First-Person Account How a Change-Weary Hospital System Implemented More Changes

Coach leaders to make sure change initiatives are followed through for each employee.

By Robin Broadnax, SPHR Apr 1, 2014

Robin BroadnaxApril 2014 CoverHealth care is an industry in flux. The Affordable Care Act and shifting reimbursement models have been a driving force for cultural change in many hospitals. When I took a job in health care a little more than four years ago, I must admit that I was suffering from a bit of change fatigue; I had left the financial services industry in the wake of sweeping transformations. While I love working in health care, I did have a moment early on when I thought, "Oh, no, not again!"

Despite the feeling of déjà vu, I felt that health care was a good fit for me. After two years in another health system, I took a position as director of organizational development in the Sisters of Charity Health System in Columbia, S.C. It was clear that I was hired to help the organization navigate change. Oddly enough, my past experiences would be both an asset and a limitation in my new role.

Fortunately, the leaders at both Providence Hospitals and St. Vincent Charity Medical Center, two entities in the Sisters of Charity Health System, could easily articulate the outcomes they wanted. In both organizations, the goal was to create an environment where employees could maximize their contributions and performance. To do that, we knew leadership behavior would be a key driver in increasing employee productivity and engagement.

Providence Hospitals needed to have a culture that rewarded employee involvement and problem-solving. "Lean process improvement"—eliminating wasteful effort and maximizing efficiency—would be key to staying competitive in the new health care environment. Leaders would need to involve employees in decision-making because front-line employees best know the processes they work with.

St. Vincent’s leadership saw a need to better manage performance. Ted Monczewski, vice president of human resources, was a crucial driving force in identifying the need to improve leaders’ ability to coach employees and have difficult performance conversations. The new reimbursement models in health care were moving to pay for performance; leaders’ ability to effectively manage performance had become even more critical.

In the end, a combination of skills training and development of in-house coaching programs was the solution chosen to begin to move leadership at both organizations toward the desired behaviors. Both hospitals have experienced positive outcomes, but there were many steps and obstacles along the way. It is clear that the solution that has had the biggest positive impact is the coaching programs. Interestingly enough, it is also the solution that received the most resistance at the beginning.

Developing the Road Map

For the most part, I am an optimist and see change as positive. I get really excited about it! That is why I was so thrilled to interview the leaders at both hospitals to find out what they felt was needed. I got feedback from more than 60 leaders at the director and executive levels about the skills gap between where they were and where they needed to be. Some questions I asked were:

What behaviors do you see leaders displaying that either support or hinder achievement of strategic goals?

What behaviors do you see employees displaying that either support or hinder achievement of strategic goals?

In terms of organizational development and leadership development, what is the greatest need in your area of responsibility now and in the next few years?

What one thing do you value most about the organization?

If you could change one thing about the organization, what would that be?

I also analyzed employee engagement data to see what employees thought needed to be changed. That’s when reality hit and my excitement faded. One of the things that folks consistently said they wanted to change was people like me coming into the organization to begin new change initiatives. Apparently, other enthusiastic change agents before me had not successfully helped leaders hard-wire changes. "No wonder people look at me with such reservation," I thought. "They must be thinking, ‘Here we go again.’ "

Yet, leaders were unsure where they would find the time to work on engagement.

After probing a bit further about why past initiatives had not been successful, I quickly became excited again. Past efforts had been based on training alone, with little or no follow-up to make sure skills were hard-wired. I was certain that my initiative could be successful when others had failed. What I saw in the other change initiatives was too much focus on broad skills development and too little on change at the individual level.

My coaching training had taught me that to change an organization, you must help individuals change. This change management at the individual level would be done with a small amount of large-group training and then participation of leaders in smaller coaching groups. The time and resources committed would be about the same, but the focus would be more on support and accountability for implementing changes. This was the proposal I made at both health systems, and both accepted it.

