INTRODUCTION
There is no question that America’s healthcare system is dynamic and complex. With time, this industry is undergoing rapid changes because of technological innovations, new policies, more focus on patient satisfaction and other system-wide transformations. For example, the biggest change which created chaos and frustration was the replacement of paper records with electronic medical records. Healthcare organizations in U.S. as well as in other developed countries faced many challenges in order to successfully implement this change. Leaders and senior management played a major role in the incorporation of this system-wide transformation. Many healthcare leaders adopted John Kotter’s 8-steps for Leading Change to guide them throughout the change process (replacement of paper records with electronic medical records). John Kotter is recognized globally as the leading speaker and author of the topics Leadership and Change. He is an emeritus professor of organizational science and change management at Harvard Business School and conducts inspirational seminars in Executive Education programs. He is the chairman of Kotter International, a management consulting firm that guides leaders worldwide in managing change based on his 8-steps change process. His 1995 book, Leading Change, is considered as the seminal work in the field of change management. Time magazine listed this book in 2011 as one of the 25 most influential business management books ever written. Dr. Kotter has outlined 8-steps for managing change in this book which is adopted by several businesses as well as healthcare organizations for managing change. Kotter’s Change Management Theory Managers and leaders feel intimidated and uneasy while thinking about a small change to one or two processes or a system wide change to an organization. This issue can be solved if leaders adopt a holistic approach required to see the change through. After thirty years of research, Dr. Kotter proved that 70% of all major change efforts in organizations fail because leaders and managers don’t focus on how to deliver the change, where and when to start, whom to involve and how to see it through the end. There are several change management theories, but Dr. Kotter’s 8-step process has been used world-wide by healthcare organizations to implement changes successfully. The 8-steps are listed below. 1. Creating a sense of urgency Creating a sense of urgency includes efforts for developing urgency among employees, so they can feel and understand that why a change is necessary. It’s easy to manage and implement a change when the whole organization wants it. According to Dr. Kotter: "At least three quarters of management must believe that change is absolutely necessary for the transformation to work." Moreover, he wrote: "you must work really hard on Step 1, and spend significant time and energy building urgency, before moving on to the next steps. Don't panic and jump in too fast because you don't want to risk further short-term losses – if you act without proper preparation, you could be in for a very bumpy ride." 50% of the companies fail to make changes because they ignore the first step and rush to make a plan and implement it. This happens because leaders underestimate the importance of driving employees out of their comfort zones or they think that they have already done it, or sometimes they don’t have the patience to create appropriate urgency. If true urgency is created, then employees will be focused on making real progress every day that can help in achieving the goal. In addition, change initiatives fail when leaders try to win the minds or change the thinking of people by just focusing and showing the theoretical value of the change and presenting facts and figures, instead of aiming to win their hearts by changing their feelings about the situation. 2. Form a Powerful Coalition As soon as people in the organization are convinced and start talking as well as thinking about the change project, a team of influential people and effective change leaders is needed who is capable of leading and managing the organizational transformation. Dr. Kotter asserts that people who are not in favor of the change or who just pretend to support the change project must not be included in the team, because this will hurt the change process. Moreover, he suggests that people who are not in the senior management or a senior position in the organization, but always support change and do not follow the traditional company hierarchy must be included in the team. Dr. Kotter asserts that the change team must have the following characteristics:
3. Create a Vision for Change Formulating a compelling statement or in other words a powerful vision that could clearly define the desirable future and make the strategy as well as detailed decisions understandable, is important. A clear and powerful vision will help employees understand what you want from them. When employees can understand what the organization is trying to achieve, then the directions given to them will make more sense and they will be motivated to achieve organizational goals. According to Dr. Kotter: "A useful rule of thumb: If you can't communicate the vision to someone in five minutes or less and get a reaction that signifies both understanding and interest, you are not yet done with this phase of the transformation process." Powerful vision statements will have the following characteristics:
