Visible, active leadership is vital to change management, says Epic emeritus CIO advisor

[Editor's Note: This is part 1 of 2. Part 2 will appear tomorrow.]Lost amidst talk of all the amazing technologies used in healthcare today is a subject very important to Robert Slepin: change management.Slepin knows a thing or two about change management. In his role as emeritus CIO advisor at electronic health record giant Epic, he is constantly helping healthcare chief information officers across the country change their health IT setups.There are only a dozen or so of these contractors, who are available on demand to Epic provider clients that need strategic advice or interim executive assistance from someone who's deeply experienced with planning, implementing and maintaining Epic EHR systems.Slepin – who has served as chief information officer or in other top IT roles at health systems such as Johns Hopkins Medicine International, Sutter Health, John C. Lincoln Health Network in Arizona, University Health Network in Toronto and AxisPoint Health in Colorado – enjoys helping other healthcare leaders manage the challenges of EHR operation and optimization. And how to manage change – which he is there to do.We sat down with Slepin for a deep dive into change management, a topic he thinks is crucial for many health IT leaders to better appreciate and understand.Q. Why do you believe change management to be such an important subject in healthcare today?A. Clinical workforce shortages and burnout, increasing costs and decreasing reimbursement, and capacity to care for patients with behavioral health/addiction issues – these are among the top issues confronting U.S. hospitals, according to the American College of Healthcare Executives.Facing strong headwinds, top healthcare managers are aiming to achieve better results and accelerate time to impact, which typically necessitates changes in the way work is done and enabling technology. While there is no magic wand to accelerate progress, in my experience you can significantly improve the outcomes in a healthcare transformation initiative with an intentional focus and disciplined approach to change management.Conversely, not being thoughtful and effective in leading change could hinder your efforts or adversely impact the outcomes, and even possibly spell disaster. "Most organizational change initiatives fail spectacularly (at worst) or deliver lukewarm results (at best)," according to John Kotter, professor of leadership, emeritus, at Harvard Business School.In healthcare, research indicates "almost two-thirds of all change projects fail for many reasons, such as poor planning, unmotivated staff, deficient communication or widespread changes." Because change often does not lead to the desired improvements in healthcare organizations' operating conditions or performance, getting the most value out of a change initiative arguably requires an effective approach to leading change.Q. In your experience, what is the best leadership approach to get adoption and participation when it comes to new technologies?A. Visible, active leadership is vital. From my experience, a critical ingredient to success in maximizing participation in projects and adoption of the changes is leaders' modeling the way. This includes clearly and repeatedly communicating the new direction, being hands on throughout the project, and setting an example for others to follow.A hands-off approach of issuing orders from the corner office and asking others to "let me know when it's done" won't cut it. When people see their senior leaders behaving in ways aligned with the vision, investing time and energy and actively participating in planning, design and implementation, they take notice.As leaders become involved and make time to discuss the changes with their respective teams early in an initiative, people impacted by the program become aware that change is happening. In time, interest sparks and excitement builds. Eventually, with education and training, users develop a basic foundation of knowledge about changes in policy, roles, workflows and technology, and the reasons for the changes.Once the new technology goes live, the workforce continues learning, adjusting and increasing their skills, knowledge and confidence in the new system and workflows – reinforced by change supports put into place not only after the project's go-live milestone but also ongoing, supporting sustainment and enabling continuous improvement.Besides being visible and hands-on, the best leaders I have worked with demonstrate a positive style; for example, they are authentic, coaching, transformational, engaging and compassionate. They remove fear and build trust, and inspire, educate, coach and support people in moving together toward a common, stretch goal. On the other hand, leaders less effective in mobilizing people to participate in and adopt change tend to be negative, dictatorial, transactional, bureaucratic or laissez-faire in style.An example of a less effective leadership style is one that frames a program as a "burning platform" that stimulates "fear-driven motivation," according to John Kotter. Focusing on fear to motivate a team encourages some initial action but increases discomfort and anxiety, which increases difficulty for people to speak up, step up and take actions required to drive change.Human psychology is one reason a positive style of leadership works best, especially in healthcare as it is a people and caring business with extraordinary social and technical complexity. Many decisions and actions on a daily basis can literally impact people's health and lives.Caregivers