The trusted source for
healthcare information and
Communicate to put yourself in the driver’s seat
If the Outcomes Assessment and Information Set (OASIS), the interim payment system (IPS), higher third-party payment hurdles, and increasing competition have your organization singing the blues, you are not alone.
Rampant changes have left most home health providers reeling. And it’s no wonder. Telling your staff to complete more documentation and increase productivity for the same or less pay while remaining upbeat is one thing. Helping them accomplish such feats is another.
Managing change is one of the most difficult, yet important of administrative responsibilities. It can make or break the effectiveness of your organizational improvement initiatives. You can put yourself in the driver’s seat, though, by understanding the phases of and obstacles to change, according to Nancy Mongeau, RN, MEd, MSW, director of recruitment for Lynn, MA-based All Care Visiting Nurse Association. Mongeau speaks frequently on organizational change.
Although it is often good, change is disruptive in the short run and can be debilitating if obstacles block progress. Some common change obstructions Mongeau cites include:
• lack of communication;
• not making employees part of planning and transition;
• not having appropriate leadership;
• not making training and necessary new skills a priority;
• seeing change as painless and quick;
• managers believing they are alone in directing change.
Every organizational change involves both hard and soft issues, according to Mongeau. Managers can more readily recognize and measure hard issues such as limited resources, increasing workload, poor quality, and declining profits. Soft issues, such as negative attitudes, lack of motivation, ineffective communication, and lack of teamwork, are more difficult to identify and address. Yet "the touchy-feely stuff will help you get through change," she says.
Gaining staff cooperation and support during transition starts with understanding the phases of change. Each high and low of what Mongeau calls the roller coaster ride of change are predictable. Recognizing the signs of each phase and its related expected behavior can put you well down the change management track:
• The big change.
After the announcement of a major new initiative, the entire staff may be numb. "They’re in denial. They want to focus on the way things were," says Mongeau. People may carry on with normal routines and work patterns, but there is usually a productivity drop.
During this phase, communication is critical. "You should provide the maximum amount of information possible, in meetings and newsletters, for example," Mongeau suggests.
Paint a big picture that covers community, state, and even national issues so staff understand the reason for the change and don’t assume that it’s just something you’re doing to them. Relate the changes to daily work life so that people know what to expect.
Lack of communication is often a factor in unsuccessful change initiatives. Make sure you provide as much information as possible when announcing a change, including the things you don’t know, Mongeau advises. (See Change Announcement Worksheet, above.) Make yourself available for employees. Consider having special "open door" office hours when staff can talk with you one-on-one.
It is also important to give employees time to accept the new requirements. "People get very needy at this stage. They ask the same thing repeatedly, and it’s not because they don’t understand. It’s because they don’t want to hear the answer," Mongeau explains.
• Resistance and confusion.
After people have time to absorb a new initiative, they often sink into resistance. "It’s the fear of the unknown. The status quo is preferable, even if it’s bad," Mongeau explains. At this stage, staff reactions range from apathy to anger, and there may be a high degree of stress. Listening to subordinates is paramount.
"The leader must listen, acknowledge, and support staff. Don’t talk people out of their feelings. Listen to their concerns; they may be unfounded. This is a good way to find out misperceptions and deal with them. You should also empower staff to give suggestions or ideas," says Mongeau.
The high-stress work environment, combined with personal issues, may send some employees into an emotional crisis. If you sense that a person is reacting to more than just work-related changes, refer her to your employee assistance program or other counseling service, Mongeau advises.
• Integration and exploration.
Given time and appropriate support, staff begin to focus on the future and look for new ways to relate to each other in the new world order.
"This phase can be exciting and chaotic. It also requires a lot of energy," says Mongeau. As employees start accepting change, they also search for ways to better function. New ideas may abound.
During this phase, focus on priorities and provide needed training. For example, if your organizational change involves new team structures, this would be the time for each team to find the best way to work together and establish communication standards, Mongeau explains.
As people form new working relationships and settle into changes, they feel less threatened and their optimism and job satisfaction re-emerge while their anxiety decreases. This is the time to set long-term goals, concentrate on team building, and validate and reward those positively responding to change, Mongeau advises.
Ongoing recognition sustains changes. When the company, teams, and individuals reach goals, make an announcement. Some organizations lose momentum at this point because they stop talking about results once the desired financial or productivity figures appear, according to Mongeau.
• Nancy Mongeau, RN, MEd, MSW, Director of Recruitment, All Care Visiting Nurse Association, 16 City Hall Square, Lynn, MA 01901. Telephone: (781) 598-2454.
When preparing to announce a change in writing or in person, be sure to have answers to the following:
• What is the change? (Be specific)
• What is the reason for the change?
• What is the likely impact of the change?
• What are the benefits from the change?
• What are the drawbacks of the change?
• What details do you know?
• What details are not known?
Source: Nancy Mongeau, All Care Visiting Nurse Association, Lynn, MA.