To Pivot or To Pirouette?

By Jalana McCasland, FACHE, Vice President Ambulatory Operations, VCU Health

Health care post-COVID is messy and complicated. The challenges today seem more urgent, more complex, more dire than in the past. Staffing and provider shortages, insatiable consumer demands, declining access, and complicated reimbursement rules mean that health care leaders must constantly look for the next wave of innovation to increase efficiency and reduce costs. We pride ourselves on being able to pivot. Webster defines pivot as “a usually marked change” as in “a modification is made to a product, service or strategy to adapt or improve.” Regarding access, we pivot daily from sick visits to well visits, from satisfying demand for our established patients to garnering new patients to build our market share.

But how do we build sustainable change? Real change is uncomfortable. Real change takes time to get it right. It isn’t just a dashboard with red, yellow, and green boxes, small font, and more metrics than any seasoned leader can manage. Sustainable change requires a pivot in our thinking and approach to change management. In his book, Launching and Leading Change Initiatives in Health Care Organizations, David A. Shore proposes five essential steps to change management:

1. Acknowledge How Hard It Will Be – Getting providers to change their behavior, to let someone else manage their schedule, will be hard. Acknowledge they will be losing autonomy and will push back. Communicate openly about the loss and look for ways to mitigate it.
2. Accept and Communicate that Change Is Not Optional – How many access projects have failed because we allowed a provider or division to “opt out?”  Change is never perfect, but it should be continuous. Secure a commitment to pilot a simple initiative, demonstrate success, build on that success to develop trust, and create momentum for additional changes.
3. Embrace “From – To” – Most of us are comfortable with the status quo. We rarely want to move “from” our current, satisfying state “to” an unknown, uncomfortable future. If there is one thing COVID taught us is that the status quo can be upended in an instant. Rather than “return to normal,” as access leaders, we must create a new normal that recognizes consumer demand for innovation, convenience, and digital engagement.
4. Think Kaizen – Kaizen is a Japanese term for “change for the better.”  Simply put, it involves bringing people together to identify problems and solutions. Access standards are not created in the boardroom. Involve key constituents – the scheduler, the technician, the call center representative, the physician liaison, and so forth – along with providers and clinical staff to develop a deeper understanding of the issues and actively problem solve.
5. Understand the Psychological Factors that Affect People’s Perceptions – Appeal to both the head and the heart. Access isn’t about numbers on a dashboard. It’s about real people, waiting weeks, even months, to get the care they need while fear and perhaps symptoms build. To get buy-in for change, tell a story about who is waiting. One of the most compelling reports we ran during our access journey was a list of patients by diagnosis who were waiting over thirty days to be seen. When physicians saw the document with names, they developed a sense of urgency to decrease the wait list and improve access.

Creating sustainable change requires a pivot in our thinking and our approach to change management. A well-executed approach is like a pirouette – elegant, flawless, and gaining momentum with each turn.