In face of major advances in medicine and technology, healthcare regularly fails to live up to the patient expectations in providing the high quality of care with clinical effectiveness and customer-centric patient journeys. The urgent need to transform the care delivery is well embraced around the world. but the journey is notoriously difficult and require discipline, resilience, bold and sustained commitment, and patience.
Twenty-two years ago, John Kotter pegged the failure rate for organisational transformation at 70% and it has not changed much since then. Major change takes long time to implement – between five and seven years on average. Transformation is also very hard because most people are reluctant to alter their habits. What worked in the past is good enough; in the absence of a dire threat, employees will keep doing what they have always done. And when an organisation has had a succession of leaders, resistance to change is even stronger. A legacy of disappointment and distrust creates an environment in which employees automatically condemn the next transformation champion to failure, assuming that he or she is “just like all the others”. Calls for sacrifice and self-discipline are met with cynicism, scepticism, and knee jerk resistance. To the typical change-averse employee, all plans look alike. The leader must show employees precisely how his or her plan differ from the predecessors’.
In health care setting, doctors must be central players in the sweeping changes and any change strategy which the doctors do not embrace is destined for failure. Generally, doctors ar anxious about the “transformation plans” and mourn about real or anticipated losses of autonomy, respect and income. In order to alleviate the stated concerns, the leader needs to engage with doctors’ and run persuasion campaigns, so they can accept the new organisational structures, ways of working, payment models and performance goals.
To help health care leaders engage physicians in the pursuit of greater goals, Toby Cosgrove MD, the CEO of Cleveland Clinic recommended a framework based on the writings of the economist and sociologist Max Weber, who described four motivations that drive social action (that is, action in response to others’ behaviour). The factors were further elaborated by Nikola Biller-Andorno and Thomas H Lee in “Ethical Physician Incentives – From Carrots and Sticks to Shared Purpose” New England Journal of Medicine, March 2013.
Adapted for health care professionals, a leader can use the four motivational levers below to earn doctors’ buy-in and bring about the change the system so urgently needs.
1. Engage in a noble shared purpose – appeal to the satisfaction of pursuing a common organisational goal, for example same day appointments
2. Satisfy self-interest – provide financial or other rewards for achieving targets, for example, 10-20% of compensation against clinical and financial performance goals designed to improve team collaboration
3. Earn respect – leverage peer pressure to encourage desired outcomes, for example making the patients’ ratings of physician’s public
4. Embrace tradition – create standards to align behaviors, and make adherence a requirement for community membership, for example, appearance and etiquettes, and when paged, response immediately
Transformation is journey to learn, discover and adapt. This was very nicely summarised by Jeffrey Immelt, CEO, General Electric, “We’re on a 40-step journey. Today we’re on step 22. I don’t know exactly what step 32 looks like yet. But we’re going to explore that together. And we will do whatever it takes to be successful. We’re going to win.”