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Change Management: Focus on People

This February, Genesis Health Consulting will be blogging about the why the practice of change management is a critical enabler of large and small efforts to generate new behaviors, processes, partnerships and outcomes. In the process, we'll highlight some of the science, best practices and tools that leaders can adopt in their own work. In the end, however, it all comes down to this: the best strategies and most sophisticated processes go nowhere if the people leading and experiencing the change aren't on board.

Enter change management, "the discipline that guides how we prepare, equip and support individuals to successfully adopt change in order to drive organizational success and outcomes." (PROSCI)

Most of us have personal experience leading or experiencing change that wasn't actively managed (and some of us have tried to block these experiences from memory altogether). Maybe in your organization the change was a great idea for new, streamlined workflows. Or perhaps you were asked to design and test a new patient service or employee practice. You likely gathered your team of experts and resources, created a plan, and worked to execute it. Some of you became stuck in organizational inertia before you even finished. Others technically met the objective by creating something new, only to have it wilt from lack of organizational support or attention.

Experiences like these are easily recognizable because they are common.

Did you know that 70% of change efforts fail? If your initiative falls in the 70%, odds are it was because the people side of change wasn't effectively managed.

For any organization, this is a daunting statistic. For healthcare organizations that are in the midst of an era of disruptive change, understanding how change affects people - staff, clinicians, administrators, patients, businesses, payers - and supporting them through that change is critical.

The foundation of any change management practice is understanding how your people are responding to the change in question. We frequently use the ADKAR® model, designed by PROSCI, a change management organization, to help us assess our starting point and our progress over time. The model categorizes five sequential stages of readiness for change: Awareness, Desire, Knowledge, Ability and Reinforcement.

Each stage (from top to bottom in the graphic below) builds toward individual capacity to enact and sustain change. Rarely does a person travel through the stages in a neat, linear progression, and rarely do all stakeholders begin at "A." Motivators and instigators to travel along the continuum are distinctly personal and situational. One person may begin supporting (or obstructing) change because of a strong emotional response; another may need to see the data and precedence before accepting that a change is needed.

Understanding the readiness of key stakeholders to endorse, enact or reinforce change allows leaders to select specific strategies to improve the likelihood of individuals moving to the next stage and beyond.

One of the common mistakes in using this tool is that leaders apply it to too narrow a population. We’ve already said that people are the key to change management, so it is important to consider the “who” in any change scenario.

Consider questions like these:

  • Who will be required to change in the new program?

Change will not be successful if the change rests on the shoulders of one person. A multidisciplinary team that includes those whom the change will impact should be engaged from the start. We often see committees formed of subject matter experts and relevant organizational leaders, based on their role and accountability. But what about those staff on the front lines who will be required to change their day-to-day workflows (and habits)? How might they respond? How will you bring their experience into the mix?

  • Who will the new program serve?

Often new models of care in the healthcare field are designed to improve the care, experience or safety of patients. Rarely are patients meaningfully engaged in shaping these changes from the start. Health care leaders should consider a how a change might affect patients (hint: ask), what it might require of them, and how to effectively incorporate patient feedback into your work.

  • Who (and what) else will be impacted by the change?

A final common mistake is to forget about the myriad of human and technological enablers of work in a modern healthcare setting. Launching a new program? Consider whether there are billing or financial reporting implications. How will an electronic health record (EHR) or other data management program need to be changed? Will access to the EHR need to be modified to accommodate the program? What are the legal and compliance implications of the change? If we make a change in specialty care, what implications does it have for our patient’s medical home?

Once you have a comprehensive list of who may be affected by the change in question, start with a "back-of-the-envelope" assessment of where they might fall along ADKAR spectrum. In our next post, we'll share some of our favorite tools and tactics for increasing stakeholder readiness, wherever a person may start.


Genesis Health Consulting has deep experience in change management principles and in co-creating smart, effective and sustainable systems change in support of child health and well-being. Please email us at to learn more about our work in this area.

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