I've spoken to dozens of hospital associations so far this year, and by and large, leaders are all too familiar with the big changes facing their organizations. Most everything is in a state of flux: reimbursement, market competition, physician employment, and pricing transparency. Of course each of these issues impacts employees, but what's really interesting is that they they're all part of a larger trend: the shift in the very nature of change itself.
By far the biggest and most profound challenge facing hospitals and health systems is the shift from episodic change to continuous change. No hospital or health system is immune to this fundamental shift, which is thoroughly explored by John Kotter in his book, A Sense of Urgency. When I mention this change to hospital leaders, I see light bulbs go off immediately. 
It may sound self-evident, given how often the term "continuous change" is cited these days, but we should not underestimate how much this jump has changed what we expect from healthcare professionals. Moving from episodic to continuous change creates an enormous and unfamiliar demand on our leaders and causes a great amount of pressure in an organization. If your hospital culture is struggling, it's because people are expected to lead like never before.
What we need from leaders today
To survive and thrive, healthcare organizations must create and maintain a culture of high performance. What does that look like? Research shows we expect different skills from high performers today than we did only a few years ago. I compared the skill sets of high-performing organizations in 2004 with those in 2013-2014, and I found some big differences.
In 2004, high-performing organizations were relentless in achieving desired outcomes and did not accept excuses. They used objective evaluation tools, invested in leadership and made concerted efforts to communicate with employees. Today, the five traits of a high-performing organization pertain to its alignment, readiness for change, self-awareness of performance, consistency and accountability.
These traits are more continuous in nature and are more difficult to measure. "Readiness for change" is a particularly huge demand that requires a different perspective from leaders than before.
Non-stop preparation
Continuous change means leaders have to always be ready. This takes a wholly different mindset, muscle set and emotional set than what our supervisors, managers, directors and employees use when managing episodic change.
Think about it this way: when you have a house guest visiting from out of state, you plan ahead and ensure the house is clean and comfortable when they arrive. You know when they will arrive and when they will leave. But what if you only knew your house guest was coming into town — but didn't know the precise date? You would need to take time every day to clean your home on a continual basis and ensure it is prepared for the surprise visitor, whenever he or she decided to show up. This is a new demand on your time and energy, and you would have to adjust your workflow, schedule and behaviors.
Healthcare providers face a similar scenario. The Joint Commission used to tell a hospital or health system that an official would be stopping by for a visit. Now, they show up unannounced. The way hospitals prepare for these visits has changed from an episodic routine to continuous readiness. This change is a good thing for healthcare organizations, as it requires excellence all the time, but it's also stressful for staff. They may feel like sprinters running their first marathon, navigating a change in pace and course that takes different types of muscles and a different endurance level than a 60-meter dash.
The shift from episodic to continuous change stirs stress throughout all levels of the organization, but directors and supervisors really feel the squeeze. They've been trained to sprint. They are accustomed to running hard for a couple of months, but there used to be an end in sight — whether it was a deadline, event or quantifiable goal. Not anymore.
Take the annual budget process, for example. Preparing the budget was always tedious and grueling, but at least when it was finished the hospital had a solid game plan for the next 12 months. Given the current external changes — performance-based reimbursement, unstable patient volume and increased consolidation, to name a few — a hospital's annual game plan can actually change very early on in the new fiscal year. Budgets have become guidelines that require continuous monitoring and change.
I know of an organization that was halfway through the year when they experienced a dramatic change in their reimbursement. The change was so extreme that if all of the leaders achieved their goals in expense management and even received good performance reviews, the organization still would have suffered a severe financial loss. So the organization had to review six months into their fiscal year and change its leader evaluations. They gave credit for the first six months of results, but changed the goals for the next six months to match the reimbursement change.
Another continuous demand is for integration, or having as many providers on a single asset sheet as possible. Politicians often refer to integrated systems when describing how to improve healthcare. They may indicate that all providers have to do is copy a particular system, but politicians don't understand that it has taken years and years to make integration work in these organizations. Trying to get everyone on the same page and the same team, either through employment contracts or another type of agreement, is a drastic change that can take years. It is hardly episodic.
How to help leaders in this time
There is one constant in healthcare, though, and that's an eagerness to learn. I continue to see a hunger to learn in today's hospitals and health systems. The key question is whether an organization provides learning opportunities for managers, supervisors, directors and staff.
If employees have healthy relationships with their bosses and training and education opportunities are made available to them, they get the feeling that the organization cares. People want to know you, as an employer, are investing in them. Here are three tips for hospital executives and senior leaders to better support their managers, supervisors, directors and staff and help them adapt in the shift from episodic to continuous change.
1. Break the silence. Most managers and supervisors don't want to let executives know how much they're struggling. They don't want to be whiners. As a result, hospitals don't know the degree of stress their leaders are under, and this is why they are so exhausted.
Provide managers and supervisors with way to tell you where they need help (without feeling like failures for doing so). You may be able to identify some of the challenges facing employees based on outcomes or performance metrics, but in other instances, you will not know they're having a hard time unless they come forward and tell you.
2. Validate fundamental skill sets. Training is only part of professional development. Leaders must help managers and supervisors obtain the skill sets they need. These fundamental skills include running effective meetings, managing financial resources, selecting and developing talent, answering tough questions, and, of course, understanding the external environment. But their responsibility doesn't end there. Validation is commonly missing in hospitals' leadership development.
Once managers and supervisors learn a new skill, does anyone judge how effectively they demonstrate it? Maybe a manager received training on how to run effective meetings. If no one observes the manager hold meetings and put that training to use, that skill isn't validated. We cannot expect employees to be competent in certain skills and traits unless we ensure they are doing things correctly.
3. Take the time to mentor. People in human resources or organizational development do a wonderful job of sharing training materials and professional resources, but they tell me they are unsure if a manager's or supervisor's boss follows up with their professional development. Take the time to mentor the people who report to you. Ask yourself, "What do my managers and supervisors need, and how do I help them?" When employees complete training or professional development courses, ask them to tell you what they learned and to describe how you can best help them.
Dealing with continuous change is not easy. But we can do it and do it successfully. That's because despite all that has changed, the values that drive people to do their best work — to throw their heart and soul into caring for the patients whose lives are in their hands — remain steadfast. It's those values that will pull us through the tough changes with our passion and dedication intact.
More Articles on Change Management:
Shifting Cultures: A Change Management Guide for Hospital Leaders
4 E's of Engaging Physicians in a Change Initiative
6 Necessities for Deliberate Culture Change in a Hospital