Adjusting to change in healthcare

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Together we developed an agenda for change and put it into action. Things were looking up on all fronts except one. This is the story of what we did to turn that around by involving our people in our organizational change process in a much deeper and more meaningful way.

Doing so, we stumbled across a formula for accelerating organizational objectives while managing even higher levels of performance and engagement. Out of more than responses, that was the one that hit me hardest. We performed pulse surveys quarterly after every town hall meeting at Saint Anthony Hospital.

The questions were developed by Press Ganey, the healthcare survey company, and were related to employee engagement. We also had open questions in our surveys to give people an opportunity to express their concerns related to leadership, operations, compensation, and staffing. The feedback could be tough at times. The disconnect between how they felt about our organization and how the organization was actually performing was perplexing.

To dig into the details, I engaged in a hospital tradition and began rounding. I talked with clinical, administrative, and operational staff where they worked and asked them to tell me more.

Our goal was to become the destination healthcare provider in our market while achieving national standards for best practices, care quality and satisfaction, and becoming recognized as a health leader in the communities we serve.

They were worried about working conditions, managerial support, staffing levels, and so forth, and they believed that leadership was just talking out of its hat because we had failed to address their long-term concerns. Listening and taking notes, I knew I could solve almost everything and still not fix the bigger problem of connection and engagement. There was a lack of trust in us and alignment with our agenda.

Years of experiences with administrators saying one thing and doing another had made people cynical. Hearts and minds would need to be changed in a fundamental way. So I did what CEOs often do when they confront a maze they might get lost in — I called for help and asked an executive advisor and organizational change expert for guidance.

He proposed that we try something new. For example, my chief strategist and one of our hospital CEOs were both passionate leaders who cared deeply about improving our system but they were always on opposite sides of key organizational and strategic issues. By getting them to dig deep and talk about their own personal motivations, it became obvious that they actually shared the same overall vision.

This helped them to identify what they each wanted to do to contribute to our larger agenda and helped us define their distinct roles and responsibilities more clearly. That sort of work had a remarkable effect on bringing leadership together, helping us to communicate with each other more openly and candidly, and making it faster and easier for us to innovate and execute.

But how do you make something like that happen at scale? Purpose is not a canned or artificial HR program. Discovering it is deeply personal and almost therapeutic. When close peers face high stakes, real problems and interpersonal challenges, the work of discovering and sharing purpose seems to galvanize their sense of team almost magically. We decided to implement a similar process among other teams, and then cascade that throughout the organization.

Then we selected 50 of these people and divided them into four model teams. Next, we set these teams to work on defined areas of organizational need — Quality, Clinical Operations, Administrative Operations, and Associate Engagement. Each of these teams went through the same team development program as my senior leadership team. For example, one front-line nurse was incredibly dedicated to patient satisfaction.

Joining the Quality team gave her a way to bring her personal perspective on best approaches to patient care to that group and helped her to see how directly her individual efforts could contribute to our larger goal. Next, we gave these teams the freedom to identify organizational problems in their area of concern.

This efficiency is a key driver of operational costs but also a leading indicator of patient satisfaction and quality since prompt discharge means clinical best practices are being applied and quality outcomes achieved. Our Clinical Operations team was composed of nine people who represented every area of the hospital that touched throughput, from the ER to the wards to pharmacy and administration. Whereas before they might have seen their roles as siloed from one another, now they worked collaboratively to solve bottleneck issues across the system.

Sometimes this work surfaced tensions so it was important to facilitate and coach people through their conflicting points of view. Team members who were initially at odds were always able to reach a collaborative solution because they had spent time getting to know each other and they understood that everyone shared the same priorities around improving patient care.

The vulnerability and openness the team-building process established made it easier to get aligned. This new group became the implementation team charged with executing on the strategy. The original team members who remained were responsible for bringing new team members through the team-building process. The team members who were recused were assigned to new teams where they also helped lead and develop team cohesion in those new groups.

Team members had grown close and wanted to stick together. But by dispersing them to other teams, we created a process of leaders teaching leaders that cascaded throughout the organization, with increasing numbers of people aligned around a shared purpose and focused on solving meaningful challenges. Our focus on meaningful problems was critical. Our approach engaged people on developing tangible solutions that would contribute to our vision.

Attendees at the 20th annual Bettye Arnold Seminar listen to Faith Roberts' stories of inspired care and sustaining energy and passion in the health care field.

Change in health care is a constant throughout our lives. I started at St. Jude in as an inpatient nurse, taking care of children with many different diseases. Arnold, who passed away in , was a nurse at St. Jude for more than 30 years. As St. Jude grew from a one-story hospital into a worldwide leader in pediatric cancer care and research, Arnold adapted her career along the way. Each session promotes professional skills development for staff with patient care responsibilities.

To stay professional, we should remember that we come to work for our patients, our families and our co-workers. Health care workers who can deal with daily change and still offer support to their colleagues are true professionals and a valuable asset to their organizations.

Being present for our colleagues helps everyone to adapt and embrace change.