In this rapidly changing health care environment, hospital-based procedural services are facing a number of daunting challenges, not the least of which is the transition to value-based services. For many hospitals, this transition will require a complete overhaul of processes and behaviour, starting with the scheduling of a patient for surgery and continuing on to include all subsequent elements of surgical care.
There are literally thousands of articles and books on managing organizational transformation and much of this business science can be used by hospitals in their transition to value-based procedural services.
Here are some important points:
All change requires a collective and individual transition from old to a new behavior. An internal psychological acceptance of change is required and is a three-step process:
1. Accepting that change is needed; associated with a letting go of the old processes and culture.
2. Once the group accepts the need for change, a carefully managed behavioral re-patterning must occur. This is essential before successful transition takes place.
- Finally, moving into the new system, with a remodeled system that promotes acceptance of new behaviors and processes.
Step 1: Creating the individual and collective acceptance that change is needed is the foundation and start of transformation.
- All change is resisted! Don’t be surprised at significant pushback.
- Carefully define issues associated with the current state. Using group discussion build an agreed upon model of the desired future state. Continual communication throughout the process is an essential element of successful transformation.
- Be understanding and supportive of the grieving, anger, bartering, depression and disorientation associated with the loss of the current state.
Step 2: Process change is always associated with behavioral modification. During this period, linked with adopting new processes and a new culture, lots of problems can surface. This is the time when careful and enlighten management is most needed.
- It should be noted that some individuals will find the proposed changes too burdensome and confusing. Polarization can destroy the transition to a well-intended future state.
- Individual and collective support and guidance during this period is essential. Carefully define the changes required, with associated metrics and agreed upon goals. Be patient, this phase consumes the most time, sometimes months.
- Allow the group plenty of time to internalize the needed changes. Often the group will ‘brain storm’ and come up with creative ideal to expedite transformation. Whenever appropriate, use pilots to demonstrate feasibility of the future state.
Step 3: In the final phase, implementation of the new processes/culture is not without issues. Despite all the effort put into behavioral remodeling of step 2, fear of failure can prevent successful rollout of a new system.
- Reemphasize the reasons and need for the change. Individual coaching may be required.
- Carefully define and repeatedly communicate a picture of the new state. Use metrics as a measure of success. Quick wins are highly desirable. For example, first case on-time starts are significantly easier to achieve than improved turnover times. Start step 3 with an emphasis of improving first case starts.
- Finally, be consistent and celebrate success! The new system should stress fairness, avoiding the favoritism that occurs today in many of our hospital operating rooms.
In summary, for most hospitals, adopting value-based surgical services, will require a significant redesign of their system, associated with extensive behavioral and process remodeling of both staff and physician activity.
Leading and managing this transformation should be a carefully orchestrated step-by-step process based upon sound business principles.
 Managing Transitions 3nd Ed., William Bridges, Da Capo Lifelong Books (August 11, 2004)
For more information on the transition to value-based surgical services and bundled payments, check out this blog post: Managing the Cost & Revenue in an Era of Bundled Payments
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