Describe strategies to manage change and innovation in healthcare

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Middle managers are important to make innovation implementation happen [ 49 , 76 ], but their variety of roles and limited decision-making authority with respect to implementation hinders their innovative capacity [ 76 ]. As managers are more involved in the innovation process than other health professionals, they feel more motivated for the innovation than front-line employees. Chuang et al. Furthermore, Birken et al. In return, middle managers can utilize this support by asking for extra assistance in the execution of the innovation strategy [ 42 ].

Commitment to innovation concerns organizational actions aimed at the attitude, training and development of individual employees to support them in their individual readiness to get better at innovating. The main factor consists of the sub-factors innovative behavior and innovative competencies. Innovative behavior concerns employees undertaking innovative actions contributing to innovation readiness and has been researched in four studies [ 48 , 59 , 67 , 73 ].

Innovative behavior is stimulated by managerial support e. Furthermore, high-involvement HRM practices e. Taylor et al. The results show that, where employees are driving innovation, they mobilize already present space, funding and staff at all levels of the organization and that the support of senior staff is crucial in facilitating access to resources.

Innovative competencies concern the skills and motivation of employees to contribute to the innovation readiness of the organization and has been researched in two studies [ 47 , 78 ]. An increase in individual competences necessary for the use of information technology, typically a non-core competence of health care workers, resulted in a higher organizational ability to innovate [ 47 ].

Weatherford et al. Five competency domains for leaders of innovation were identified: disruptive change positive open attitude toward change , experimentation and design thinking, innovation and creativity, translating innovation into operations and risk taking.

Our study identified 10 sub-factors contributing to the innovation readiness of health care organizations that were clustered into four main factors: strategic course for innovation, climate for innovation, leadership for innovation and commitment to innovation Fig. The factors found in this review show overlap with the literature about factors contributing to innovation readiness in business [ 83 , 84 ] and health care [ 17 ].

The theme strategic course for innovation is reflected in elements such as innovation strategy [ 17 , 83 ], project management [ 83 ] and planning [ 84 ]. Climate for innovation is reflected in elements such as the culture [ 17 , 83 ] and context of the organization [ 84 ], whereas leadership for innovation is reflected in leadership [ 17 ] and commitment to innovation in support [ 84 ] and competencies [ 17 ]. Despite the overlap, there are also differences.

Adams et al. According to Weiner et al. This scoping review shows that the concept of innovation readiness in health care is described in the literature with a variety of terms and there does not seem to be a generally accepted definition of innovation readiness. Furthermore, it reveals that the likely interplay within and between the four main and sub-categories contributing to innovation readiness are understudied and understanding their interplay will support organizations in becoming better at innovating.

Hardly any theoretical frameworks encompassing innovation readiness were used in the reviewed studies. The other half of the studies were undertaken in a variety of health care settings e. Organizational characteristics such as facility size , market characteristics such as competition [ 85 , 86 ] and the educational level of staff [ 85 ] are found to influence innovative activities of organizations and might explain the larger representation of hospitals in this review.

The question is whether research findings about innovation readiness can be transferred from one context to another. Besides the above-mentioned characteristics, the external setting and the roles played by external stakeholders e. It might be worthwhile understanding how innovation readiness differs over the diverse contexts in health care.

Of the 44 studies reviewed, 21 researched factors contributing to innovation readiness in the implementation stage of the innovation process. The main stages of an entire innovation process are described as idea generation, idea selection, solution development, implementation, scale-up and diffusion [ 17 ]. Opportunities for innovation are sought, selected and developed in the first stages. In the implementation phase, the innovation is put into practice by health care professionals [ 92 ].

In the last stage, actions are taken to support full scale spread of the innovation in the organization. The focus in research on the implementation of innovations is reflected by the attention in research to heavily cited implementation models Rogers [ 93 ] and Greenhalgh et al.

