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The Vurge
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The Vurge
Navigating Organizational Change in Healthcare: Insights from Divurgent
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On this episode of The Vurge, we welcome Debi Smith and Lily Farris to the show to unravel the tapestry of organizational change management (OCM). The duo tap into their rich experience in healthcare OCM to share how understanding the human side of transitions can lead to a successful transformation, especially when integrating intricate systems like Epic. Their stories reveal the delicate dance between developing strategic communication and nurturing leadership to guide teams through the ebbs and flows of change.
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Hi everyone and welcome to a new episode of the Verge. I want to introduce Debbie Smith and Lily Ferris. They are both divergers along with me, and today they're going to talk about organizational change management. But first I want Debbie to, if you don't mind, going ahead and introducing yourself and tell us all about what you do at Divergent.
Speaker 2Absolutely. Thanks, Rebecca. My name is Debbie Smith and I've been at Divergent for about a year and a half now and my primary focus is in training and development primarily Epic, Go Live training and building out learning programs and I have a real deep passion for organizational change management. I got involved with organizational change management as I moved into the training space about 15 years ago and realized very quickly the importance of recognizing the need for change management in a training space and that kind of developed into this more overarching organizational change management passion that I have now. So that's kind of me in a nutshell. I've been in health care for about 20 years and in consulting for about three years now and I primarily focus on OCM and training initiatives, Lily.
Speaker 3Fantastic, debbie. I'm Lily Ferris and I joined Divergent a couple months ago and I specialize in clinical change management. So I have spent my career in and around the healthcare space and how to do organizational change management, how to do large scale transformation in the complex world of healthcare delivery and healthcare enablement. So I actually started out in research and evaluation. I did an undergrad and master's in sociology studying how we can make improvements to the healthcare system, doing research through the School of Nursing on how we could actually deliver better primary healthcare to communities, and then got really interested in how we could actually make that happen from a delivery perspective within the actual health organization. So very, very interested in first in evaluation, but then also how do we actually execute that at an enterprise level? And most recently, before joining Divergent, I worked at a provincial level here in British Columbia and Canada across different health systems looking at how we could do that standardization of alignment in terms of organizational change management best practices. So we could, you know, meet the evolving IT needs in a post COVID world.
Speaker 1And make the processes lean as you're making the changes right. Like I always tell, like I don't want to go up and down the stairs, you know 12 times how do I do it? Just once and carry everything down. So which one of you lovely ladies wants to give us the definition of organizational change management? Because we all know what change is. We know what management is Bringing the organization together. What is the definition that you go by to help people understand everything that encompasses that?
Speaker 2I could take that. So organizational change management there's really a lot of different ways that it's defined, but what we are trying to say with this is that it's a systematic approach and application of knowledge, tools and resources to address a given change necessity. So, really, what we're looking at when it comes to organizational change management is what's the change, what needs to happen, and then how are the people impacted by it? What kind of tools and resources do you have in place to create a smooth transition from one current state into a new future state, and how do you minimize the negative impacts that we feel when we're dealing with change? Because, regardless of what the change is, change is uncomfortable and it has an impact on us.
Speaker 1And lots of politics are pulled along with the change right. You can't just implement it without involving the people and pulling it along. A lot of it has to do with the people that are involved. What about technical change management, and how is that different or not so different from organizational change management? Lily, do you want to take that one?
Speaker 3Yeah, Organizational change management Lily, do you want to take that one? Yeah, I think it's really important that we're clarifying that we're not talking about technical management of changes, Because when you're in a IT software setting, you're going to have a system by which there will be, say, software updates and there will be a team reviewing those software updates, software updates and there will be a team reviewing those software updates and there will be a need to make technical changes to that environment and a structure for managing those. We're talking about the entire way in which the organization including the adoption or incorporation of technical management into that entire approach for how we do that full business solution of managing that changes, understanding what they are, engaging all those key stakeholders within and outside of the organization and moving that entire organization through that transition process. One step in that may be a change managed on a technical side of a piece of software, but that's just one small slice of the big picture.
Speaker 1Yeah, and a lot of this goes with the governance committees that are in place at the organization, right. So they have a governance committee so that everybody has a voice and know the changes that are coming, and then once that change is set or developed, then the OCM team can come in and really start to implement that throughout, throughout. Correct.
Speaker 3Yeah, rebecca. One point to add to that is that I think a lot of people think they know organizational change management and there's a lot of folks that are sort of armchair, you know. We think we know what needs to be done in this space and where we want to really add value is in terms of a robust strategy, because a lot of times people will say, well, we'll just go talk to so-and-so and add their thoughts, but have you systematically brought a strategy to how you're approaching this work, or have you just sort of had a brainstorming conversation without a framework behind it?
Speaker 1Yeah, absolutely Great, great point. So when it comes to assessing the change right, so that say, the governance committee decided that there, you know, could be a change, or they're starting to think about a change and you need to assess the size and and what might happen what would be your approach in doing that assessment?
Speaker 2That's a really great question. I think with any potential change that's upcoming, the first thing that you need to do when you're assessing it is really sit down and understand why we need to change. So it's really easy to say surface level hey, we've got this problem, we have a process that's just not working, it's not functional or it's not efficient enough. We need to change this, we need to be better at this. Well, that's really easy to do. But really sitting down and getting to the root of what it is that's broken is how we initiate the assessment of a change.
