Constant change takes a toll

The Report: October 2003 vol.24 num.5

by RAE JOHNSON

malgamations. Privatization. Restructuring. Layoffs. Service cuts. Multi-site chiefs. Imposed conditions of employment. The only thing constant about the working conditions in health care is change. It is constant, multi-faceted, relentless• and it is taking a toll on health science professionals as they struggle to meet the ever increasing needs of patients and residents with fewer resources.

Many health workers have reached a point where they dont even want to engage in change; they have been hurt by past change processes, or had their hopes dashed by change process into which they invested their time and energy to no avail. Yet we cannot ignore change, and the health care system needs our contributions.

During the past year, I completed a thesis on organizational change. I wanted to talk to people about change experiences that had gone well ... and what had contributed to them going well. This type of research is called appreciative inquiry, based on the belief that if we focus on what works well, rather than trying to fix what doesnt work, we have a better chance of improving our workplaces.

The data I gathered clustered into five dominant themes: -teams and team relationships," -facilitative leadership," -character," -learning," and -ethics." While the research was specific to Providence Health Care ... my employer ... I believe there is applicability for everyone undergoing change. These days that is all of us!

Whenever people spoke about change, the credit went to the team they worked with. They spoke of mutual respect, struggling and learning together, sticking together through -thick and thin" and respecting the diverse talents and perspectives that each person contributed. They spoke of the team being strengthened by the change experience. Think about your various teams at work. Do you give and receive support? Learn together? Ask difficult questions of each other? Each and every person can influence the functioning of their team.

Under the heading of -facilitative leadership" came the message of the importance of good change processes. People spoke of the need for well-planned, inclusive processes with decision making as close as possible to the operational level. Change went well when the goals of the change were clear and the team knew the boundaries ... the -box" ... within which they could formulate plans and make decisions.

Captured under the heading of -character" were the personal traits of individuals. Honesty was described as not just telling the truth but telling all the truth and doing it consistently ... that people, leaders in particular, were clear about what they knew and did not know and how much influence they had or did not have on decision making. Frequently the comment was made that bad or potentially bad news should not be sugar-coated but delivered in a timely, respectful and comprehensive way by leaders known to the group. Integrity. Respect. Openness. These and other similar words were also used frequently by participants as they spoke about their change experiences and the characteristics needed to foster trust and build support.

-Learning" was a thread that wove among many of the stories shared by participants. Learning about process; technical learning; learning about self; and learning about others. Many spoke of the opportunity to take the learning from one experience, strengthen the process and the team, and apply it to the ongoing work. Learning was also discussed in the context of turning a potentially negative situation into a positive by a change of mindset toward learning. What can be taken from this experience which will help us in the future? Is there an opportunity for learning here that we havent identified or acknowledged? The orientation toward learning was seen as a way to see past the current circumstances to the opportunities ahead.

The crux of change is in the decisions that are made. Participants spoke of the need to struggle through an honest ethical reflection and dialogue with regard to some of their decisions, particularly those which had the potential to negatively impact staff or patients and residents. They emphasized the need to allow and expect ethical debate to occur in order to surface all the issues and give them fair hearing.

In all, these were the elements that constituted successful change processes. Participants concluded that a change process is successful when it:

• is inclusive of all stakeholders;
• is based on clearly stated principles and assumptions aligned with mission or objective;
• respects all perspectives;
• recognizes and nurtures the diverse strengths of the team members;
• allows time for the team members to build relationships ;
• has a mind-set for learning from the process and the outcomes;
• clearly places the patient and resident at the centre of decision making;
• encourages and expects ethical debate;
• strengthens and encourages team members to take their learning into the next change initiative;
• evaluates the outcomes based on the guiding principles and makes adjustments as necessary;

You may be thinking by now that this is all well and good, but you should see what is happening in my workplace! We all have stories of change gone wrong, change poorly planned, and negative effects of change on staff, patients and residents. These stories are all around us.

What I hope to have contributed to the discussion is a picture of what change looks like when it is done well. It is possible. It is needed. Lets keep trying!

Rae Johnson, who earned an MBA this year from Royal Roads College, is a pharmacist at St. Vincents Hospital. She represents Region 6 on HSAs board of directors.