The emphasis on an evidence-based approach in care might have provoked an impulse for the implementation of innovation, although experience revealed that innovations developed elsewhere cannot simply be implemented in any other context [ 94 ].

Furthermore, the focus might be explained by the funding of national and regional governments to enhance the implementation and up-scaling of innovations to benefit specific target groups [ 10 , 40 , 95 ].

Consequently, understanding innovation readiness in health care might benefit from research encompassing every stage of the innovation process. This study has several strengths and limitations. In terms of strengths, it offers a unique contribution by presenting the state of the knowledge reflected in peer-reviewed literature from empirical studies, on factors contributing to innovation readiness in health care organizations. The study used a transparent and replicable review process.

However, our study presents some limitations. First, it is subject to publication bias, since we only included studies published in peer-reviewed journals and excluded gray literature. Second, as there is no clear and consistent definition of innovation readiness, related search terms used for the search strategy can cause selection bias due to searching for specific words within the selected databases.

Selection bias in the selection of studies was prevented by considering a broad range of words in relation to innovation readiness and reflection in the research team. Third, all but two studies Pakistan and South Africa were performed in the developed world and may impose a limitation on the findings of the study. The study increased the understanding of the determinants of innovation readiness and can support managers in health care organizations to decide on how to manage their efforts to become better at innovating.

This scoping review has summarized four main factors contributing to innovation readiness in health care organizations: 1 strategic course for innovation 2 climate for innovation 3 leadership for innovation and 4 commitment to innovation.

The factors contributing to innovation readiness Fig. Research into the innovation readiness of health care organizations is a rather new field and lacks a generally accepted definition of innovation readiness, as well as a theoretical framework to guide research into innovation readiness. Future research could be directed towards defining the concept of innovation readiness and the development of a framework for innovation readiness to support managers in diverse health care settings to meet the challenges that health care organizations face.

This review contributes to the first stage of theory building on factors contributing to innovation readiness. However, a better understanding of the interplay of factors contributing to innovation readiness in all stages of the innovation process and in diverse health care settings is needed.

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Planned change is a decision to make a deliberate effort to improve the system. Innovation is the use of a new idea or method. Transformation means the use of new ideas, innovation, and creativity to change fundamental properties or the state of a system. Resistance means to refuse to accept or be changed by something. Change agent is a person or thing that produces a particular effect or change. The term has come to be used for a person who functions as a change facilitator.

Longitudinal field research on change: Theory and practice. Organizational Science, 3 1 , In the s, surveys began reporting disappointing failures with organization change.

CEOs reported that up to 75 percent of their organizational change efforts did not yield the promised results. These change efforts fail to produce what had been hoped for yet always produce a stream of unintended and unhelpful consequences. Leaders end up managing the impact of unwanted effects rather than the planned results that do not materialize. Change has long been a topic of interest to individuals and organizations.

In the past, writings on organizational change emphasized a top-down planned change strategy. In most of these, the focus was on the role of administrators and top managers in the change process.

Change was seen as initiated by administrators who formulate a plan for the change and communicate it to middle managers and others.

Strategies for disseminating the change, informing staff, and dealing with resisters often viewed as stubborn and irrational are developed and implemented Table displays contrasting views of change. Alternative views emerged that promoted the idea that top-down change is not just undesirable; it does not work Balogun, All levels need to be involved in planning for and sustaining change, and ideas for change can come from all levels.

In addition, when considering the processes of change, issues of power and how individuals make sense of the change are essential. Evidence supports this emergent view of change Shanley, There is little evidence in the literature showing whether any of the specific approaches to planned change actually work.

There is evidence about what does work Balogun, The literature points to the decreased importance of executives and increased importance of those affected by any change. The planned approach is too simplistic, takes too much for granted, and does not allow the analysis of the complex aspects of change over time.

Theories of change that focus on the human side of change are important to consider. The leader-collaborator relationship needs to be central to the process. Along with communication, change management is a critical leadership competency.

