While the times may be changing, the values of healthcare professionals will be the industry’s saving grace.
Working in healthcare today can feel like being adrift in uncharted, highly treacherous waters. Thanks to health reform and other disruptive forces, it’s hard to know what lies over the horizon. It’s tough to predict and plan for next month, let alone next year. Whether you’re a leader or a staff member, this uncertainty generates massive stress. The antidote is realizing that healthcare people have what they need to navigate this storm of constant change.
We live and work in interesting times. It’s true that many things have changed, and yes, the changes are quite dramatic. Yet many other things—which may ultimately be the most important things—have stayed the same. It’s these constants that will pull us through.
I’m talking about the deeply-held values that drive the typical healthcare professional. We have to get better and better at providing quality care, but the good news is healthcare professionals already want to do that. I’ve seen it all my life. The solution is to create organizational cultures that harness and maximize that hunger for continuous improvement. When people have the right structure and the right tactics, they can create miracles.
Here are the six big changes shaking up our industry—as well as the four “constants” that will bring us safely through to the other side.
The Six Big Changes
Change #1: The nature of change itself has changed. The biggest and most profound challenge healthcare organizations have had to deal with—and the one that’s requiring the biggest adjustments—is the industry’s move from episodic change to continuous change. John Kotter’s book, A Sense of Urgency, explores the intense pressure that occurs when cultures go from experiencing the first type of change to experiencing the second. Certainly, this is true of healthcare.
Think about the annual budget process. This has always been tedious and grueling. But in the past, when the budget was done, the organization had a solid, 12-month game plan in place. Today, that 12-month plan can actually change very early in the new fiscal year. Payments may change, volume may not be what was projected or expected, or supply costs may be higher than what was anticipated. In essence, a budget is now just a guideline that requires continuous monitoring and change.
Another great example is how Joint Commission visits are handled. In the past, the Joint Commission would tell a hospital or health system they were coming for a visit. To ready themselves, the organization would prepare rigorously by testing knowledge, auditing processes, checking records and so forth to ensure compliance. This is episodic change. Now, the Joint Commission will show up unannounced, so an organization is expected to be ready always. In other words, we’ve been forced to move to a state of continuous readiness. This is a good change, but it is stressful and hard to accomplish.
Change #2: New rules are disrupting the external environment. Although uncomfortable, disruption is a very effective way to force change. One can disrupt the environment—via a new invention, a new technique, a new tool—in a way that completely challenges the status quo and causes us to rethink and start over. Certainly there are plenty of imposed changes in healthcare that are creating an ever-shifting landscape. Many feel that the government’s goal is to disrupt the current healthcare environment. And certainly, government-driven cost pressures are causing upheaval in the industry.
Reimbursement has been—and remains—the biggest change. As healthcare expenditures grow, they consume an ever-increasing portion of the U.S. gross national product. If they continue to escalate, healthcare costs would eventually become the entire GNP. This cannot be allowed to happen—thus, we are seeing disruption through a drastic change in what the Centers for Medicare and Medicaid Services will pay for, as well as the amount it will reimburse healthcare providers.
Healthcare providers now have a more complete understanding of reimbursement changes and an understanding of what must happen. We now know that winning healthcare organizations will be those able to achieve higher quality with lower costs.
Change #3: Healthcare technology is making what was once impossible possible. The healthcare industry is a hotbed of innovation. Big brains have always questioned what’s possible and sought out advancement after advancement. Without this innovation, we wouldn’t have organ transplants, robots performing surgeries, or even digitalized medical records. Naturally, the push to come up with the next great technological advance is and forever will be alive and well.
It is absolutely amazing what is being done with technology today. Recently, I was on a flight, sitting beside a radiologist who was reading films from his iPad. In just the very recent past, this same radiologist would have had to stay at the healthcare facility to complete that work. Now, he can do it remotely. Even as we speak, new advancements in technology are developing.
In fact, right now reimbursement changes are driving an explosion of technology and applications that will help us manage our own health, as well as allow others to look at the state of our health, even from a distance.
Change #4: Transparency is driving accountability. When my organization got its start in 1999, most organizations used a measurement tool to diagnose patient satisfaction. However, the results were not truly transparent unless the organization decided to release them and could be compared to other organizations using only the same tool. Also, consumers would often base their judgment on what the hospital might communicate excellence to mean.
Today, via HCAHPS, CGCAHPS and so forth, this is no longer the case. I can get on my computer and go to the medicare.gov or cms.gov websites to find out how well a hospital manages pain or what core clinical outcomes look like. Costs, too, will continue to be more transparent. Now, consumers are able to ask, “Why are there such cost differences for the same procedures?” In fact, our research team recently went online and obtained CMS data to do an analysis that showed hospitals that had higher quality ended up being less expensive for the patient/payor.
Anyone can go to the Hospital Compare website (medicare.gov/hospitalcompare) to look at the metrics of various hospitals. Within minutes, one can find a “snapshot” of the quality of hospitals in an area and across the nation by looking at how they rate on timely and effective care, readmissions, complications and deaths, use of medical imaging, survey of patients’ experiences, number of Medicare patients, and information about how much Medicare pays hospitals. ED wait times can be seen on electronic billboards. This is transparency. As one healthcare system president put it, “Transparency equals accountability.”
Change #5: Research is proving the connection between great leadership and great clinical outcomes. Research is and has always been an essential part of healthcare. Without it, we couldn’t achieve new clinical outcomes. What’s new, however, is vital research on operational performance. It shows that when leaders lead a certain way—and that includes the use of so-called “soft skills”—patient outcomes improve.
