Innovation in any field involves change. Medicine or health care is no exception. However, not all change involves innovation. With the passage of the Patient Protection and Affordable Care Act (PL 110-148) in March of 2010 there will be change in the way medical care is paid for or purchased, and in the way it is delivered in the acute care facility as well as in the outpatient arena. Payment changes are already underway. CMS has demonstration projects on ways of sharing the cost risk with systems (e.g.: Physicians’ Group Practice and the Acute Care Episode Project) and is rushing to create Accountable Care Organization (ACO) models. The projects that are ongoing or have been finished show that care can be delivered more effectively and efficiently than at present. Patient acceptance of these models of care delivery and patient satisfaction with their care have improved in these projects. As payment models change, systems and physicians will have to work together to be effective in the new marketplace. There will be groups within the stakeholder groups – systems, physicians, ancillary staffs, and patients as well as payers – that will not want to embrace this change. They will be the losers in the “new healthcare” landscape. Change WILL happen. Are we ready to manage this?
It is said that 50-70% of attempts to bring about change in an organization fail. This need not be an inevitable outcome of a change initiative. If there is no organized change initiative, the likelihood of failure will be great. If the potential disruption that change can bring about is anticipated and systems actively manage the process, then success is more likely.
John Kotter the Professor of leadership and change at Harvard Business School, outlined in HBR (March-April 1995) why change efforts fail. He posits 8 steps to initiating, implementing and maintaining change:
- Establish a sense of urgency
- Form a Coalition to guide the process
- Create a Vision that is understandable by all stakeholders
- Communicate the Vision
- Empower others to act on the Vision
- Plan for and Create “Short Term Wins”
- Consolidate Improvements and Produce more wins
- Institutionalize these New Approaches
We will need to be cognizant of the opportunity for managing change in a proactive manner so that 70% of our change initiatives to help implement innovation will NOT fail, but we will have a running start at success.