At the most recent quarterly medical staff meeting I presented the results of the physician’s satisfaction survey, the focus group, and my responses to the information provided.  Part of my response was directed at SFMC’s past effectiveness at implementing change efforts. Most often, both in the focus group and from direct communication with physicians, this has been relayed to me in a simple statement: “Nothing ever changes.” Usually that comment comes with frustration, because the physicians want things to improve. That’s a good thing. It means physicians care.

My observation is that SFMC is eager to improve anything for the patient. Likewise, the organization, meaning staff and management, want to please the physicians. They care deeply about what they think and want to be responsive and helpful.  This is a good thing. It means the organization cares.

It’s a puzzling paradox. Physicians and the organization want things to improve for the patient.  Clearly, things stay the same (if they do stay the same) not for want of desire for change.

Another premise offered by some physicians is that there is an ability deficit. It’s not that there is a lack of desire by SFMC but a lack of management skill in pulling off change. I disagreed. If that were the case, then we wouldn’t see improved patient satisfaction scores (now exceeding the 94^th percentile in the HealthStreams national database), or core measures (a 6% increase improvement in 12 months), or new technology, physician services, and any number of adaptations to the ever changing healthcare environment. These things did not occur by happenstance. It took leadership to pull it off.

I don’t think it’s about ability or willingness. Simply put, most change efforts fail. They fail for everyone, in every business, including healthcare and Saint Francis. Change management and leading change are topics of textbooks. But there are key sequential steps which must be achieved in order for change to be successful and be sustained. [1] The textbox shows eight steps which must be followed sequentially in order for change efforts to be successful and to stick.

Think about your past experiences with major change efforts in your clinic or at SFMC. If you think of a success story, you’ll see how these steps were applied. If you think about change efforts that didn’t stick, you’ll where steps were missed.

When I hear about problems that “never change” at SFMC, it tells me that what needs to be changed is difficult and complex. These are issues that will require substantial contribution from all involved, persistence, and attention to the realities of change. Most often, as clinicians, we are tempted to shoot from the hip, give an order, or tell someone to fix something, and move on. We are trained to think this way and act this way. But that doesn’t serve us well when we are attempting to deal with complex, large problems. Then it becomes more like internal medicine than surgery; requires a rigorous scientific method-based methodology, involving teams made up of multiple disciplines, and leadership attentive to the realities of the 8 steps of change.

This reality is part of the reason why I continue to appeal to physicians to roll up their sleeves and participate in major change efforts. Without exception, physicians are part of the “powerful guiding coalition” step. Without you, change efforts will fail. With you, we have hope and opportunity for moving forward and addressing those things that have ‘never changed’ before. Join us in the journey to exceptional patient care.

[1] Kotter, JP Leading Change: Why Transformation Efforts Fail, Harvard Business Review, Jan, 2007 #R0701J-PDF-ENG

I want to thank John Wagoner. He spoke. I listened. And I learned something important about organizational communication.

Soon after my arrival at SFMC I observed an opportunity for improved communication to physicians. Information is the lifeblood of effectiveness. We are relying on mailboxes and quarterly staff meetings to share our most vital information. Like coarctation, relying on these two channels alone severely restricts the free flow of information and subsequently hampers our ability to adroitly adapt to our changing environment. This concerned me, but John expanded my understanding of why we should be concerned.

 He shared that one consequence may be the unintentional creation of an ‘in the know’ group and a ‘not in the know’ group. One group more involved and the other less so. One group is more aware, the other unaware. Therefore, one more amenable and adaptable to, and the other surprised by, change.

Because some see surprise as equivalent to resistance, over time, some individual physicians or physician groups are labeled as “trouble-makers” or “resistant.” Preconceived perceptions of participatory unwillingness hamper communication – people are more reluctant to interact with them – creating the proverbial negative feedback loop.

We need to be careful. Incredulity is not equivalent to resistance, especially if the response is due to a lack of information. And if the lack of information is because there are structural deficiencies, such as a department that no longer meets, then we need to take ownership of those deficiencies and correct them.

Divisions are critical communication distribution channels, and provide fertile ground for peer-to-peer education, accountability, communication, and leadership development. Without them, we create an organization that favors false labels and significantly hampered adaptability.

We continue to expand communication channels to physicians. This blog is one example. But we also need to make certain that the formal organizational structures support the adequate exchange of information.

Thank you to John Wagoner for the illumination.

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Welcome to something new. Not new in the sense that others haven’t already made this part of their daily life, but new to Saint Francis, and new to me.

On occasion, hopefully several times a month, I plan to post some thoughts regarding health care, broadly speaking, and how these thoughts may play out within the context of a rural midwest community, its medium-sized hospital, and the broader healthcare infrastructure. The  audience is my colleagues and peers;  very bright, hardworking physicians and other clinicians, who are caught up in a rapidly changing contextual environment that is at the same time disruptively challenging and also full of eye-popping opportunity.

I suspect there will be a wider spectator audience, which is fine. My hope is that you all find something interesting; sort of Saturday-morning-with-coffee interesting. Perhaps we’ll have a brief dialogue through your comments on the blog, or you’ll be motivated to click on the hyperlinks and learn more. Enjoy.