Two major types of change are applicable both to individuals and to organizations. They are first-order and second-order change. A classic book by Watzlawick and colleagues popularized the terms. In their definitions, a first-order change is one within a given system in which the system itself is unchanged. The terms first-order change and second-order change can be applied to individuals, small systems, and organizations. First-order change occurs in a stable system and is characterized by rational stepwise processes.

It is seen as a method for maintaining stability in a system while making small incremental adjustments. First-order change is not seen as a vehicle for innovation, nor would it achieve organizational transformation Alas, For an organization, it is adaptation based on monitoring the environment and making purposeful adjustments.

At the industry level, this is evolution as a response to external forces such as markets. An example in nursing is when a new evidence-based protocol is developed and put into use in clinical practice. This is adaptation and adjustment. Second-order change is discontinuous and radical and occurs when fundamental properties or states of systems are changed. Second-order change calls for transformation, using innovation, new ideas, and creativity.

In a second-order change, however, the occurrence changes the system itself. Watzlawick and colleagues found that second-order change often appears strange, unexpected, and even nonsensical. At the organization level, second-order change is described as metamorphosis. The entire organization is transformed, reconfigured, or moved along its life cycle. At the industry level, second-order change occurs when an entire industry is revolutionized or experiences quantum change such as emergence, transformation, or decline.

These efforts are often described as planned change and involve top-down conception, communication, and implementation. Literature on organizational change is extensive. In addition, newer approaches to organizational change, consistent with the emergent views, and can be found in the literature. In the s, Senge introduced the idea of learning organizations. Learning organizations are ones that learn to adapt to change Alas, How organizations adapt is related to their ability to be open, dynamic, and responsive to changes in the environment.

The success of the learning organization is directly related to the people within the organization and their own learning. Within the learning organizations, Senge described the following five learning disciplines:. Learning organizations are about change and helping people embrace change. Although Senge and colleagues noted that change and learning are certainly not synonymous, they believe they are clearly linked.

Anderson and Anderson also challenged hierarchical approaches to organizational change. They described how organizational leaders realized that traditional top-down, manager-driven approaches were no longer working. On encountering obstacles and resistance, leaders learned that they had to focus more on the process of change and human relationship aspects.

Anderson and Anderson call the old way of viewing change as the industrial mind-set, and that organizational leaders need to move towards an emerging mindset. The industrial mindset is a mechanistic world view, relying on power and control, certainty and predictability.

Anderson and Anderson identified the emerging mindset, like other complexity views, as one grounded in wholeness and relationship, embracing co-creation and participation.

A component of this emerging mindset is that leaders need to move to what they call conscious change leadership. Conscious change leaders are aware of the dynamics of change and learn to lead from the principles of the emerging mindset. Conscious change leaders must be willing to look internally to transform their own mind-set, expand their thinking about process, and evolve their own leadership style.

Like learning organizations and conscious change leadership, systems theory, complexity theory, and chaos theory are all models or worldviews that influence organizational change.

These models suggest that the behaviors of complex systems are nonlinear, spontaneous, and self-organizing. Small changes can often produce larger dynamic and sometimes unintended effects.

However, these are not prescriptive models; instead, the focus is on interrelationships, processes, and systemic behavior. Nurse leaders, from the bedside to the executive suite, need to understand and be able to apply a variety of change theories.

The majority of change theories originate from the work of Kurt Lewin. Most nurses have heard of Lewin and his three elements for a successful change: 1 unfreezing, 2 moving, and 3 refreezing Figure Since his work outlining the basic concepts of the change process was first published in , it has been influential to those interested in change. It might be tempting to consider his ideas more consistent with the older, more traditional views of planned change Burnes, However, Lewin was not only a remarkable thinker but also a humanitarian who believed that it was essential for democratic values to permeate all aspects of society.

