We know where we need to go, but how do we get there? Should I eat the whole elephant at once?
Making successful change within the healthcare environment often produces a complex, resource-intensive Desired State that will take months, if not years, to achieve. For the people impacted by change, it can be challenging to learn the new way while “doing their day job”. They do the best they can and often are left feeling like it is all too much change, too fast.
I am frequently asked by leaders for assistance with a way forward for their organization and the people impacted by these complicated change efforts. The question is whether they should/can consider developing interim Desired States of the change to manage the journey. You should determine the development of your approach by the anticipated level of organizational and people impact and resistance, as well as the urgency to change.
Consider the following:
- Is there a regulatory or other deadline for this change? Is there a penalty or consequence if the deadline is not met? Are there safety or quality concerns?
- Will those impacted by the change be expected to work in a very different way once the change is made? Do you anticipate resistance to this change? If so, can the change be broken into phases?
- Are the Leaders of the impacted areas aligned and ready to support the change? If not, can you start where alignment and support already exists?
- Will making this change put the organization, your people or your patients at risk if you proceed with all of the change at once? Will there potentially be impacts to productivity, capacity, quality and/or satisfaction? Can we mitigate the impact by breaking the change into phases?
In order to develop a map of the way forward for managing the change with a phased approach, I often employ a tool similar to the Multi-Generation Project Plan (MGPP), which is used by Project Managers to break a project into more manageable or logically sequenced phases. It describes the functional change expected as well as the current or new technology that will be used in each phase of the effort.
I use the information from the MGPP and an understanding of the impact to people, process, culture and structure to develop a Multi-Generation Desired State (MGDS). A change management plan will be subsequently developed to enable the level of adoption that is required at each phase.
The MGDS includes the following for each phase or generation of the change effort:
- Description – Concisely explain the change people can expect. Includes group(s), location(s) and/or division(s) impacted
- Structure - Describe the organization, technology, geography and infrastructure
- Process - Describe the way the work will flow: characteristics of the process(es)
- People - Describe their competencies, experience, skills and knowledge
- Culture - Describe how people will behave, what they will believe and the rules they will follow
- Metrics – Document the metrics you will use to know when you have achieved the Desired State
Using a MGDS to map out the way forward benefits the organization and those impacted by change in several ways. It establishes the big picture and helps everyone to understand the change anticipated at each phase of the journey. It documents how each phase supports and moves the organization and its people toward the overall Desired State. It keeps everyone focused on the end goals and supports incremental improvement and celebration of interim goals.
A phased approach to the Desired State allows the organization to manage the change over time, dispersing the impact to people, resource utilization and cost. It also supports re-evaluation, refinement and recommitment to the Desired State at the end of each phase.
Skilled change agents and the Leaders they support realize that the project isn’t finished until the level of adoption proposed in the business case is attained. Without that level of adoption, it will be impossible to realize the return on investment and meet the goals that led them to undertake this effort. Many business cases assume 100% of those impacted by the change adopt the new way of working but there is often little in the plan to enable that adoption. While it may be possible to complete all of the tasks in the project plan under one umbrella, it does not mean that those impacted by the change will get what they need to choose to adopt the new way of working.