Leadership 103 – Change

April 19, 2021

Written by Clay Smith

Spoon Feed
Change is hard but is what leads to breakthrough medical interventions, innovations, and improvements. Here is how to lead through change.

Why does this matter?
Imagine managing a major blunt trauma without a fast CT scanner to identify injuries in seconds. Remember (or at least imagine) when a prior paper ECG had to come from the medical records hub. Imagine watching a patient with an M1 occlusion hit the door at 30 minutes, and there is nothing you can do. Every medical advance means change. And change is difficult. Being a leader (or a good follower) means learning to manage change. Because if we are not changing, we are not offering our patients the best care.

“Today the only thing that is permanent is change.” Charles H. Mayo, 1928

How to manage change

There are three models for managing change covered by the author. I’m going to cover this one.

Eight stages of change – Kotter from Harvard noted 8 ways that 100 companies failed to change. Here they are stated positively. And they really work best when done in this order.

1. Create a sense of urgency – the idea is like one of a burning platform. You have to move or fall. You have to show that change is essential.

2. Create a guiding coalition – You need enough people behind an idea to move it forward. This team needs to coalesce and to be empowered to implement the change.

3. Create a vision to help direct the change effort – The vision must be clear and concise. For example, a friend recently gave me this advice for new grandparents, “Open your door. Shut your mouth.” More relevant is the simple statement of William Mayo, “The best interest of the patient is the only interest to be considered…”. If it’s not pithy, your team can’t and won’t remember it.

4. Communicate the change vision – Use every means possible: in person, email, online, signs and flyers, etc. The vision must be put before the whole team, and the guiding coalition helps this come from varied voices.

5. Empower broad based action – Clear obstacles; change systems; encourage risk-taking. Give real power away and delegate this to the leaders under you and let them innovate.

6. Create short term wins – Change is hard, and showing your team small successes can help the vision to snowball. Reward and celebrate successes along the way.

7. Consolidate gains to produce more change – As the vision grows in credibility through small wins, continue them by, “hiring, promoting, and developing people who can implement the change vision, and reinvigorating the process with new projects, themes, and change agents.”

8. Anchor new changes in the culture – Sustainable change means growing the management and leadership structure and leadership succession process to continue and grow the vision.

How to decide on changes

Since change is hard, you need to choose wisely. Here is a matrix to consider.

The Change Curve

Also, it’s important to know that our teams have to process change. This is based on Elisabeth Kübler-Ross’ stages of grief. Did I mention – change is hard?

Change among physicians

Physicians are as change averse as anyone else. However, an advantage as a leader of physicians is that most tend to be, “data-oriented, committed to serving their patient’s best interests and to relentlessly pursuing excellence, and have a well developed habit of inquiry.”

Source
Leadership Essentials for the Chest Physician: Change. Chest. 2020 Sep 21:S0012-3692(20)34515-3. doi: 10.1016/j.chest.2020.09.094. Epub ahead of print.