His model is also meant to help increase understanding about how groups and organizations change, and not as a rigid strategy to impose change. Lewin coined the term planned change to distinguish the process from accidental or imposed change Burnes, An awareness of the need for change occurs. This first stage is cognitive exposure to the change idea, diagnosis of the problem, and work to generate alternative solutions. The unfreezing stage is considered to be finalized when those involved in the change process understand and generally accept the necessity of change.

The second change stage is moving. This means proceeding to a new level of behavior, which implies that the actual visible change occurs in this stage. When the individuals involved collect enough information to clarify and identify the problem, the change itself can be planned and initiated. As a first step to launch a change, a pilot test may be done so that the change can be pretested and a transition period launched.

The final change stage is refreezing. In this stage, new changes are integrated and stabilized. Reinforcement of behavior is crucial as individuals integrate the change into their own value systems. It is important to reward change behavior. Leadership strategies of positive feedback, encouragement, and constructive criticism reinforce new behavior. Leaders point the way throughout the process of change.

Unfreezing is like assessing in the nursing process and like problem identification and definition in the problem-solving process. Moving is similar to planning and implementing in the nursing process and similar to problem analysis and seeking alternative solutions in the problem-solving process.

Refreezing is like evaluation in the nursing process and like implementation and evaluation in the problem-solving process. Data from Workman, R. The change experience. Schroeder Eds. Rockville, MD: Aspen. Individuals and systems naturally strive for equilibrium. Lewin saw this as a balance between driving forces that promote change and restraining forces that inhibit change. Both driving and restraining forces impinge on any situation. The relative strengths of these forces can be analyzed.

To create change, the equilibrium is broken by altering the relative strengths of driving and restraining forces. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.

Unfreezing occurs when disequilibrium is introduced into the system to disrupt the status quo. Moving is the change to a new status quo.

Refreezing occurs when the change becomes the new status quo and new behaviors are frozen. The process of change may flow back and forth among stages. It is not a simple linear process in which one step follows the preceding one.

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These requirements and mandates, paired with the constant innovation in the IT space, invariably impact the operations and outcomes of care delivery. This change affects health care professionals at every level, from the physician dealing with new reimbursement models, workflow alterations and regulations to the leader evaluating strategies for profitability and patient satisfaction.

Change in our industry is a reality, and as leaders, it's essential to manage the impacts of change for the benefit of the health care organization, the care team and, most importantly, the patient.

Health care is too important to stay the same , and health care professionals should understand how to manage change when it inevitably comes. Following are some key strategies for navigating in times of change. Regulatory adjustments, shifts in consumer behavior patterns, the accelerated pace of IT development and the aggressive rate of health care organization consolidation are all factors in the health care industry.

There are a number of factors driving up the rate of consolidation among hospital organizations and physician practices, including the shift from fee-for-service to value-based payment models and the changes brought on by the Affordable Care Act and the current discussion around its repeal and replacement.

For many, the potential need to change — especially to create new partnerships, become part of an organization or affiliate with a larger organization — is top of mind. For decades, marketers in other industries have been appealing to the consumer by making their experience more connected and more personalized. It's no surprise that health care consumers expect similar engagement strategies from providers. Increasingly, consumers want to be more involved in their health care decisions, and that means providers are looking to innovative technology, informed patient engagement strategies and different organizational structures to drive better patient experiences.

These factors can result in disruptive, voluminous and rapid change. The first step in leading through such dynamic times is to expect and accept change. Rather than resisting or avoiding what can feel like looming disruptions, it's important to proactively engage. Whether it be an organizational shift, a change in business models being adopted or an improvement in technology, it is important to seek to understand the drivers, goals and expected outcomes of such change.

Understanding the rationale for any given change is essential to being able to not only support, but to positively impact, the intended outcome. Think about what the change may mean to the organization, your team, your patients and you personally. Considering all the impacts in advance can provide a blueprint. Communication is the foundation of a successful change management strategy.

Most important is communicating the right content, at the right time, to the right stakeholder. When change comes for a health care organization, it happens on multiple levels — and the pieces move differently. For example, an organization's leader is not going to broadcast a discussion about consolidation until decisions are made. At that point, transparency is key in communications with the internal team.

