Organizational transformation is notoriously difficult. Twenty years ago, John Kotter pegged the failure rate at 70% and the needle hasn’t moved much since. Major change also takes a long time to implement — between five and seven years on average — and the performance improvements that are achieved rarely last.
In healthcare, change is even harder than in most industries. Clinical and administrative staff often view their work as a vocation as much as a profession, and they are historically suspicious of senior administrators and resistant to strategic agendas. While a desperate need for change and organizational performance improvement may be obvious to the top team, staff can view that premise as fundamentally flawed. They’ve lived through tumultuous times before and the status quo has always returned.
In 2011, when I came to Centura Health in Colorado as President of its largest operating group (Mountains and North Denver Operating Group or MNDOG) and CEO of its flagship health organization, Saint Anthony Hospital, I saw a clear mandate for change. The organization had a strong community tradition and over 4,500 talented employees. Yet, a variety of financial and operational problems impeded success and we lacked a clear strategic path toward building the kind of coordinated care delivery system healthcare desperately needs. I put my immediate energies toward building an exceptionally strong executive team. Together we developed an agenda for change and put it into action.
Within a few years, we had dramatically turned around the organization’s finances, performance measures, and market share. Things were looking up on all fronts except one. Our employees weren’t along for the ride.
This is the story of what we did to turn that around by involving our people in our organizational change process in a much deeper and more meaningful way. Doing so, we stumbled across a formula for accelerating organizational objectives while managing even higher levels of performance and engagement.
“I have hope that you are actually listening to associates now.”
Out of more than 500 responses, that was the one that hit me hardest. We performed pulse surveys quarterly after every town hall meeting at Saint Anthony Hospital. The questions were developed by Press Ganey, the healthcare survey company, and were related to employee engagement. We also had open questions in our surveys to give people an opportunity to express their concerns related to leadership, operations, compensation, and staffing. The feedback could be tough at times. Though we’d achieved significant organizational change and performance improvement in a very complex and challenging industry and market, it was clear that our employees didn’t feel included on the journey or excited about our accomplishments. The disconnect between how they felt about our organization and how the organization was actually performing was perplexing.
To dig into the details, I engaged in a hospital tradition and began rounding. I talked with clinical, administrative, and operational staff where they worked and asked them to tell me more.
I learned that people didn’t feel connected to our vision or the changes we were working to make. Our goal was to become the destination healthcare provider in our market while achieving national standards for best practices, care quality and satisfaction, and becoming recognized as a health leader in the communities we serve. Most of our employees’ concerns were far more basic. They were worried about working conditions, managerial support, staffing levels, and so forth, and they believed that leadership was just talking out of its hat because we had failed to address their long-term concerns.
Listening and taking notes, I knew I could solve almost everything and still not fix the bigger problem of connection and engagement. There was a lack of trust in us and alignment with our agenda.