Healthcare organizations are adjusting to shifting payment paradigms and responding to government mandates targeted at macro trends. At the same time, they are dealing with severe staff shortages and massive technology uplifts that threaten to change the way care is delivered. Addressing these challenges leaves limited bandwidth to target improvements that are more tailored to their own organizational needs, while also delivering quality care to their patient population. Dealing with all the conflicting pressures at once leads to cognitive overload on healthcare’s clinicians and providers, so healthcare organizations must have clear methods to choose the right improvements for their organization – detailed in a previous post, Overworking Your Working Memory: The Effect of Cognitive Load on Patient Care.
There are more challenges in U.S. healthcare than you can shake a stick at, all of which are opportunities for healthcare enterprises to target improvement. Unfortunately, with each targeted improvement comes change.
Organizational change can be impactful in terms of process, training and the mental focus of the staff at the organization; however, there is a finite capacity for change in each organization. Every change requires people to make it – people with limited resources at hand, which include:
- Time to change systems and processes
- Mental capacity to learn new behaviors
- Performance measurement
- Focus to refine approaches and ensure adequate improvements have been made
As many organizations are finding, it is easy to reach the point of change saturation. Change saturation occurs when there is so much change going on that it negatively impacts individuals and the organization. There are some methodologies of change management that will measure the impact of change on the organization in terms of teams and productivity, but few focus on the impact that a change has on the mind of the individuals required to make this change.
Change Management: A Portfolio Management Approach
To achieve a healthy balance between productivity and improvement, healthcare organizations should take a portfolio management approach to change management. This can be done by executing, at most, one of each of the following three types of changes per employee:
- Metric-driven improvements
- Strategic cultural improvement
- High value, low incidence
The set of these changes minimized the overall cognitive interference on the individual.
These are changes driven largely by the identification of a problem, a measure to track progress, and limited or no prescribed behavior changes. An initiative like improving hand washing before and after interacting with patients is a perfect example.
Healthcare organizations employ methodologies to measure their employees’ performance of hand-washing protocols without giving the employee specific tools to improve their behavior. Just knowing the initiative is important and being tracked is enough for the employee begin to change a behavior.
Metric-driven improvements require conscious thought to achieve their end, increasing the cognitive load on the caregiver and should therefore be limited in their application. Having to remember too many things will result in the failure to successfully achieve any, so organizations should limit these high-cognitive-cost changes.
Strategic Cultural Initiatives
These reflect changes focused on improving the identity of the organization by attempting to co-opt a positive behavior to all employees of the company with the aim of improving some facet of the organization. A campaign – say, to be the friendliest company in healthcare – is an example of a strategic cultural initiative.
For changes of this type to be successful, employees must personify the intended characteristic of the organization. An effective implementation of a strategic cultural initiative requires employees to identify themselves with the change, to be the change. While changes of this type are typically personal, successful change does not require a significant amount of cognitive capacity, making them attractive to pursue.
Strategic cultural initiatives are a powerful tool for change. They take a while to percolate; and, because they require full buy-in to a personality trait, they should not be overused.
High Value, Low Incidence
These changes target rare events that incur a high cost with the goal of increasing the likelihood of a positive outcome. Examples of these events can be found throughout the healthcare industry because many rarely-occurring, high-risk conditions incur high costs (e.g. post-delivery maternal sepsis).
Effective change management that addresses this issue requires the organization to introduce awareness of the issue to the caregivers and provide best practices that are easy to recall when the incident arises. Since these incidents are generally unlikely, successful improvements require the caregiver to have the knowledge in their near memory, making this type of change a low to medium cognitive impact.
High-value, low-incidence changes offer a rich target for improvement, but require an initial mental investment that prohibits successful adoption of too many at once. A better strategy for implementing this type of change is to cycle through a series of changes allowing the caregivers to master one topic at a time before moving on to another.
In a Nutshell
To reduce the cognitive load on caregivers and employees, healthcare organizations need to be diligent in selecting the changes they wish to achieve in the organization – pairing low-impact with higher-impact cognitive load changes. This can be done by managing the change portfolio across the employee base and focusing on one metric-driven improvement, one strategic cultural initiative and one high-value, low-incidence change.
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