How to Create Change Agents Who Will Sustain those Hard-earned Healthcare Improvements

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chang-agentChange agents are the driving force behind sustainable healthcare improvement. According to Don Berwick, MD, MPP, Institute for Healthcare Improvement (IHI) President Emeritus and Senior Fellow, these experts are the “diamonds” of improvement. But they can only succeed in organizations in which senior leaders understand the nuances of improvement and what is needed to support these valuable individuals. In other words, improvement education is just as essential at the senior leadership level as it is on the agent, or “doer,” level.

Effective education equips change agents with the mindset, methods, and tools to help others come along in the work. They become the teachers and modelers of the science of improvement and influential leaders within their companies. The IHI defines the science of improvement as “an applied science that emphasizes innovation, rapid-cycle testing in the field, and spread in order to generate learning about what changes, in which contexts, produce improvements.” This approach is built on expert subject knowledge in combination with improvement methods and tools.

What Are Change Agents?

According to the IHI, change agents are “devoted to helping identify, plan, and execute improvement projects throughout an organization, deliver successful results, and spread changes across the entire system.” Berwick likens change agents to diamonds because they tend to be rare individuals with great value. It is up to an organization’s leadership to discover those diamonds and provide them with the specific training, expertise, and support to legitimately qualify them as change agents.

Why We Need Change Agents

While a specific goal may be singular, the path there is almost always guaranteed to have many layers—from the multiple steps in the process to the individuals working in the system. This is why organizations need specific leaders in improvement, particularly as leadership experts have forecasted increasing complexity in the healthcare industry. For example, in his book Managing in the Next Society, the late management professor and renowned author Peter Drucker dubbed healthcare “the most difficult, chaotic and complex industry to manage today.”

Change agents are prepared with advanced knowledge in every level of the improvement process (from identifying opportunities to leading programs using the necessary support tools) to ensure that the goals set are pragmatic and geared toward improvement. Throughout the process, they are the main liaisons between their teams and senior management, making sure leadership understands the process and needs of the project at hand. For organization-wide improvements to succeed, effective, trained leaders need to be in place to align all aspects of the plan for change.

Educating Change Agents

Health Catalyst offers change agent training through the Accelerated Practices (AP) program. There are two versions of the program. In one version, education is geared toward the agents (the doers). The second version is for executives to ensure organization-wide understanding and support of improvement.

The AP Program training focuses on:

  • Facilitating systemwide change by using proven leadership principals, such as managing both technical and adaptive challenges, exercising leadership – not just authority, and keeping teams engaged.
  • Improving quality, cost, and patient satisfaction outcomes.
  • Analyzing data using statistical process control methods.

AP Program for Executives focuses on:

  • The power of alignment for enabling broad scale transformation.

The AP Program Provides Effective Change Agent Training

The AP Program is comprehensive, as participants implement all steps of an improvement project with the guidance of a Health Catalyst coach. Organizations identify an improvement opportunity for the team to investigate and improve during the program. In this way, the program ensures that participants are able to apply what they are learning on a project that’s prioritized and aligned with goals of their organization.

Participants in the AP Program come away with the skills and knowledge to begin serving as change agents within their organization. They’ve learned and practiced how to establish and maintain a culture of trust and honest dialogue and execute an improvement project.

Five Principal Concepts of Effective Change Agent Training

  1. Engage others in the work: Participants learn how to get others excited about improvement and how to create believers throughout the organization. They see how to identify opportunities for pragmatic, sustainable improvement, and what’s being done well.
  2. Data analysis: They learn to correctly array, analyze, and interpret data to make effective decisions.
  3. Improvement science: Improvement methods, all built on the Scientific Method, differ and are useful in varying circumstances. Participants become familiar with several and learn which to apply to specific improvement challenges.
  4. Change management concepts: In keeping with the principles of adaptive leadership, these concepts include the engaged and transparent decision-making process and relationship management by which leaders help bring about change.
  5. Cost benefit analysis: Successful cost management and calculating return on investment relies on understanding reimbursement in the United States and how to calculate a health system’s costs. The AP Program provides this information and helps participants use it to develop a cost benefit analysis for their project.

The Vital Role of Executive Leadership

The AP program for Executives is geared toward the senior leadership level. Aiming to ensure that executives are not only aligned with improvement efforts, but also vigorous champions of these goals, the executive course delivers key principles related to the identification and implementation of effective, improvement initiatives as well as strategies to mitigate challenges experienced by the teams to encourage successful initiatives.

Leading successful change requires a strategic approach to sustain results. This is a critical task and often the most challenging. Key elements in this approach include establishing governance structures that enable systemwide adoption of new programs, permanent work teams, monitoring systems and a rewards, recognition and accountability structure that encourages team members to take ownership of improvement.

Three Principal Concepts of Effective Executive Leadership Training

  1. Case for change: To effectively lead improvement, executives must be able to articulate the case for change to their workforce. And they need to do so on a detailed level—namely, not only a cost perspective but also a quality perspective. This includes the moral imperative for change and how improvement will play out for members of the organization as well as patients. In other words, the case for change needs to comprehensively and compellingly cover the why of improvement (improving health of populations) to capture the hearts and minds of the workforce.
  2. Alignment through governance: Executives guide alignment by understanding and articulating how improvement strategy aligns with the overall mission of the organization. This includes aligning resources, incentives (see principal #3), data and analytics strategy, investments, and teams to support the strategy, and importantly, always linking back to the organization’s mission.
  3. Culture of improvement (practice, rewards, and accountability): An aligned incentive program helps build the foundation of a culture of improvement. These incentive programs must exist within the organization (internal) and with contracted parties, such as payers (external). For example, internally, a recognition system that rewards achievement of a quality objectives, which inspires the workforce to strive for positive change for patients. Externally, payer contracting can align incentives around improving health of populations, establishing monetary system to award achievement of quality objectives. With such a culture of improvement, all involved feel a sense of purpose and accountability with value in the mission.

The above concepts are critical for improvement initiatives to succeed, not only because they propel transformation but also because they sustain them, making the role of executive leadership all the more vital. When the case for change, alignment through governance, and a culture of improvement are in place, sustainability happens. The workforce has a clear understanding of the “why” for change and are aligned around the mission.

Trained Change Agents and True Improvement

These diamonds within your organization, the prime candidates for change agent education, are likely current leaders with a solid interest in improvement work who are looking to deepen and expand their roles. They’re eager and ready for opportunities to improve patient care while also reducing costs to your organization.

Like Don Berwick, we believe trained change agents with solid improvement principles in place are, in effect, the engines behind transformation and the drivers that keep progress moving forward. The combination of specifically prepared team members and leadership that comprehensively understands and supports their work makes possible lasting and meaningful improvement. With change agent training, you can make a small investment in the people who can make your immense data investment come to life—that coupling will create real, sustainable transformation.

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