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Make Your Initiatives Stick

To drive adoption in an organization that is already stretched thin, apply a precise change management approach.

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The Three-Pillar Framework

Look back at the major initiatives your company implemented in the past three years. What percentage of those achieved their promised benefits? And how many continue to sustain those benefits?

Healthcare organizations invest their top resources, generous time, and money into defining a strategy and executing important initiatives to transform quality, patient access and experience, operational efficiency, and more. Yet when they conduct an objective review—if, in fact, they have data to evaluate—they often find they have not realized the intended results or their benefits have not been sustained over time.

Healthcare can no longer allow the potential benefits of critical, high-effort, high-cost initiatives to go unrealized or only partially realized. In a climate where you absolutely must achieve transformational strategies, you need to bring the entire organization along with you. Priorities, procedures, and processes have to evolve, and employees must embrace and adopt new ways of working. To make this happen, they must be engaged, so they not only buy into the change, they help to champion it and make the results stick. If not, the organization will slide back to its old ways of working and any improvement will quickly fade.

Organizational adoption is the outcome of effective change management.

Even companies that recognize the importance of change management often don’t understand all the elements that need to be in place. For instance, they may believe that “change management” means great communication or effective training. Telling people what to do and then telling them again is not change management. Change management comprises a much broader perspective.

Change management requires empathy, building trust, and an understanding of company politics. And it also demands hard evidence and data, discipline and consistency, and the ability to hold people—even those who are higher on the organizational ladder—accountable. There may be fear, reluctance, and resistance. There may be pressure to succeed, and to do so quickly, especially if it’s a critical transformation. Trying to manage change too quickly, or without engaging the affected employees and considering operations and processes, will make the change difficult, if not impossible, to sustain.

While some organizations overlook or assume adoption and sustainability, others err to the other extreme. If you overengineer the change management approach—for example, by incorporating demanding paperwork or surveys, soliciting input from employees who aren’t directly impacted, or requiring consensus from too many people—you risk wearing out what is likely an already overtaxed organization before adoption can occur. The best approach strikes the right balance by considering the specific situation and the level of change that the project will introduce.

There is no shortage of change management models. But IPM has consistently had to adapt them to suit the initiatives we lead for our clients. So through our experiences, we established and utilize a model that assesses and addresses only the most important elements: the people, the organization, and the project. Why these three pillars? People are the key to any change, and individuals have different experiences, needs and mindsets that need to be considered. The organization—the ecosystem of employees, functional departments, and processes—has a history and environment that influence behaviors and attitudes. And the project is the vehicle by which change is being implemented. If any of these three pillars is neglected, the risk of failure increases.

Implementation leaders and executive teams will find this three-pillar framework helpful for assessing their own situation and applying the insight to successfully execute and sustain major transformational change.

CASE STUDY: Applying the Framework

Integrated Project Management Company, Inc. (IPM) partnered with a midwestern system of long-term-care facilities that wanted to streamline and focus on its core competencies and mission. Among other goals, plans included divesting some facilities, relocating some operations, and outsourcing a corporate function to a third party. The changes would impact many functions, facilities, and residents. So the project plan included a robust change management plan to ensure adoption and sustainability.

IPM used this three-pillar framework to assess the change readiness of the system and build a diligent, right-sized change management plan that leveraged organizational strengths and addressed critical deficiencies. The assessment began with one-on-one interviews with employees across and at various levels within the company.

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Elements to Assess for Change Management Readiness

People are the key to any change, and individuals have different experiences, needs, and mindsets that need to be considered. The organization—the ecosystem of employees, functional departments, and processes—has a history and environment that influence behaviors and attitudes. And the project is the vehicle by which change is being implemented. If any of these three pillars is neglected, the risk of failure increases.

Implementation leaders and executive teams will find this three-pillar framework helpful for assessing their own situation and applying the insight to successfully execute and sustain major transformational change.

Elements to Assess for Change Management Readiness

Are the People Ready?

Change impacts individuals directly and indirectly. They are not only the recipients of change; they are the enablers. It is crucial that employees who are directly affected are engaged, so they buy-in and support the effort. These are the people-related elements to assess to determine if they are ready for change:

  • Leadership commitment to change: Is there sincere and engaged support from leaders at all levels of the organization? Conversely, do leaders demonstrate tacit buy-in or skepticism? Have they successfully led change in the past?
  • Communication history: Are communications typically transparent, at a regular frequency, two-way, and encouraged? Or are they limited to a select group, leaving others in the dark or reliant on rumors?
  • Understanding: Do employees feel well-informed about the change, and do they understand how it will affect them personally? Or are they unaware of the change or its impact?
  • Enthusiasm: Are employees excited about what the transformation will bring? Or are they angry, afraid, or even working against the change?
  • Preparedness: Do people understand and are they accepting of the new competencies, capabilities, knowledge, skills, techniques, and behaviors that the change requires? Or has the necessary training and development not yet been considered?

