When the desire for status gets in the way of change
One unfortunate challenge we see change leaders in healthcare have to handle is status. While status can be an important motivator and incentive, sometimes people get so concerned about their status that it gets in the way or results. Here four examples from our work:
- A physician leader is more interested in positioning himself to be the next CEO of the institution than in helping the current CEO succeed in making mission-critical changes for the organization’s ongoing success. As a result, he sometimes derails initiatives that might not get him the credit or visibility he desires.
- Executives and leaders want to attend all meetings that the CEO and COO attend about the change initiative, or else they feel slighted or that they are not as important as their colleagues. Sometimes meetings are crowded with far more people than are needed to make decisions, and the leadership team is not as productive as they could be.
- The leader of the revenue cycle is proud of the fact that days’ receivables are among the lowest in the industry. However, he has achieved this feat backwards — by loading employees at the back of the process to correct errors and collect bills, rather than at the front of the process to get the insurance information correct in the first place. Two benchmarking studies have shown that his group is very overstaffed compared to industry benchmarks, even for institutions with similar receivables numbers. By changing his process to be more in line with the industry, he could help his organization be much more efficient and still get the same great results. Still, he will not let anyone change his process, and maintains his power and financial budget by keeping as much information in his own head rather than with the organization, as well as by making threats about what will happen to cash flow if anyone even suggests that he make a change.
- During a significant performance improvement initiative, administrators challenge employees to come up with cuts that will not have an impact on patient care or quality. Meanwhile, many employees notice that the administrators have a number of visible perquisites, and suggest that the administrators make some sacrifices themselves. For instance, one C-level executive receives a lease to a fancy sports car. All of the executives receive memberships to not just one but multiple country clubs in the community. While some executives jump on board to show their commitment, a few refuse to make a single sacrifice, even as a symbolic gesture to show employees that they are serious about the change initiative.
The change leader in healthcare has to wrestle with situations like the above, and these are only a sample of the types of issues that can come up. Solutions range from demonstrating through example to using tactful influence, applying incentives and pressures, setting expectations with a bit of edge, and – when needed – diminishing someone’s role or even removing them from the organization. Knowing what to do and then doing it in an efficient time frame while being observed in a highly political environment only adds to the challenge.