At some point in life, you’ve probably felt disrupted by change.
“But this is the way it’s always been.”
“This is the only way we’ve ever done it, and it works.”
“If it’s not broken, why fix it?”
Process improvement plays an integral role in creating a culture of internal innovation – in healthcare and beyond. The tools needed to drive improved workflows, outcomes and satisfaction inside out are dependent on well thought-out processes. Taking the time to rethink and redesign workflows can turn something that simply works into something that truly transforms.
Julie Campbell, director of Innovation Consulting at Healthbox, a HIMSS Innovation Company, has learned this first-hand. She’s spent the last decade consulting with health systems looking to leverage innovation to drive process improvement.
“I think the healthcare industry has fallen prey a lot to ‘this is the way we’ve always done it.’ So any type of change needs to be user-driven. You’re trying to change a process so it’s improving quality care, reducing costs, or whatever the end goal is. But in order to be successful, you need to make that process the easiest decision for the stakeholder to make,” said Campbell.
Change management and technology need to work hand-in-hand to drive process improvements that create actionable innovations, she explained. “At Healthbox, we define ‘internal innovation’ a little bit differently. We call innovation ‘invention adopted,’” Campbell said, emphasizing that innovation cannot occur without the adoption piece and the element of sustainability.
Process changes inevitably mean a major cultural shift. During these times, employees must be willing to adapt and participate in order for the desired changes to occur – which, in turn, can often lead to resistance.
“If you expect people to change their behavior, you really need that process change first for a complete redesign – using some type of technology to hardwire that change, and with employee change management on top of it to make sure it is sustainable,” Campbell said. “You can’t just implement technology and expect people to get on board. That’s why it needs to be accompanied by change management; that type of education is necessary in order to ensure sustainability.”
“During HIMSS19, I overheard a statement about how nurses are great at finding ‘workarounds’ in order to get where they need to go,” Campbell said. “They are great at figuring out how to do the right thing for the patient in the midst of obstacles, but workarounds have unintended consequences, like reporting inaccuracy or information asymmetry.” The ultimate goal is to design processes that won’t require workarounds – because they are efficient enough on their own – and to implement technology that makes it easier to take the right action, Campbell explained. “That could mean eliminating redundant documentation but ensuring it is pulled in to the right places, building alerts or hard stops into the electronic medical record (EMR), or integrating separate applications that enable evidence-supported decision making.”
To demonstrate this, Campbell talked about a session that she attended at HIMSS19, led by Michael Meyer, MD, physician executive and operating room (OR) leader at Pulse Heart Institute, and Sanjeev Agrawal, president and chief marketing officer of LeanTaas. Dr. Meyer set out to change a long-standing process of using historical information to build OR block utilization. However, this arbitrary process did not effectively solve the issue of low OR utilization resulting from a mismatch of fixed OR supply and variable surgical demand. Instead, the center implemented a new process for booking surgeries that included block utilization as well as an open marketplace model. They also developed new metrics that more accurately measured utilization and encouraged surgeons to release block time when unused. As a result, they implemented a technology that aided in intelligent booking and block release, as well as actionable reporting. It was rolled out so effectively that today it is now considered to be a key factor when recruiting other surgeons.
If you’re not observing any resistance, you may want to take a closer look at your culture internally and ensure it is promoting overall transparency, Campbell said.
“Consistently, things that require process change will generate resistance, but when you make the process easier for people to follow, you’re able to overcome that resistance more effectively. Of course, that needs to include education, communication, training – involving stakeholders up front in the design process as well,” Campbell said, citing examples like 30-day check-in meetings and surveys to gauge employee feedback throughout the process.
“You’re unfreezing bad habits and replacing them with new, better habits. It takes a while and a lot of coaching and encouragement to do that, so you need to have the right team not only from a governance perspective, but from a design perspective – because your governance team could be very different from your working body.” Governance may come from the top, but design must be peer-led.
In addition to governance, managing incentives is critical to change management. Rewarding change, whether through recognition, spot awards, or aligning pay to performance, is the last step to ensure sustainability and change champions.
Mary Ellen Skeens, recipient of the 2019 SHS/HIMSS Excellence in Healthcare Management Engineering/Process Improvement Award, has also dedicated much of her career to process improvement – such as implementations that involved connecting medical devices to IT solutions in order to aggregate and distribute the relevant data.
“Technology alone cannot usually solve clinical problems,” said Skeens. “This requires the integration of people, process and technology to effectively solve clinical workflow problems. Sustaining change is the most difficult part of process improvement.” Skeens cited daily management of process behavior charts as one way to track ongoing success of process improvements.
“Typically, the process change is significantly harder than the technology implementation. Unfortunately, more time and effort is often spent on the latter.” This can result in simply automating bad processes, Skeens explained, which limit the solution’s potential impact.
Skeens underscored Campbell’s points about the importance of governance and change management during times of transition. “Governance structures may vary based on specific project, but having a steering committee and identified project sponsor is key. Identifying relevant workstreams and leads for each is another best practice.” Identifying appropriate process measures and leading KPIs is critical for sustaining and improving processes, Skeens emphasized.
What’s the most important part of the change management process? Skeens said it’s all about the people, emphasizing that there’s no ‘one size fits all’ approach. “It is important to step into their shoes and really understand how they feel about the change. The human element of change is very powerful,” she said.
A people-centric approach to governance and incorporating change management strategies into workflow changes will take time, but it’s worth it, Campbell added.
“Once technology is assimilated into the culture – once people essentially forget that it even exists in post-implementation, that’s when the technology will transform and change healthcare.” And that, of course, is when the real transformation begins.
Healthbox, a HIMSS Innovation Company and healthcare advisory firm, drives innovation from the inside and out, helping organizations build internal innovation programs, assess the potential of employee-led projects and look to the market to find solutions to implement or invest in.