The Three-Pillar Framework

Look back at the major initiatives your company implemented in the past three years. What percentage of those achieved their promised benefits? And how many continue to sustain those benefits?

Healthcare organizations invest their top resources, generous time, and money into defining a strategy and executing important initiatives to transform quality, patient access and experience, operational efficiency, and more. Yet when they conduct an objective review—if, in fact, they have data to evaluate—they often find they have not realized the intended results or their benefits have not been sustained over time.

Healthcare can no longer allow the potential benefits of critical, high-effort, high-cost initiatives to go unrealized or only partially realized. In a climate where you absolutely must achieve transformational strategies, you need to bring the entire organization along with you. Priorities, procedures, and processes have to evolve, and employees must embrace and adopt new ways of working. To make this happen, they must be engaged, so they not only buy into the change, they help to champion it and make the results stick. If not, the organization will slide back to its old ways of working and any improvement will quickly fade.

Organizational adoption is the outcome of effective change management.

Even companies that recognize the importance of change management often don’t understand all the elements that need to be in place. For instance, they may believe that “change management” means great communication or effective training. Telling people what to do and then telling them again is not change management. Change management comprises a much broader perspective.

Change management requires empathy, building trust, and an understanding of company politics. And it also demands hard evidence and data, discipline and consistency, and the ability to hold people—even those who are higher on the organizational ladder—accountable. There may be fear, reluctance, and resistance. There may be pressure to succeed, and to do so quickly, especially if it’s a critical transformation. Trying to manage change too quickly, or without engaging the affected employees and considering operations and processes, will make the change difficult, if not impossible, to sustain.

While some organizations overlook or assume adoption and sustainability, others err to the other extreme. If you overengineer the change management approach—for example, by incorporating demanding paperwork or surveys, soliciting input from employees who aren’t directly impacted, or requiring consensus from too many people—you risk wearing out what is likely an already overtaxed organization before adoption can occur. The best approach strikes the right balance by considering the specific situation and the level of change that the project will introduce.

There is no shortage of change management models. But IPM has consistently had to adapt them to suit the initiatives we lead for our clients. So through our experiences, we established and utilize a model that assesses and addresses only the most important elements: the people, the organization, and the project. Why these three pillars? People are the key to any change, and individuals have different experiences, needs and mindsets that need to be considered. The organization—the ecosystem of employees, functional departments, and processes—has a history and environment that influence behaviors and attitudes. And the project is the vehicle by which change is being implemented. If any of these three pillars is neglected, the risk of failure increases.

Implementation leaders and executive teams will find this three-pillar framework helpful for assessing their own situation and applying the insight to successfully execute and sustain major transformational change.

Elements to Assess for Change Management Readiness

People are the key to any change, and individuals have different experiences, needs, and mindsets that need to be considered. The organization—the ecosystem of employees, functional departments, and processes—has a history and environment that influence behaviors and attitudes. And the project is the vehicle by which change is being implemented. If any of these three pillars is neglected, the risk of failure increases.

Implementation leaders and executive teams will find this three-pillar framework helpful for assessing their own situation and applying the insight to successfully execute and sustain major transformational change.

Are the People Ready?

Change impacts individuals directly and indirectly. They are not only the recipients of change; they are the enablers. It is crucial that employees who are directly affected are engaged, so they buy-in and support the effort. These are the people-related elements to assess to determine if they are ready for change:

• Leadership commitment to change: Is there sincere and engaged support from leaders at all levels of the organization? Conversely, do leaders demonstrate tacit buy-in or skepticism? Have they successfully led change in the past?
• Communication history: Are communications typically transparent, at a regular frequency, two-way, and encouraged? Or are they limited to a select group, leaving others in the dark or reliant on rumors?
• Understanding: Do employees feel well-informed about the change, and do they understand how it will affect them personally? Or are they unaware of the change or its impact?
• Enthusiasm: Are employees excited about what the transformation will bring? Or are they angry, afraid, or even working against the change?
• Preparedness: Do people understand and are they accepting of the new competencies, capabilities, knowledge, skills, techniques, and behaviors that the change requires? Or has the necessary training and development not yet been considered?

Is the Organization Ready?

Beyond the collection of individuals that make up an organization, the organizational culture, structure, business planning capability, and process maturity all impact the ability to manage and sustain change. Change will be more successful with the following factors in place; address missing elements within the change management plan:

• Organizational alignment: Is there clear alignment between the goals and objectives of the organization, functional areas, and individuals?
• Change culture: Has the organization demonstrated a culture of continually accepting change and remaining agile to respond to new internal and external influences?
• Change capacity: Is the organization primed for change, or are they fatigued due to prior frequent or ineffective change efforts? Are they currently trying to change too much too fast?
• Business processes: Have new business processes, systems, policies, performance indicators, and rewards been planned and documented in alignment with new ways of working?
• Sustainment and success measures: Are functional groups and employees empowered to support and reinforce the change effort? Do they understand the success metrics and how their work impacts the metrics?

Is the Project Structured to Drive Change?

An effective project plan begins with and provides definition to the strategic initiative. When the project is being structured, you must consider the impact on people and their mindset, as well as organizational and business elements. If you don’t have a strong project management competency, including best practices and disciplined leadership, and if the project isn’t well defined with unambiguous objectives and the appropriate level of motivational urgency, the chances are low of implementing the change and sustaining it over time. Here are the elements to evaluate:

• Strategic disposition and business case: Is the project aligned to the company’s values, vision, and strategic goals? Is there a clearly defined business case that explains the rationale for the undertaking?
• Role and responsibility clarity: Is there a clear delineation between roles, including level of authority to make decisions? Are individuals’ responsibilities clear? Has a dedicated project manager been assigned? Is it clear who is responsible for developing the change management activities?
• Solution viability: Is there confidence the project plan will deliver the expected value and meet the success criteria defined in the business case?
• Schedule confidence: Are the project schedule and milestones reasonable, or is the schedule unrealistic?
• Risk understanding and management: Have potential risks and mitigation plans been identified, especially risks to adoption of the change?

Setting Up the Organization for Success

By focusing on the three key pillars of people, organization, and project, and assessing each element upfront, one is able to determine the organization’s strengths and weaknesses and establish a precise change management plan to bolster your ability to sustain your initiatives’ results.

SCROLL DOWN: ‘Set Up for Success’ Case Study →

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If you are struggling with redefining your strategy, prioritizing initiatives, or reliably implementing and sustaining your mission-critical projects, IPM’s strategic realization consultants can help. We combine our time-tested expertise in strategic planning, portfolio management, project execution, and organizational engagement to provide a holistic approach to transforming your organization.

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