A major difference between my organization today and when it started out is in the research available to support our tools, techniques and processes. In the beginning, there were a handful of case studies that made sense, but the wide area of research we have now was not yet available. Today, there are hundreds of healthcare organizations in our database, and others whose results prove that when certain behaviors are performed and certain tools and techniques are used, the desired outcomes are achieved.
There is also research that proves the more engaged the employee is, the better the patient safety and the better the success in process improvement. This means less rework and fewer workarounds. Other research shows the more objective a leader evaluation tool, the better the patient experience. In the past, we wouldn’t have been able to prove many of these connections.
Change #6: There’s a big push for integration. In this case, integration means efforts to put as many providers on a single asset sheet as possible. Sometimes when politicians talk about how to make healthcare better, they talk about integration. What they do not fully understand is that it takes years and years to make integration work. Trying to get everyone on the same page and the same team is a drastic change, and one that takes time.
Integration between physicians and a health system is hard. I was on-site at an organization that had over 1,000 employed physicians. If they just looked at their employed physician group as a stand-alone entity, they were losing $18 million on the practices. They quickly said as a system they actually did well from a profitability standpoint. Those doctors weren’t competing with them, they weren’t duplicating services, and they could contract together. So they could offset the $18 million loss.
The question is, for how long can one do that? Possibly, it makes strategic sense to do it for the short term. However, the reality is in the long term, each organization must figure out how to make their systems work. To hardwire excellence means to be more effective and more efficient and to achieve greater consistency and reliability, which in turn drives higher quality and lower costs. Easier to say or write than to do!
The Four Core Constants
Constant #1: Passion. Passion is demonstrated and lived out each and every day by healthcare providers. You see it in the nurse who clocks out but stays to sit with an ill patient. You see it in the physician who carefully explains to a family their father’s deteriorating condition, helping them decide whether or not to resuscitate him. You see it in the hospital staff that pulls together to bring a Christmas tree and presents to a sick patient’s family.
When we take time to notice, we see passion around us everywhere. Passion is no different today than it was in the beginning, and it continues every day in healthcare. As an industry, we are blessed with an abundance of great people filled with passion.
Constant #2: Fortitude. Working in healthcare has always been challenging, but with all the change happening, it’s even more complex today. It takes great fortitude to thrive in the midst of these changes. Change is difficult all around. It is hard for the people experiencing it, and it’s hard for the people on the receiving end (the patients). But it may be hardest of all for the people tasked with managing it. The good news is that the healthcare industry is taking steps to help leaders channel their fortitude in ways proven to lead to successful change.
I am fortunate enough to be part of a committee at the Harvard Business School created to recommend a 21st-century curriculum for our future healthcare leaders. A subject that comes up consistently is how best to manage change. Yes, one needs skills in selection, understanding a profit/loss statement, process improvement and so forth. However, being able to manage and navigate change is an absolute “must-have” skill.
After all, leaders carry tough messages. They are the ones who have to inform staff they will not be getting more resources and they need to be more efficient and effective with their current resources. They are also the ones who lead through failure. And while all highly reliable organizations learn from failure, the experience is painful. Sometimes things get worse before they get better. This is why leading in today’s changing healthcare environment takes tremendous fortitude.
Constant #3: A willingness to learn. Every day in healthcare, people save lives, handle disease with dignity, and help family members cope with death. Yet in the middle of these intense emotions, people continue to learn. Whether it is mastering a new technology, learning a new procedure, or studying what’s happening with a disease or illness, healthcare people consistently exhibit that a desire to learn is in their DNA and that quality patient care is their ultimate goal.
In 2008, Studer Group conducted a study of work/life blend among women in the healthcare industry. The research clearly showed that outside of their relationship with their supervisor, the second-biggest factor impacting satisfaction with their work environment was the organization’s level of commitment and investment in their development. This supervisor relationship and the education offered helped create the sense that the organization cared. People want to know you are investing in them. It is always encouraging to attend training and see individuals who walk out feeling better and more hopeful.
I absolutely continue to see a hunger to learn in today’s organizations. The key is the organization providing such an opportunity. In my book Hardwiring Excellence, I wrote that one can tell the values of an organization by the investment made in leadership development (training). With the external environment getting tougher and tougher, the need to provide skill building becomes greater and greater.
Constant #4: A desire to do work that has purpose and makes a difference. While people may initially feel their work meets these criteria, this feeling can be fragile. That’s why it is so important, when asking them to make significant changes in their day-to-day work, leaders explain the why behind the changes rather than just giving orders. And the real why is never just saving money or complying with government regulations—it’s improving the well-being of the patients we serve and saving lives.
There are so many traumas and problems that take withdrawals from a person’s emotional, mental and physical “bank accounts.” These withdrawals can cause one to lose sight of the fact that they have great purpose, do worthwhile work and make a difference. It’s up to organizations to help connect people back to the positive difference they make each day in people’s lives.
What may be helpful to realize is that healthcare professionals are not being asked to reinvent the proverbial wheel. Yes, we need new skillsets, but they build on the skillsets we needed in the past. We’re not being asked to learn different behaviors and techniques—we’re being asked to improve the existing ones. Not different. Better.
The good news is the timeless values we possess—passion, fortitude, willingness to learn, and the desire to do worthwhile work and make a difference in the lives of others—will drive us to master the skills we need. It’s those values that will pull us through the tough changes with our passion and dedication intact. iBi
Quint Studer is author of A Culture of High Performance: Achieving Higher Quality at a Lower Cost and founder of Studer Group, which works with more than 850 healthcare organizations in the U.S. and beyond, and was a recipient of the 2010 Malcolm Baldrige National Quality Award.