3 Steps for Engaging Health Care Providers in Organizational Change

One of the hardest things about introducing innovation or change in organizations is getting people on board. This is especially true in health care.

As health care organizations are being pressured to cut costs, reduce medical errors, and adopt both standardized processes and new innovations, providers are being asked to give up established and comfortable ways of working. They are having to spend more time on documentation, see more patients in a day, and use unfamiliar processes and tools. For many staff, physicians, and nurses, these changes mean less time healing patients and fostering wellness — the reasons they became health care professionals. Naturally, many start to question the direction of their organization, as these new behaviors and practices appear to conflict with the values of their profession.

When staff view innovations and changes as clashing with longstanding patient care values, they are less likely to adopt new behaviors and practices. This is why health care leaders need to focus on aligning innovation with existing cultural values, and devote more time to explaining how new processes and behaviors will allow employees to better enact their values and deliver high quality care.

Based on our research on organization change, our involvement in health care leadership training, and our conversations with over a hundred health care executives, we offer three key ways managers can engage providers in change and connect innovation efforts to their core motivations, passions, and values.

Seek to understand why staff think innovations or changes do not align with the existing culture and mission. In a leadership training session we observed, the CEO of a nonprofit medical practice and research organization listened to division and department chairs share their employees’ concerns: quality care is sacrificed for financial pressures, standardized processes negate years of expertise, techniques once heralded as best practices are being replaced, and so on.

The CEO told these leaders to take two steps: first, listen to the doctors and staff to understand why they perceive misalignment between the myriad of changes and the values of the organization; second, reframe and strengthen the connection between innovations and the core values of the hospital, so it no longer seems like a misalignment. For example, standardized processes or instruments are not negating doctors’ expertise, but rather helping ensure consistent quality of care.

Elsewhere, a CEO of a large integrated health system told us about seeking to understand staff perspectives through weekly rounds. In one case, he listened to nurses express resistance to a new process for end-of-shift patient handoffs. The old handoff process was simply a private conversation between two nurses; but the new way included a “bedside shift report” that included the patient in the nurses’ conversation. Many nurses thought the new process took much longer and hindered the exchange of information.

The CEO addressed their concerns by focusing on the improvement in patient care. He highlighted that with the new process, patients were more engaged in their care and better understood the need for medications or procedures, which in turn affected the ultimate outcome of patient health. He reminded the nurses that good patient care was central to the hospital’s values and why most of them became caregivers. Once the nurses accepted the rationale, the focus of the conversation shifted to logistical barriers that kept them from adopting this change (e.g., what to do if the patient is asleep at shift change). Alignment of common values enabled and motivated them to work through this change adoption together.

Engage employees with data to explain the problem, its urgency, and how to address it. Data and metrics can create an awareness of problems, a means to explore them, and a goal post to measure progress. Let’s look at a problem shared by many health care organizations — health care-associated infections. Based on data from the Centers of Disease Control and Prevention (CDC), on any given day, about one in 25 hospital patients gets at least one health care-associated infection. A common cause is poor hand hygiene: The CDC suggests that, on average, health care providers clean their hands less than half of the times they should.

The leader of a large integrated hospital system shared with us how they used data to change existing norms and routines and drive more hand washing. The hospital assigned “stealth monitors” — employees at various levels and roles who worked across several units and covertly collected observational data at set times. A safety group collated this data by unit and included it in a posted weekly report.

During morning huddles, unit and division leaders shared the data and started conversations about potential reasons behind the numbers. This weekly dialogue not only kept the problem in the forefront, but also engaged employees in diagnosing the barriers and factors outside of their control that made change hard to implement.

In one discussion, employees shared that when the batteries in the hand sanitizer dispensers died, it decreased handwashing until workers from another floor could replace the batteries. A simple change of moving spare batteries to the units and allowing anyone to replace them eliminated a critical barrier to improving adoption. This combination of data, engaging staff in problem-solving, and appealing to the mission of good patient care drove the rate of handwashing from 45% to 82% in one year.

Pay attention to the behaviors you reward and tolerate. As part of the same hand washing initiative, hospital system administrators created a Speak Up program, which empowers and trains nurses, staff, and doctors to call out anyone failing to wash their hands, on the spot, as they moved from patient to patient. For the campaign to work, no one, regardless of level or status, was immune from a reminder to wash his or her hands. Engrained cultural norms and power relationships about speaking up needed to be shaken (e.g., technicians were empowered to remind surgeons to wash their hands).

The weekly huddle meetings became a time to acknowledge those who bucked the existing power norms and reinforce the new behaviors. At these, the CMO handed out Starbucks gift cards to the staff that spoke up to physicians and others when they did not wash their hands. Rewarding new behaviors that contradicted the existing norms reinforced the message that it is safe to act in new ways. The change would not stick if doctors were exempt from feedback about noncompliance.

Doctors were also encouraged to thank anyone who spoke up to them when they forgot to wash their hands. When physicians negatively reacted to feedback from staff and resisted the culture change, an administrator reached out to them. The administrator reminded the physician of everyone’s responsibility for patient health, often using an emotional appeal: “How would they feel if their family member was seen by staff that did not engage in healthy hygiene?” Their comments linked physician behavior to the shared core values of high quality patient care.

The status quo persists when bad behaviors at any level of the organization are tolerated. When leadership understands that turning a blind eye to one bad behavior can decimate the adoption of innovation by others, they may be more willing to hold difficult conversations with the highest-status employees in their organization.

As health care continues to transform, aligning new innovations with existing cultural values will make it easier to lead successful change initiatives. Seeking to understand staff perspectives, using data, and holding all employees accountable for patient safety and care will help providers understand how change can support, rather than contradict, the values they hold dear.