4. Communicate the vision It is important to communicate the vision in a way that catches the attention of the whole organization and maintains the sense of urgency developed in step 1 as well as motivates people to follow the directions. Under-communication of the vision often results in the failure of the change project. Studies show that most companies under-communicate their vision by at least a factor of 10. Memos, e-mails, special meetings, and speeches given by the CEO or the change team at occasions are not enough. Communication of the vision will have a competition with other things communicated on a daily basis. Therefore, in order to keep the vision fresh in the minds of the employees, everything – presentations, meetings, problem-solving, decision making, speeches, company newsletters, training, e-mails, daily activities etc. – must be tied to the vision. In other words, the senior management and change coalition must use every effective communication channel to broadcast the vision of the organization. Moreover, the communication style should be creative enough to win the hearts of the employees or connect to their deepest values, so that the employees are motivated to accept the change. Another important thing is to “walk the talk”. Leaders and managers must lead by example and communicate the vision through their actions. A communication program is undermined if the leaders and the change coalition do not back up their words with behavior. When an entire team of senior management demonstrate the change they want to see, it increases motivation, inspires confidence and decreases skepticism. 5. Remove Obstacles At this stage, an organization must have incorporated the change vision in all aspects and hopefully convinced people from different levels to participate in the change project. As more and more people struggle to achieve the goals, they might encounter certain obstacles that halt their progress or hinder the change management process. Therefore, it’s important to remove barriers that dis-empower people and makes the change process slow. The barriers might be the supervisors, the system, mental walls, and lack of information. Troublesome supervisors are notorious for hindering the change process. Their management style is quite different from what is required to easily adopt the change. It’s difficult to change their behavior. The best solution is honest dialogue. Moreover, A system which fails to reward and promote people who successfully adopt the proposed changes must be modified, otherwise it may discourage people from progressing. Physicians, nurses, radiologists, etc. might think that the proposed changes are not practical or they are so complex that no matter how much effort they put in, the organization won’t be able to survive the changes. These are mental walls which don’t allow people to adopt the change. The change coalition can call consultants or people from other organizations who successfully survived the changes in order to convey the message that ‘‘I survived this type of change, you can too.’’ The last barrier could be lack of appropriate information. Proper information can help people in decision making and improving their performance. Accurate and timely feedback about the level of performance will motivate people to improve. Otherwise, some might think that they are performing at a high level. If that is not the case, then the change process gets slow. 6. Create Short-Term Wins Setting of short term goals is necessary because it breaks the change project into simple and achievable steps as well as provides a framework which can be easily understood and followed by employees to achieve the final goal. Short term goals should be clearly related to the core changes being sought after. The short term wins must be rewarding for the employees, so that they are motivated to achieve them. Moreover, the short-wins will help boost employee morale, enabling them to put extra effort in the future. According to Dr. Kotter: "Most people won't go on the long march unless they see compelling evidence in 12 to 24 months that the journey is producing expected results." In addition, achievement of short-term goals frustrate the opponents of the change project, thus making it difficult for them to criticize and hinder the process. On the other hand, proponents get more support from the senior management. This may lead to the buying-in of more people who were hesitant before in joining the change process. Nevertheless, the short term goals are hard to come by. They need careful planning and efforts to materialize. Lack of commitment, lack of enthusiasm plus poor management by key people may lead to the creation of irrational short-term goals which are hard to achieve and imagine. If this is the case, then people will fail in achieving the short-term wins and this might lower their morale as well as allow the opponents of the change process to demotivate them and criticize the change initiative. 7. Build on the Change Quick wins are just the start of what should be done to accomplish long-term change. Real change runs deep. Following success in the previous stages, failure or challenge is eminent when you don’t expect it. However, leaders should not give up. They must chase their dream. They must not allow failure to sink them back because starting all over again is hectic. Leaders must encourage continuous progress reporting, highlight achieved and future milestones, examine what went right and what needs improvement, set goals to continue building the momentum achieved in the past and, keep ideas fresh by including new change agents and leaders in the change team in order to instill the changes into the organization and make sure the practices are firmly rooted in the organization’s culture. This will help them in building the change. 8. Anchor the changes in corporate culture The new practices which helped in the successful implementation of the change, must be deeply rooted in the organization’s culture. Success must be clearly seen and well communicated. However, on the way some people will leave the organization. Hence, reinforcing the new recruits on the culture of the organization is essential. It is important that the company’s leaders and senior management continue to support the change. This includes old and new staff members. The change team and leaders must:
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