Guest article: Dealing with change. Is the healthcare system well prepared for it?

Dr. Martina Oldhafer MBA
Head of Change Management
University Hospital Schleswig-Holstein

Initiating or creating change is not one of the most popular things for most people. We love routines and recurring processes because they give us security and free up our energy for other things. This is, of course, true in healthcare as well. There are endless studies that prove this, and a few examples quickly make it clear to everyone how difficult it is to initiate change. We usually always drive the same way to work in the morning, after every move the furniture is almost the same as in the old apartment and we don't change our sleeping habits either. Try swapping sides in bed with your partner. Even in a hotel without a partner, most people sleep on their usual side.

As a manager (clinic manager, senior physician or manager in nursing), employees must be positively accompanied and motivated through a change process. This only works if this challenge is done in a planned and authentic way. It's not a trick, it's an attitude that makes employees come along. Some will inspire you and you will have to part with others, that is also part of the change process.

There is countless literature on change management and leadership. Leadership tools to help you implement, fables and stories, studies and experiments, psychological tests regarding personal affinity for change, phase theories and processing patterns. All worth reading, but in the end it is the personal characteristics and emotions of the leader and the employee that determine whether he or she will or can be carried along in the change process. Decisions are made unconsciously and emotionally to a high degree and often the gut helps the head in the decision-making process.

The university hospital with its approx. 13,000 employees at two locations, which are more than 70 km apart, is a true El Dorado for an incredibly large change process, which was initiated by the new buildings of one central hospital each at the Kiel and Lübeck locations. Combined with the new structures and building conditions, this entails changes in the daily work environment for almost every employee. Employees who have been working at the hospital for more than 30 years have to be taken into account. Likewise, employees who are just starting their careers after completing their training must be reached. Not everyone can be motivated with the same approach. Nevertheless, it is helpful to consider a number of things along the path of change that can help maintain or even increase motivation and that can help prevent demotivation.

Employee motivation and change philosophy

The ability to inspire people requires a triad of open mind - open heart - and open will. With his Theory U, Otto Schamer has described a process that assumes that change is not subject to linearity, but that there are always phases in which the employee must be reached on a cognitive level before he or she can let the issue become a matter of the heart and then turn it into action. In each phase, there are different options for action that help to initiate the next phase. It can be assumed that every change request always requires these three aspects and that they accelerate, prolong or even set back a change implementation through their different characteristics, namely if open heart does not become open will because certain framework conditions and/or emotions oppose an implementation.

Every manager needs a number of characteristics that he or she should have and support in his or her employees in order to initiate innovations and change processes. These are curiosity, empathy, courage, the ability to develop, cooperativeness and a certain degree of relaxation in the sense of trust. Being curious in order to discover new things. Curiosity is important for the overall development of the human being. In terms of change, it is crucial to expand one's field of vision and be open to what is hidden.

Compassion/empathy refers to the ability and willingness to recognize and understand another person's sensations, thoughts, emotions, motives, and personality traits. This plays a crucial role in dealing with resistance. Courage means being daring and capable of taking a chance and embarking on a new path. This requires self-confidence and reflection. Courage is needed to propagate innovations, to accompany them and to fill them with life in the long term.

The ability to develop one's own personality and environment. Only those who can and do question themselves will perceive further development as something positive and valuable. Relaxation - remain calm and relaxed during all changes. An excessive amount of activity leads to a reduction of relaxedness and composure, which you need to be able to convince others and take them along with you. Commonality and cooperativeness (working together) is the decisive criterion in all change processes. An egocentric disposition is not only a hindrance, but usually prevents most corporate change efforts. Regarding motivation and motivators, there was the time of Reinhard K. Sprenger, who started a special movement in 2002 with his motivation bible "Mythos Motivation". Now, healthcare companies always lag a bit behind in terms of establishing management techniques, and since patients are something special, whenever changes are made using management techniques, it is immediately postulated that this does not work in medicine and that medical processes are something very special.

But this is only half the truth. Yes, medical processes and patients are special because they consciously and unconsciously intervene in or influence the quality of treatment and the outcome. No, because all healthcare professionals must adhere to specifications that occur independently of the patient. Too often, the patient is used as an alibi for not enforcing treatment-oriented changes. To this end, it is important to note that healthcare workers struggle with dissonance; personal safety versus personal agency.

In summary, healthcare organizations will intensively manage all upcoming challenges and changes only if they

  • take into account the motivation of employees in change processes
  • establish a management culture that succeeds in convincing their employees of the need for change on a factual level and wins them over to commit to it on an emotional level.

Most change requests or change projects fail not because of a lack of motivation on the part of employees, but because of managers who attach too little importance to the human factor and do not consider their presence with employees to be necessary. Only through proximity to employees, appreciative exchange and the integration of employees into the process can the motivation of employees be maintained in the change process and used as potential.

Hierarchy and power are no longer "state of the art" in healthcare either.

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