Influencing Change

The creaking sound that you are hearing is the ice beginning to break up in the overly ossified structures of what has for many years passed as a “system” of health care in the US. While the policies and regulations are yet to be fully in place and a few courts and a majority in the House of Representatives are calling for its demise, the organizations, institutions, professions, practices, companies and agencies that form our crazy quilt arrangements for care are beginning to imagine what a more integrated, more consumer responsive, more value added approach to health care might look like.

The first task of course will be to envision what shapes could emerge if the practice models for primary and specialty care, hospital services, prevention and management were put together in some new and different ways. There are lots of good ideas and a growing evidence base establishing what works and what amounts to ephemeral rearrangements. Change efforts need to be understood and interpreted by each team, practice, and organization that is pursuing change. Otherwise they will not be fully embraced and owned by the change agents and everyone else that will need to change.

The second step of successful change will be for the change agents to embrace the need to influence others toward the change. Every change agent harbors a secret desire to be able to phone in the change and have others “just do it” and get on with the business of making care better. Unfortunately, such a fantasy land does not exist. Leaders of change need to be masters of influence and this is a conscious and deliberate art. One useful way of thinking about influence is that it moves in three directions: down, out and up. Understanding how influence is similar and distinct in each of these vectors will improve the effectiveness of the change leader’s efforts. 

Influence down is about motivating and the key to motivation is development. The more our coworkers understand and value the change that is afoot, and the more they see that they have the skills to be successful in the new order of things, the more they'll support the change. This is not an easy task. Almost by definition, the leader in a change effort has come to see and value the cost and benefits of making the change. She may take on the change herself for their benefit so that they don't have to struggle to accommodate the new idea. Nothing could be a bigger misstep. The change agent should share the information that has led her to making the change and facilitate the process that every stakeholder must make to come to a new order of things. She short cuts that process at her own peril.

As health care moves to more integrated systems influencing outward will be more and more important. Outward influence will be of two kinds. First there is the influence a leader brings to professional peers and colleagues within the organization. Health care has bred a value of independence and autonomy for most of its history. Much of this has been valuable as the professional used that independence to serve patients. But now these patients will be best served if the organizations that provide care work at the most optimal level. To do so will mean that all of the professionals align their efforts toward such a goal. Influencing professionals to align their work will require activecollaboration and transparency by the leader. Initially this will take much more time than may seem desirable or possible to sustain but, over the long haul, organizations that can align professional staff through influence will become more competitive. The same collaborative and transparent approach will also benefit efforts to influence out to other organizations. The nature of professionals and health care will always present situations where this core value of engagement will benefit organizations seeking to align their interest and change to something new.

Finally, any effort to change will require a leader to influence up. In an ideal world the mandate for change comes from the top, but the health care world will not be ideal for some time. Leaders who get the new reality and landscape will emerge throughout health care organizations and practices and they will not always be at the top, but they will need the top to advance their change agenda. The core value here is loyalty. Not the blind type that follows order without asking, but the courageous variety that is willing to take the time to intelligently, systematically and bravely assemble a change initiative and push it up into the system. No leader should think that everything will always have the stamp of higher authority. There will be times particularly in the early stages of change when courageous acts, informed and skilled, will be absolutely essential to change health care as we know it.

In health care influencing out, up and down will be the hallmark of a successful leader in the coming years. There are many discrete skills which attend to the practice of influence. Health care leaders would be wise to develop them all.