Those are the people who will help develop an external communication strategy so that the community and patients the organization serves are included in the change. For CIOs who are reframing their IT plans for the future, it's essential to engage stakeholders early and be transparent about what is coming.

Engaging stakeholders will help define an IT implementation and adoption approach that will positively impact team members and their work processes. Part of being transparent is inviting them into the change process.

There will be questions and concerns through every stage of the change process, and perhaps the most important thing leaders can do is to pay close attention to their people. Open and frequent communication is essential. Consider using a variety of forums such as email, blogs, newsletters, town halls and roundtables, all of which can help establish trusted relations in advance of and in the throes of change.

Typically, changes introduce new team members, stakeholders and processes. Don't wait until members of your team may have heard through the grapevine that change is on the horizon — make sure they are hearing from you first.

Part of being transparent is inviting them into the change process. There will be questions and concerns through every stage of the change process, and perhaps the most important thing leaders can do is to pay close attention to their people. Open and frequent communication is essential. Consider using a variety of forums such as email, blogs, newsletters, town halls and roundtables, all of which can help establish trusted relations in advance of and in the throes of change.

Typically, changes introduce new team members, stakeholders and processes. Don't wait until members of your team may have heard through the grapevine that change is on the horizon — make sure they are hearing from you first. Health care and HIT is a team sport — there are multiple players that make it successful. If the focus is only on the software, with input only from stakeholders on the IT side, you miss the opportunity to understand the user perspective. How do users want to improve their workflow and how might those insights may be incorporated that into the change?

Think of it this way: If we have to upgrade an IT system due to a regulatory requirement and the upgrade is going to change the user's workflow, the sooner that you engage the user community, the sooner they can impact how the change happens.

Getting that buy-in upfront is critical, because if the user community hasn't been a part of the adjustment and the new system isn't optimized for their workflow, optimal outcomes will not be achieved. Likewise, during an acquisition or reorganization, take the lead in reaching out to new colleagues, seek out opportunities to learn about upcoming changes so you can proactively prepare yourself and your team.

Being proactive also gives leaders an opportunity to influence and shape the direction and impact of change. To succeed in times of change, it's important to make personal adjustments, including learning new tools or processes as well as adjusting your approach to be effective in a new landscape.

Reflect and assess what may be required operationally and personally, and then commit to making it happen. You can be part of the solution by focusing on the goal and jumping in to help where you see it's needed. Managing change is making it something that doesn't scare you and that you don't resist.

It's being resilient while accepting change at face value and becoming part of the process. It's assessing the situation, anticipating the needs of your organization and looking forward. As cliche as it sounds, the goal should not be to survive change — it should be to thrive in it.

Thriving in change means finding the potential benefits, communicating through it and bringing people along with that. Do you want more HIT insights?

Check out Cerner's Perspectives , a thought leadership publication. Skip to main content. Skip to footer. Change is coming — learn to be ready for it Regulatory adjustments, shifts in consumer behavior patterns, the accelerated pace of IT development and the aggressive rate of health care organization consolidation are all factors in the health care industry.

Increased rate of consolidation in health care organizations There are a number of factors driving up the rate of consolidation among hospital organizations and physician practices, including the shift from fee-for-service to value-based payment models and the changes brought on by the Affordable Care Act and the current discussion around its repeal and replacement. Shifting consumer behavior patterns For decades, marketers in other industries have been appealing to the consumer by making their experience more connected and more personalized.

Expect and accept change The first step in leading through such dynamic times is to expect and accept change. Be transparent, timely and frequent with communication Communication is the foundation of a successful change management strategy. Be proactive and engage Typically, changes introduce new team members, stakeholders and processes. Commit to thriving in change To succeed in times of change, it's important to make personal adjustments, including learning new tools or processes as well as adjusting your approach to be effective in a new landscape.

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