1. Knaus, Michael A.

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In the last column, information was provided to help understand change in healthcare. The changes in healthcare have been caused by (a) social issues (e.g., aging population and consumer demand), (b) economic issues (uncertain financial issues for organization), and (c) technological issues (e.g., tremendous changes in information technology and electronic records). To implement a successful change, the organization and employees must be open to change and make short-term and long-term planning. The clearer the objectives, the better the plan will be for change.


Healthcare organizations often have a vision where they want to be, but they end up having a gap between where they are now and where they want to be in the future. To plan change, the organization and employees must realistically assess the current strengths and weaknesses. This will help identify gaps. Gaps may be identified by asking clients, taking what clients complain about seriously, and asking employees. This can be done by interviews or surveys.


Once you know what needs to be changed, you can plan your short-term and long-term goals or objectives. It is important to include employees as much as possible when developing goals and objectives and planning and implementing the change. The more people consulted, the more information will be available for developing change plans.


The following are the do's:


1. Invite suggestions from everybody possible.


2. Hold frequent formal and informal meetings.


3. Involve teams in planning and implementation.


4. Manage individual's expectations of the change with care.


5. Communicate, communicate, and communicate during change.



The following are the don't's:


1. Do not coerce individuals into change.


2. Do not keep unnecessary secrets from employees about change.


3. Do not leave any individuals isolated.


4. Do not break promises you have made about change.



Planning for change is a time to unite the entire organization and may help trigger new ways of thinking. It may be helpful to set up teams to assist in planning and implementing change. You may also want to establish "champions" to help communicate the potential change.


Despite having a detailed plan with specific goals, objectives, and action steps, it is important to prepare some contingency plans. Table 1 describes several contingency plans for implementing change.

Table 1 - Click to enlarge in new windowTABLE 1. Potential Problems and Resolutions to Change

As can be seen in Table 1, communication is vital. You can never communicate too much in the planning and implementation phases. Be honest. Be sure all aspects of the plan for change are communicated as soon as possible to all employees affected. Letting employees learn about a major change from outsiders (e.g., clients or families) is detrimental. This will create anxiety and distrust. Training is also essential if employees need to learn new skills. There are several ways you can communicate about change and training. You can use any newsletter or Web site you have. Presentations to groups of employees or one to one can be used. Hold team meetings (or town hall meetings) in which individuals may discuss issues, problems, and suggestions. Personal communication is much better than a written e-mail because individuals can ask questions.


Everyone can be an effective change agent. Once you understand change, you can begin planning and implementing the change. Be realistic when developing your plan. Be sure to involve other individuals in the process. Definitely, communicate frequently and provide adequate training.