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Healthcare Change Management: Two words to avoid (and three to embrace)

Healthcare Change Management

In innovation and healthcare change management, one of the things I enjoy most about working with people who provide health & social care is their passion for what they do. The relationship between the people who provide service and the people who use service generates great intrinsic reward and you find a sincere dedication to achieving the best possible outcomes for people in need.

Often that sincere dedication to achieving best outcomes for individuals can face challenges when providing service in very large organisations, which by virtue of their size operate ‘one size fits all’ systems. As organisations grow their systems are standardised on rules that fit most situations. Of course, as organisations grow those rules are challenged by more and more exceptions. Complexity, cost, challenge.

At its best, ‘one size fits all’ is really ‘one size fits most‘. However, passionate people who care about making a difference for all the people they work with don’t draw a line at most. This deficit between the present state and a system that delivers individual-focused outcomes at a system-wide scale that defines integrated care is at the core of substantial innovation and change programs promoting better care.

Innovation means change and change is tough. Asking (particularly large) organisations to do things differently is not easy. Asking for change means being the person who says no to the status quo. The status quo tends not to take no for an answer. So when seeking change, there are words that make your mission easier and some that make it much, much harder.

Shelve ‘should’

One sure way to get people offside is to start brandishing the word ‘should’ around like a rusty sabre. Sure, it’s a galant way to declare your ambition and defining how things ‘should’ be may even draw you a few fans. However, the people it draws were looking for change already and you’re liable to cut your initiative off at the knees putting people offside before you’ve even begun.

When we declaring how things ‘should’ be, we simultaneously pass judgement on the current state (and in the same sweep judge the people who permit them) while also dismissing the factors that created the current state. Effective change means inviting people to collaborate and build the path to a better way. That path will have mountains to go over, around and through, challenges not to be ignored. By contrast, ‘should’ blames for the present without a path to the future and is at best indifferent to the obstacles in between.

‘Just’ nothing

They say a journey of a thousand miles begins with a single step, recognise that every step on the path is important to achieve change. When taking on major change the size of the task can cause us to pass over details, “…we’ll just X, Y, then Z and we’re done”, “if you just do ABC this way…”. Never ‘just’ anything.

‘Just’ does no justice to the effort for change. ‘Just’ diminishes the ask and offers no respect or engagement for the person taking that step. Even if a step seems small to you, it may not seem that way to the person who has to take it. Diminishing the effort of the people you are bringing on your path to change wins your mission no support.

When JFK announced his plan for a manned moon landing by the end of the decade, he didn’t declare “America should be the world leader in space exploration, so we’ll just send a rocket to the moon and plant our flag up there to reclaim top spot” (had he it would have been a rather less inspiring speech and likely far less quoted a half century on). Instead, he highlighted that “we do these things not because they are easy, but because they are hard” and so enlisted a nation through the worthiness of the challenge.

Your change may be slightly more modest that asking to plant your flag on the moon, but nonetheless its success relies respecting the challenge and the effort of those you are asking for change. Three words that Tim Brown offers for building innovation and supporting positive change have the counter effect to ‘just’ and ‘should’.

‘How might we…?’

By reframing change as a shared challenge and inviting collaboration we embrace positive language that engages people in the conversation. By asking ‘how might we?’ you help focus people on achieving a solution, build engagement and share ownership of the path to change.

While ‘should’ and ‘just’ are the language of solution statements, ‘how might we?’ appreciates the nature of change as an ask of people and presents a question that invites participation. In Tim’s own words:

“How” assumes that solutions exist and provides the creative confidence needed to identify and solve for unmet needs.

“Might” says that we can put ideas out there that might work or might not—either way, we’ll learn something useful.

“We” signals that we’re going to collaborate and build on each other’s ideas to find creative solutions together.

Driving change that makes a real difference is tough. We do it not because it is easy, but because it is hard. Of course, there’s no need to make it any harder than it has to be. Switching up language and reframing the challenge in a way that invites collaboration and focuses effort is one small way you can start to get traction. You may not end up with the solution you had in mind, however by inviting collaboration and focusing effort you can improve your chances of achieving the outcomes that make a real difference.

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Integrated Care Definition

Confused by all the talk on integrated care? You’re not alone.

So what is integrated care?

Integrated care is any system that seamlessly delivers each person’s health and social support
Integrated Care Definition

This is in contrast to current segregated systems which encourage individual silo-ed professionals and organisations to work in isolation. Uncoordinated service provision relegates service users to a position of piecing together their care solutions, left to shuffle between referrals as they try to transfer the necessary information for each provider to support them.

The current segregated system in most developed countries is very expensive. It leads to duplication of testing, unnecessary procedures, conflicting advice, reactive response and inefficient process. All of these expenses put added stress on the service user and their family. We pay too much for less than ideal outcomes.

There is substantial interest in integrated care from communities around the globe as the premise of better cooperation between services has the potential to achieve better individual and community outcomes at a lower cost. In his work for the UK, Sir John Oldham described an integrated care system succinctly as the circumstance where one person is supported by people from organisations acting as one team behaving as one system.

Integrated care is often confused with a number of initiatives that seek to facilitate it. This is in part because a number of global accounting firms have built big businesses charging governments advisory fees on this topic and their fees are dependent on prolonging confusion. It is also in part because health & social care organisations are filled with smart, passionate people who are motivated to actively connect their initiatives with the direction of change.

Our integrated care definition is easy to say, but don’t be fooled, it is immensely difficult to achieve. While few will disagree with a system that offers better care at lower cost, many will quarrel over how to design it.

It’s important to maintain a clear line between the vision of an integrated system of care and the specific changes (outcome-based commissioning, accountable care, shared care planning, etc) that are seeking to achieve it. Try not to think of integrated care as a ‘thing’ and more as a state. A number of things can be done to create an integrated system of care, however what those things are will be determined by local circumstances.

Below are some brief examples of  initiatives that seek to achieve a more integrated system of care. This should give you an indication how initiatives are distinct from the vision and vice versa:

InitiativeDefinition
Outcome Based CommissioningA type of contractual arrangement with providers where compensation is based on the achievement of an outcome (rather than the performance of an activity). It seeks to reduce the perverse incentives in current systems by rewarding good care outcomes rather than volume of activity.
Care CoordinationCare Coordination adds another player to the team who’s role is to help the rest of the team work together. To this extent it is somewhat of a bandaid solution as it does not address the issues in current systems, but instead seeks to patch up their shortcomings. It’s primary effectiveness is in transferring the responsibility of system navigation from the service user to a professional who has the system knowledge to support a more seamless experience for the user through guided navigation and coordination.
Shared Care Planning ToolsUsually software or web application based tools to improve the sharing of information between providers. The premise of shared care planning tools is that they transfer responsibility for sharing information about the service user’s current condition from the service user to a provider platform. This facilitates asynchronous communication of higher quality communication between providers for better informed decision making. Fundamentally, this is a teamwork oriented tool which doesn’t address system issues but does improve providers ability to work in existing systems more effectively.