put patient safety first, aiming to do no harm, and they are motivated to do what is best for their patients; they are not inspired by managers telling them what to do, especially when management directives seem contrary to patients' (or caregivers') best interests.Q. What would you say are the important components of a change management initiative? What must CIOs be doing?A. In health IT, a change management initiative could be a project or program, which is a collection of related projects, that significantly impacts the organization, including its staff and patients, with an aim to change for the better. The scope could be the implementation of an electronic health record, enterprise resource planning, clinical information system, digital health, cybersecurity, artificial intelligence, and/or other technologies.Numerous factors contribute to the success of a change initiative. I will speak to some of the most important components, from my experience.Visible sponsorship. A change initiative will have the best chance for success, if it is extremely important to the organization and has highly visible sponsorship. The initiative should address a major pain point, for example, workforce burnout or decreasing reimbursement, or a strategic opportunity, for example, improved patient safety, quality, experience or equity, and the case for the change should be extremely clear and broadcast repeatedly throughout the organization.To steer direction and signal the importance of the initiative, the project should have one or more executive sponsors who champion the cause. One of the sponsors typically should be the CIO as most change initiatives have a major information and technology component.Encourage participation. Participation powers change initiatives. A related concept is inclusion. Leaders exercise their change superpowers when they create an inclusive environment where people feel they belong and are encouraged to participate in something bigger than themselves. Most people feel good being part of a group. Being included and participating in group activities is beneficial not only for people, but for organizations aiming for innovation and transformation.Here are three pieces of advice regarding participation as a tool for leading change:Include everyone. Anyone impacting or impacted by the change should participate. Leave people out at your own risk.Start early. Participation means more than taking part in downstream activities like training or operations. It should start much earlier, ideally at the problem definition and solution ideation stages.Be curious and humble. If you believe you have all the answers already and are engaging people to participate as a technique to manipulate them, you are being disingenuous, and there is a high risk of people being disengaged. Instead, be authentically open-minded and curious. Ask lots of questions, listen attentively and be open to adjusting your views and shaping decisions in collaboration with others informed by evidence and different perspectives.Persuasive communication. Communication is a critical aspect of a leader's role during a transformational initiative. Leaders should see and be able to talk clearly about what success looks like, framed in positive terms, and adopt a can-do attitude while remaining realistic, honest and straightforward in considering and discussing the challenges, issues and risks inherent in a complex change program.Some examples of excellent communication and change leadership include celebrating key milestones, for example, kick-off, design complete, build complete, testing complete and go-live:Participating in major project events. Inviting project leaders, giving guidance, recognizing progress, expressing thanks and asking, "How can we help," at senior executive committee meetings.Occasionally dropping in project steering and advisory council meetings to observe and show support. Delivering inspirational introductory or closing remarks at project team all-staff meetings, especially saying "thank you" to teams for their efforts and "congratulations" for accomplishments.Rounding and speaking with team members and subject matter experts one-on-one and in small groups, asking thoughtful questions, listening intently, and responding with humility, curiosity and encouragement.Here are three ideas for using persuasive communication as a tool for leading change:Be intentional. When deciding what to say, choose your words wisely because they matter a lot.Be consistent. From day to day, week to week, message to message, stay consistent. Repeat. Reinforce. Consistency and repetition are more likely to break through the conversational clutter and get your message across, understood and acted upon; risks of inconsistency and insufficiency of exposure include inattention and poor credibility.Get help. Perhaps most important of all, don't go alone. Work with professional communications partners. They are experts. You need all the help you can get. Change is really hard. Make it easier, with professional communications support.When the people implementing the changes and being impacted by the changes hear and see leaders' inspiring words and actions, they are more likely to align themselves with the direction, volunteer to participate and feel safe to speak up, act and stretch outside their comfort zones to help the organization move toward its ambitious goals.[Editor's Note: To be continued tomorrow.]Follow Bill's HIT coverage on LinkedIn: Bill SiwickiEmail him: bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication. Enterprise Taxonomy: Workforce DevelopmentCore TechnologiesEHRWorkforceTechnology