Rolling Out the Program

The next step was to select and train a group of 40 coaches and get them on board for the initiative. These individuals included the senior leadership team and supervisors chosen based on high engagement scores of their departments’ employees and on recommendations from senior leadership. In my experience, leaders really appreciated being chosen for programs like this. It was clear that these leaders felt honored, but they were also dealing with limited resources and time. 

I knew that if those coaching felt their role in the program was an extra burden, they would not support it in a way that helped others to buy in. That is why I gave them the option of not being a coach. I knew it would be better to have a smaller group of committed coaches than a larger group made up of people who participated because they felt they had to.

The training I provided gave them the experience of being coached. I told them that if, after the training, they didn’t want to participate, they just needed to let me know. Once it was over, they all said they wanted to be coaches. I had overcome the first obstacle.

The next step was to conduct the training that would serve as the basis for letting the leaders know what the new expected behaviors were at both campuses. One of the key steps in effective change management is to include feedback in the design and communication of the program.

I made it clear that what we would be working on was behaviors the leaders said the employees needed to work on. I emphasized that this was not my initiative but, rather, a way of supporting them in the changes they said they wanted the organization to make.

As noted earlier, my past experience was both an asset and a limitation. I didn’t realize it at the time, but I viewed change management somewhat as a formula—a formula that, it quickly became clear to me, would not work in this organization.

As I looked at the faces of the leaders, I could see that they were all suffering from change fatigue from current and past attempts at change. My efforts did not create the excitement I had seen before in other organizations. Many leaders started the process with great reservations—that is, until they got started in their coaching groups.

Coaching groups of three to four managers each meet monthly to focus on development plans that each leader developed based on his or her employee engagement results. Some plans are more about leadership skills, but others also include technical competencies. A lot of plans have focused on how to have difficult performance conversations.

The meetings serve as both emotional support for change and an accountability mechanism to ensure that leaders are working on their plan.

Reaching Our Destination

Once the leaders started meeting with their coaches and coaching groups, the positive feedback began to flood in. Monczewski, who served as a coach, said his "group meetings were very productive and were helping the leaders implement the plans they created." Monczewski also saw evidence of better performance management in the HR department. Leaders were documenting performance better and having difficult performance conversations that some may have shied away from in the past. By all accounts, the groups have helped their leaders remain focused on implementing their changes while providing much-needed emotional support.

Time will tell how successful our efforts have been. Turnover has decreased during this time, but changes in employee selection and compensation may also have affected that. An important indicator will be new employee engagement data this summer.

Nevertheless, anecdotal comments have been overwhelmingly positive. Many who resisted because it was "just one more thing to do" later told me that it had really helped them and that they enjoyed having the group support to help them implement their goals. One told me that she was so happy that I "held her feet to the fire and didn’t let her not go." She said that her group had been a great help in offering support and ideas for solving problems and that the suggestions helped her create better working relationships with her leader and co-workers.

Lessons Learned

Starting these coaching programs has been one of the most challenging and rewarding things I have done in my 14-year career as an HR professional. This process helped me realize that creating change in an environment that is lean in terms of resources and time requires different skills than in organizations that have more time and resources.

This experience was also humbling for me. Even though I had worked in several organizations, I didn’t know it all. I needed to grow and look at my own personal ideas and ways of doing things. If I had to do it over, I would take more time helping people get an experience of coaching before implementing the program. Letting people experience the new process is one of the most powerful tools in change management.

I later found a group decision-making simulation and included it in a subsequent training class with a group of leaders about how to coach their employees. They said it made it really clear what the benefits of collaborative decision-making were. I believe using simulations helps people understand change. Experiencing something and having a positive outcome make it easier for them to try the change in their work.

Anyone thinking about implementing an internal coaching program should step out of any past change management experiences they have had. Each organization and person has its own unique needs.

Robin Broadnax, SPHR, is director of organizational development at Sisters of Charity Health System.


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