CASE STUDY: Are the People Ready?

In the instance of the long-term-care organization, the assessment revealed a clear level of understanding of who was driving the change. And staff agreed that it was necessary. There was opportunity to build accountability among other layers of leadership, including those on site at each facility.

A potential inhibitor to change was communication; the system was historically siloed and provided information on a need-to-know basis. This led to concern and rumors, especially among the team in the office that was to close. To address this, IPM recommended that the executive team broadly share communications on the rationale for the changes while also highlighting the organization’s strengths. Communications were personalized so people could see how the change would impact their work and how their work would then contribute to the strategy. Leadership communicated with those who were losing their positions with respect and empathy, providing both emotional and outplacement support.

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Is the Organization Ready?

Beyond the collection of individuals that make up an organization, the organizational culture, structure, business planning capability, and process maturity all impact the ability to manage and sustain change. Change will be more successful with the following factors in place; address missing elements within the change management plan:

  • Organizational alignment: Is there clear alignment between the goals and objectives of the organization, functional areas, and individuals?
  • Change culture: Has the organization demonstrated a culture of continually accepting change and remaining agile to respond to new internal and external influences?
  • Change capacity: Is the organization primed for change, or are they fatigued due to prior frequent or ineffective change efforts? Are they currently trying to change too much too fast?
  • Business processes: Have new business processes, systems, policies, performance indicators, and rewards been planned and documented in alignment with new ways of working?
  • Sustainment and success measures: Are functional groups and employees empowered to support and reinforce the change effort? Do they understand the success metrics and how their work impacts the metrics?

CASE STUDY: Is the Organization Ready?

At the healthcare facilities, IPM found strong alignment to the corporate mission and goals. The employees were committed to serving their residents and open to and inspired by change that would let them do that better. The system was less effective at sustainment and applying success measures; specifically, identifying and holding people accountable to meet specific performance expectations. Leaders throughout the system were hesitant to let go of poor performers. IPM worked with the organization to establish metrics and hold people accountable to them—not only to affect and sustain change, but as an ongoing effort—to define and reinforce high performance.

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Is the Project Structured to Drive Change?

An effective project plan begins with and provides definition to the strategic initiative. When the project is being structured, you must consider the impact on people and their mindset, as well as organizational and business elements. If you don’t have a strong project management competency, including best practices and disciplined leadership, and if the project isn’t well defined with unambiguous objectives and the appropriate level of motivational urgency, the chances are low of implementing the change and sustaining it over time. Here are the elements to evaluate:

  • Strategic disposition and business case: Is the project aligned to the company’s values, vision, and strategic goals? Is there a clearly defined business case that explains the rationale for the undertaking?
  • Role and responsibility clarity: Is there a clear delineation between roles, including level of authority to make decisions? Are individuals’ responsibilities clear? Has a dedicated project manager been assigned? Is it clear who is responsible for developing the change management activities?
  • Solution viability: Is there confidence the project plan will deliver the expected value and meet the success criteria defined in the business case?
  • Schedule confidence: Are the project schedule and milestones reasonable, or is the schedule unrealistic?
  • Risk understanding and management: Have potential risks and mitigation plans been identified, especially risks to adoption of the change?

CASE STUDY: Is the Project Structured to Drive Change?

In the case of the healthcare provider referenced, they possessed capable and disciplined project management. And the project was aligned with the strategy, the value to the business was well-defined, and the schedule was reasonable and achievable. However, it was noted that responsibilities should be more clearly defined.  IPM stressed defining expectations at all levels to enable people to make decisions and take initiative without waiting for approval or consensus. Risk management was also new to many of the leaders. IPM collaborated with the team to define a process and, at the end of the project, provided recommendations to drive continuous improvement.

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Setting Up the Organization for Success

By focusing on the three key pillars of people, organization, and project, and assessing each element upfront, one is able to determine the organization’s strengths and weaknesses and establish a precise change management plan to bolster your ability to sustain your initiatives’ results.

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CASE STUDY: Set Up for Success

When IPM concluded the change readiness assessment, the long-term-care provider was able to establish a tailored change management plan. This included establishing a clear business case and success metrics to provide a strong rationale to the organization. Armed with information from and about stakeholders throughout the organization, they customized communications and training. By engaging the subset of stakeholders most impacted by the change, they were able to identify those who would be enthusiastic adopters and help encourage their peers. And ongoing two-way communications helped as the organization identified risks to gaining and sustaining adoption.


Change Management Assessment & Recommendations

Change Management Assessment & Recommendations

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If you are struggling with redefining your strategy, prioritizing initiatives, or reliably implementing and sustaining your mission-critical projects, IPM’s strategic realization consultants can help. We combine our time-tested expertise in strategic planning, portfolio management, project execution, and organizational engagement to provide a holistic approach to transforming your organization.

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