The Art and Science of Making Change Stick in a Clinical Setting

I am a co-founder of a software company for the healthcare industry. And while I am new to the start-up game, new to software and new to sales, there is one thing I know: how to successfully implement a new workflow or a new technology in a healthcare setting. 

(My company, ReadyList, marries these two ideas to create clinical environments that are 100 percent ready for excellent patient care.)

I have implemented more than 20 change initiatives in healthcare environments over my career. 

A change initiative is a transformational project within an organization. Examples include transforming hospital patient rooms so they are 100 percent “nurse ready,” and building a high-performing hospital service department.

One thing I have learned is that there is an art and science to making change stick. 

My wife, Claire, once said that my work is part professional organizer and part psychologist. Oh and I am also a professional cat herder. 

In this article, I will share with you 12 things I have learned about the art and science of implementing a change initiative and how to make it stick. 

Entire books have been written on each of these 12 concepts…please let me know if you need any recommendations!

The Science of Change Initiatives

For anyone running a change initiative, this is the part of the job that requires professional organization skills.

There are six building blocks of a solid change initiative you need to consider as you embark upon your journey:

1. Strategic Goal

First and foremost, the change initiative should be tied to solving a business problem. For example, your goal might be to improve infection prevention or improve OR turnover time. 

2. Scope of Work

Sometimes, the scope of work can be underestimated.

Let us say the change you are making relies partly on implementing new technology. Do not forget that as part of that, you will need to consider the operational changes that come along with that technology or the scope of training staff to use it.

3. Project Schedule

You have to be able to budget time appropriately when mapping out timelines. 

For instance, you may have eight hospitals in your health system that could benefit from a change initiative. If you have a one-year timeline, you cannot simply divide 12 months by eight hospitals. 

You will need to think about the fact that you may need to budget more time in the beginning for the first two or three hospitals while you work out the kinks.

4. Budget

There are three things that work together when planning an initiative: scope, schedule and budget (aka triple constraint). And each one impacts one other.

If you have a lot of work in a short amount of time, for example, you are going to need more resources to complete it. More resources drives up your budget.

5. Issues and Risks

Active management of issues and risks is key to a successfully run project. 

Issues are problems that currently exist that need to be fixed, and risks are potential problems that could hinder the initiative in the future. 

For example, if your entire project hinges on one key resource, your project has a delivery risk. When that resource falls ill when you are days from launch, you have a real issue.

6. Sponsors

Sponsors of a change initiative are usually senior executives who have bought into the strategic goals. They hopefully control budget when needed and go to bat for you when it counts. 

The six areas I covered in this section are the basics of project management. The next six areas I will discuss are more advanced techniques in making change.

The Art of Change Initiatives

There is certainly a science to managing projects. But there is an art to bringing about change, and it starts with understanding how people work. This is where the psychologist in you can do wonders.

If you try to instigate change purely based on a scientific approach you will fail. Successful project managers know this. 

For proof, just take a look at this advanced project management program curriculum at Stanford. 

Note class titles like “Managing Without Authority” and “Building Winning Stakeholder Commitments.” (This is an incredible program, by the way, if you ever have an opportunity to attend.)

Here are six things you need to consider as you try to affect change:

1. Incentives

So you have your sponsors, but each will have their own goals tied to the initiative. You will need to be clear when communicating the initiative in a way that aligns with their individual goals. 

This is not trickery--it is a way to align right the message with the right audience, and then deliver. 

2. Influence

To be successful, you need to get people to do things, but you have no power over them.

One way to influence up the chain of command is “managing upwards.” Essentially: thinking like leadership and doing what it takes to make busy executives’ jobs easier, so they can continue to buy into the initiative. 

That can be in the form of simple messaging, touching base quickly and regularly to update and resolve issues, sharing snapshots of the KPIs you are tracking, and so on.

But you also have to win the hearts and minds of everyone else in the organization. According to McKinsey, “What the leader cares about (and typically bases at least 80 percent of his or her message to others on) does not tap into roughly 80 percent of the workforce’s primary motivators for putting extra energy into the change program.”

MicKinsey suggests creating messaging around the change initiative that relates to the five factors that motivate employees: 

1. Impact on society
2. Impact on the customer
3. Impact on the company and its shareholders
4. Impact on the working team
5. Impact on “me” personally

3. Agility vs. Discipline

Agility is underrated. Sometimes you have to take the long winding road to be successful.

As frustrating as that can be for some, if you keep your eye on the prize, you will eventually make that change.

A professional mentor of mine whom I worked with at Kaiser Permanente, Les Sherry, once shared his perspective with me on obstacles to change.  

He showed me a picture that represented the “Kaiser landscape.” In it there was a road that encountered forests, rocks, desert--basically things that were getting in the way of traveling from Point A to Point B in the easiest way possible. 

I will never forget how he explained it. 

All those things, he said, were obstacles within the organization that will try to stop change. But there is always a way to work around those obstacles--you just may have to take the long and winding road to do it.

4. Servant Leadership

Servant leadership is a philosophy and approach to managing that focuses on serving others. Drive the initiative yourself, but let others be successful and have the glory. 

This is a fantastic way of motivating others by putting their needs first. 

5. Foresight

When faced with an obstacle, sometimes it is easy to lose sight of what is coming down the road, say, three months from now. 

Having foresight can ensure those obstacles do not become bigger than they are. Looking ahead can help you better solve problems in the moment.

6. Self-Reflection

The first construct of emotional intelligence is self-awareness. 

Anyone running a change initiative knows they cannot do it alone. You need both left brain and right brain skills. 

The key is recognizing your own strengths and weaknesses, and partnering with the right individuals to get it done.

And if part of your change initiative requires working with outside vendors, make sure they are true partners. 

If you are implementing a new technology into your clinical setting, for example, you want them to not just hand off the software, but help you implement it successfully. 

Closing Thoughts

Being a change agent is a little like being a professional organizer, clinical psychologist and cat herder all rolled into one. 

While there is no magic formula that guarantees you can make a meaningful change in your clinical setting, the 12 factors I have outlined in this article have helped me make changes and make them stick.

Brian Herriot is a hospital operations leader and CEO of ReadyList, Inc. ReadyList software ensures fully operational clinical environments to help clinicians dedicate more time to their patients.