If you have been working in healthcare for the past 15 years, regardless of your position, you have likely felt it. Something has changed. It may seem intangible, something in the climate, something to do with regulation? But you have no doubt, something isn’t the same and you are right. That something is change. Not the fact that it occurs, but the rate at which it is occurring. A physician remarked to me two years ago, as he was retiring, that there were more changes to the practice of his specialty in the last 5 years than the initial 30 years of his career !
In my own experience, it seems that change not only comes annually from government regulation, but also with each regulatory visit. In addition, each specialty organization and medical specialty board has contributions it wants to make to my practice in the way of clinical pathways, scoring systems, and management guidelines. Also, institutions use metrics for performance measurement and present a new set regularly as old ones are successfully incorporated into common practice and retired. All of that and we are yet to include changes to insurance regulation, pharmaceutical regulation, formularies, policies, paperwork, diagnosis codes, and the rest of the administrative language that makes up the daily practice of medicine. Change is no longer a single large project to be completed. It has a life of its own and I find myself slowing down to catch my breath with increasing frequency.
Change is tiring. Wether it be in personnel or policy, in technology systems or physical structure, the impact of change is significant. Though it may be beneficial, it comes at a cost. We become fatigued with the training and new procedures. We become numb to the cause of process improvement. And, we lose sight of the purpose and interpret change as a weakness and attrition. We can be quick to blame it on a lack of clear direction, poor motivation, and uninformed leadership. But I do not find that to be the case commonly. Instead, change becomes a part of our daily existence and an expectation of continual improvement. Again, this is not a bad thing, but it requires a new framework. It requires a new method of approach to our daily work. Without that framework, change is unwelcome, intrusive, distracting, and in some cases, meaningless.
How do we introduce it? Without the sarcasm, without the anxiety, and without the eye rolling and deep sighs. We incorporate it into our infrastructure and expect it. In fact, when change is not seen regularly, we should question if we are slipping. Walk this exercise with me:
You make boxes (yes, back in this factory again…We Must Do Something … ). Your factory is thriving and you are limited by a lack of employees to hire. You are making boxes as efficiently as you know how. When you first began, there were 10 of you. Each one received a personal training by you, captured the vision and dream, and worked at your side as a member of the team. Employees would approach you and ask “why are we doing this step this way instead of like this?” and improvements would arise. Not everytime, but often. Now the company is 8000 strong. Questions rarely come your way and change is seen as something that has to be endured to maintain business. You decide to change that view. You recreate the orientation process. Instead of telling employees “this is how we do this step” you start with “this is how we currently do this, but I’m waiting for one of you to tell me how we can do it better”. When employees are given their duty, they are shown the impact of their work through a tour of the entire process, and then shown a box with a defect. “This is why your step is so important, and when we figure out how to do it better, we will change what you do and how you do it”.
Others have remarked that change fatigue is combatted by employee retention, retraining, and a change in overall culture. All of this is true. The central tenant, however, is embracing change as THE process, not a part of it. We make boxes and we continually change to make them better. We care for patients and we continually seek change in what we do to improve the care we deliver.