Advancing better outcomes by focusing on change. Partnerships, power and professionals. The role of physicians in healthcare reform

Colleen Grady – Centre for Studies in Primary Care

Ms. Colleen Grady explained that she conducts research in the areas of physician leadership and burnout. She examines change and dynamics; getting behind and momentum; the power to stop, partners/stakeholders and professionalism.

An activity for workshop participants showed that change is uncomfortable because individuals prefer to find or use their own method of completing tasks. Recognizing the value of unique perspectives helps stakeholders see that every perspective matters.

It is important to acknowledge the difference when people participate in changes in comparison to instances when they are expected to comply with changes. A second activity demonstrated that feelings and emotions are linked to the concept of change.

Various models of change can be effective, but it is most enduring and sustainable when people are active participants in change. A slide focusing on the first two steps of Kotter’s Eight Steps to Change, establishing a sense of urgency and creating a guiding coalition, were presented and discussed.

A research study involving doctors in Ontario had two main objectives:

1.      Understanding physician engagement

2.      Developing physician leaders 

This study concluded that physicians were viewed as leaders by others; however, many physicians do not have formal leadership training. Another finding was that family physicians would be more likely to learn about changes if they were compensated for their time; as a result, patient care would become more evidence-based and physicians’ work would be more relevant to their area(s) of practice.

A third activity involved a physician case for change, and resulted in a discussion about establishing urgency and forming a guiding coalition. With guidance from Ms. Grady, solutions should meet the following criteria:

·        Establishing a clear why (i.e. defining results and benefits)

·        Defining a critical nature of change (i.e. now, future, funding, employment status, consequence without change)

Creating urgency may include imagery, emotional connection or inspiring action to show patient reaction, financial stress or future problems. Criteria for how to establish a guiding coalition included:

·        Engaging expertise (i.e. acting as a champion without an ego)

·        Engaging someone in a position of power to initiate change

·        Engaging people with credibility

·        Engaging individuals regarded as trustworthy

Stakeholder groups will adopt the following roles to proposed changes:

·        Resisters (i.e. people who overtly or covertly oppose change)

·        Bystanders (i.e. people with a neutral reaction to change who can be swayed)

·        Helpers (i.e. people who will move the cause forward)

·        Champions (i.e. influencers who fully support the change)

A final exercise focused on stakeholder analysis for a particular change process. Participants were asked to relate the exercise to their own work environment. Answering the following questions identified how to assess stakeholders in each group, and how to leverage that information to move change forward:

·        Who are they?

·        Why are they in this group?

·        What would success look like to you to move them into change?

·        What would success look like to them?

·        What is the most important thing you could do to influence this group?

In conclusion, not all stakeholders will support proposed changes. Some may need to leave the environment if they continue to resist after the change is implemented. Participants were encouraged to critically examine stakeholders in each group, and commit to understanding their unique perspectives to achieve the highest rate of change adoption in a healthcare environment.






Report written by: Julie Ferlisi, The Write Approach Professional Services

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