the solution," she says.
Done right, this takes a ton of effort. "If you're used to delivering orders in the ER, this is a different engagement style, and it can feel ineffective," Powell says. She sees this in the business world, too. Take for example, a corporate executive who was used to giving orders. When he needed to adjust his company's pricing strategy, he decided to take a different approach. Rather than his usual top-down style, he conducted workshops with employees around the globe.
This planning took 50 times more effort, but throughout the process, employees became "enrolled in and engaged" with what needed to occur. And for the first time ever, the company was able to not just design a strategy that was effective, but also implement it successfully.
While this took time, it allowed for fast implementation. "It's this idea of going slow to go fast," Powell says. "If you're conducting a change effort, it can feel like you're not doing anything. And without enrollment and engagement, people are not going to change their behaviors unless they buy in and feel like this is
going to be good for them and the organization." It's easy for leaders to get into the mindset they can solve everything on their own. But without engaging all stakeholders, implementation will fail.
Listen to understand
Effective leaders know they don't have all the answers. Instead, they question those around them to seek information and understand, not to assert or tell. To get a sense of your tendencies, Powell recommends monitoring your conversations during a day. What percentage of the time did you ask questions versus telling or asserting an answer or direction—was it more than 50%?
As you're asking questions, don't forget to truly listen. "If you actively listen, you will hear what people are actually saying," Perryman says. "I spend a lot of time listening to physicians and staff who take care of patients, and a lot less time having meetings where we preach to people and tell them what they need to do. There are solutions I would've never guessed if I didn't listen to the people who are confronting them every day."
Grow more leaders
Think about how to build the capabilities and talents within an organization so it thrives into the future. And once that team is in place, step to the side. "I try to stay out of the way," says Marc Gorelick, M.D., president and CEO at Children's Minnesota in Minneapolis. "I want to be informed about what's going on, but I don't want to interfere—the team is empowered to make decisions."
If exhibiting leadership means using influence to guide others, most people, no matter what their role in the hospital, are leading. "We can help employees see they are all leaders in their own way by acknowledging it with small acts of recognition, like a handwritten note," Gorelick says. "This can reinforce behaviors of frontline staff members who demonstrate leadership and our values, and it encourages them to step up more."
At Levine Children's Hospital, daily huddles and administrator rounds empower frontline caregivers to pitch ideas, speak up and develop their leadership skills. "When I was a frontline leader, I always said to my team, "If you have an idea, let me know, and let's see how we can put it into action,'" Dobbins says. "And I practice that as an executive now. If you give people the space and the place, they will solve it better than any of us would independently."
And when an employee takes a project from idea to implementation or problem solves and makes something better, even if it's not something he or she can implement, go back to that unit and give the colleague credit. "This organically stimulates that next person to say, "Well, if she did it, I can do it,'" Dobbins says. "It becomes contagious in a positive way."
Stephenson says some of the best leaders in her organization are those at the bedside. "It's important to make sure the people who are the experts who are providing the care are the ones who are empowered to make clinical recommendations and decisions," she says. "I defer to the clinical expertise of the nurse or the respiratory therapist or the physician. That's how you grow more leaders."
Most leaders are in their positions today because they were an expert at something. But Gorelick says it's important to have the humility to realize you don't know everything. "Use collective rather than individual wisdom to develop solutions during times of change," he says. "And then have the courage to push those solutions in the face of the inevitable resistance to change."
Perryman says conflicts and disagreements will diminish when an organization truly lives a culture that puts patients and families first. "It takes courage to do things that are right for children but are not necessarily the most profitable," he says. "Internally, it's a rallying cry for our staff and our physicians. And it allows us to get on the same page and focused on what's important, which is who we're taking care of."