The Times Are Changing, But the Values Remain the Same

It's hard to turn on the TV, open a newspaper, read an industry blog or even talk to a colleague without being reminded that the healthcare industry has sailed off the edge of the map as we know it and is now navigating uncharted territory. This is true — to a degree.

In healthcare, many things have changed, and yes, the changes are quite dramatic. Yet many other things — which may ultimately be the most important things — have stayed the same.  

What has changed in healthcare? Quint Studer

Our industry's move from episodic change to continuous change. In his book "A Sense of Urgency," John Kotter talks about the challenges and intense pressure that occur when cultures go from one kind of change to the other. Of all the changes healthcare is facing, this one requires the biggest adjustments inside organizations.

Moving from episodic change to continuous change is like a sprinter becoming a marathon runner. This is why today's external environment is so difficult, particularly on frontline supervisors, managers, directors and employees. They need a whole different muscle set, mindset and emotional set to operate in a field of continuous change. (Let's think of it as a disruptive environment; although uncomfortable, disruption is a very effective way to force change.)

Joint Commission accreditation today versus the process of years past is one example of the shift from episodic to continuous change. In the past, The Joint Commission would tell a hospital or health system they were coming for a visit. To ready themselves, the organizations would prepare rigorously by testing knowledge, auditing processes, checking records and so forth to ensure compliance. Now The Joint Commission will show up unannounced, so an organization is expected to be ready always. As a result, organizations have been forced to move to a state of continuous readiness. This is a good change, but it is stressful and hard to accomplish.

Reimbursement. Reimbursement has been — and remains — the biggest external change. As healthcare expenditures grow, we are seeing disruption through a drastic change in what CMS will pay for as well as the amount it will reimburse healthcare providers. There are also pressures from commercial payers, as well, as they become more aggressive in contract negotiations. Providers know that winning healthcare organizations will be those that achieve higher quality with lower costs.  

Technology. I was reminded of how much technology has changed after sitting beside a radiologist who was reading films from his iPad during a flight. In fact, today's reimbursement changes are driving an explosion of technology and applications that will help us manage our own health, as well as allow others to look at the state of our health, even from a distance.

Transparency. When Studer Group got its start in 1999, patient satisfaction results were not truly transparent unless the organization in question decided to release them. Today, via HCAHPS, CG-CAHPS, etc., this is no longer the case. Within minutes, one can find a "snapshot" of the quality of hospitals in an area and across the nation. ED wait times can be seen on electronic billboards.   

Research. I don't mean research just on clinical outcomes, but research on operational performance. When Studer Group started out there were a handful of case studies that made sense, but the wide area of research we have now was not yet available. Studer Group has conducted some of the largest research that has ever been done in the area of leadership. There is also research from others, such as the University of Alabama at Birmingham, that proves that the more engaged the employee is, the better the patient safety and better success in process improvement. This means less rework and fewer work-arounds. Other research shows the more objective a leader evaluation tool, the better the patient experience. In the past we wouldn't have been able to prove many of these connections.

Integration. By integration, I am referring to efforts to put as many of the providers on a single asset sheet as possible. Sometimes when politicians talk about how to make healthcare better, they refer to a fully integrated system and indicate that all providers should copy that system. They do not fully understand that it has taken years to make integration work in these organizations. Trying to get everyone on the same page and the same team, either through an employment contract or some type of agreement, is a drastic change. In "Good to Great," Jim Collins writes that moving to great is a complex task that happens over an eight- to 12-year timeframe.  
    
What is constant in healthcare?

Passion. From the very beginning of healthcare, passion is one characteristic that has remained absolutely constant. Passion is demonstrated and lived out each and every day by healthcare providers. I am amazed at the range of emotions that healthcare people handle each and every day that would paralyze most others. This takes great passion, not to mention compassion and resilience.  

Fortitude. I am fortunate enough to be a part of a committee at the Harvard Business School created to recommend a 21st century curriculum for our future healthcare leaders. The subject that comes up consistently is managing change. Leaders carry tough messages. They are the ones who have to inform staff they will not be getting more resources and they need to be more efficient and more effective with their current resources. They are also the ones who lead through failure. And while all highly reliable organizations learn from failure, the experience is painful. This is why leading in today's changing healthcare environment takes tremendous fortitude.

A willingness to learn. Every day in healthcare, people save lives, handle disease with dignity and help family members cope with death. Yet in the middle of all the intense emotions that come with their jobs, people continue to learn. In 2008, Studer Group conducted a study of work/life blend among women in the healthcare industry. The research clearly showed that outside of their relationship with their supervisor, the second biggest factor impacting satisfaction with their work environment was the organization's level of commitment and investment in their development. With the external environment getting tougher and tougher, the need to provide skill building becomes greater and greater.

A tremendous desire to do work that has purpose, is worthwhile and makes a difference. While people may initially feel their work meets these criteria, this feeling can be fragile. There are so many traumas and problems that take withdrawals from a person's emotional, mental and physical "bank accounts." These withdrawals can cause one to lose sight of the fact that they have great purpose, do worthwhile work and make a difference. It's up to organizations to help connect people back to the positive difference they make each day in people's lives.
    
So, yes, plenty has changed in healthcare. But 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, and that will drive us to master the skills we need.

The above is a modified excerpt from Mr. Studer's latest book, "A Culture of High Performance: Achieving Higher Quality at a Lower Cost." It is part one of a two-part series.

Quint Studer is the founder of Gulf Breeze, Fla.-based Studer Group, a recipient of the 2010 Malcolm Baldrige National Quality Award. Inc. magazine named Quint its Master of Business, making him the only healthcare leader to have ever won this award. Twice, Modern Healthcare has chosen him as one of the 100 Most Powerful People in Healthcare. He is the author of numerous books. There are currently 700,000 copies of his BusinessWeek bestseller, "Hardwiring Excellence," in circulation.

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