Speaker 2So, really looking at what's the true nature of the problem and then what's the scope after that, how many people really are going to be impacted? Is this going to be one department? Is it going to be the entire industry or the organization? Is this going to be something that feeds out into our vendor relationships or our patient relationships? So, really looking systematically at to Lily's point being very systematic and about identifying that root cause who all is impacted, and then how do we tackle that problem in a way that is least disruptive to the organization, as least disruptive as we can make it?
Speaker 1Yeah, sometimes they're very disruptive, right, and so how do you go about assessing the employee readiness and pulling along the ones that have their feet in the sand? I'm not going through with this change. How's your approach on that?
Speaker 2Great question as well and probably my favorite part of OCM.
Speaker 2Not going to lie, it's the most frustrating part of organizational change management dealing with the naysayers, the people who are dragging their feet in the sand, et cetera.
Speaker 2But they're kind of my favorite the people who are dragging their feet in the sand, et cetera, but they're kind of my favorite and the reason they're my favorite is probably the challenge behind it. I really do like the challenge, but those are the people that when you can win them over, if you can show one single naysayer in a field of employees why it's important that we change and you can move them out of that space of oh, I have to change to actually recognizing and feeling I need to change and this is going to benefit me. Guaranteed you are going to flood in probably 50% more of your naysayers from that one person. So really it comes down to spending the one-on-one time in coaching and communication, face-to-face communication with those individuals to say tell me what you're afraid of, let me explain to you why it's important that we move down this path and let me help get you there mentally and emotionally so that you can help me help others.
Speaker 1Yeah, a lot of times they just need to have their voice heard, right, and and they've been there a lot of times, um, for 20 or 30 years, and this is the way they've done it for so long and then trying to convince them that this new shiny thing is the best, you know the best, and so, a lot of times, just letting them talk and hearing what they have going on. Lily, when it comes to the stakeholders, how do you handle a situation when the stakeholder doesn't seem open or ready for the change and how do you assess that they, what level or what scale they're on to help move them forward?
Effective Communication Strategies for Change Management
Speaker 3I always start by confirming what their particular role as a stakeholder is in terms of the change. So there's their level of resistance, but who are they to this particular change effort? Are they someone that does need to be deeply involved or do they just need to be informed? So, understanding that bigger picture in terms of who all the stakeholders are involved and then who specifically needs to be contributing, and then I look at that stakeholder as an individual and we have tools that we use from an organizational change management perspective to classify folks in terms of where they are from an engagement and resistance perspective and what we know in terms of how folks show up and how they receive information so that they can process it to be a part of that change effort.
Speaker 3I often will then look at where is that person in terms of. Are they receiving information? Are they in a fight or flight mode and they literally can't hear me? Do they need more information? Do they need more understanding? Do they need messaging from their senior leadership so that they feel engaged and they've heard from the right people? Do they need a story about why this is important, especially from a patient perspective? Do they need the numbers and the detail and the background that will help guide them in terms of understanding why they would hit that metric. So I try and understand them better, ask those open-ended questions, but also guide that all in terms of where that stakeholder sits within our bigger picture. If they're one of our key resistors and one of the leaders, from a clinical standpoint, that needs to champion this, then we need to spend whatever time is needed to help them so that they can move through their own change journey, so that they can then take their organization along the change journey we need them to go on.
Speaker 2And I think too, to kind of piggyback on that most change resistance comes from a place of fear. So to Lily's point especially when it comes to an actual stakeholder of a project or an implementation or a go-live, whatever it is really sitting down with that stakeholder and getting to the root of that fear. Are you afraid of the unknown? A lot of us. Take Epic, for example. If you've been on one system for 30 years and now you're transitioning to Epic as a new EHR platform, that's really scary. And if you've been on the same platform for 30 years and you're an executive leader and you're now responsible and you're a stakeholder in this new go-live, it's really scary to have to learn a new technology when you've been using the same technology for 30 years. So, getting to the root of our fears change resistance always, always, always, comes from a place of fear. Figure out what the root of the fear is and you can help that person move forward into a better space.
Speaker 1How important is it to have a structure where you know for those take the Epic Go Live right, the board's going to help decide that this is going to go then the executives and the VPs all the way down. And so, with that said, how important is it to have that structure of buy-in all the way down and then all the way back up to pull people along?
Speaker 2It's really super important. If you don't have buy-in from every level, you're not going to succeed, and what I mean? I mean you may implement Epic, but you're not necessarily going to use Epic then to the best of its ability as efficiently as possible. If you don't have buy-in from every level, you're going to find people that are still trying to kind of like sneakily work around and use some random spreadsheet to do this work instead of using a work queue in Epic, things like that. So buy-in is essential to a successful implementation or a successful change of any kind. It can be a culture shift. You can be changing the culture of your organization and if you don't have buy-in from every level, you're guaranteed to have silos and they're going to impact what success looks like for your organization.
Speaker 1Absolutely. When you're coming in and doing an OCM project, what is your process in terms of communication? Because communication is key. You need it on so many different levels and different platforms, and so what platforms do you like to use? What do you find people are most receptive with and what do you go in with in your mindset for a strategy, lily?
Speaker 3So I always try and start with what is the structure within that organization right now, what's working well, what's not? So if we can piggyback and match our approach to what's working well in that organization, sometimes we can bring in the most dynamic tools from a communication standpoint. But if it doesn't land like I'll give you an example in a clinical setting, you know, doing something with video actually may not work that well because of the challenges of shared devices. They can't actually hear the video or they're looking at items on their phone, so there it doesn't actually show up as nicely in terms of actually receiving those materials. So, know your environment. If you have to go foundational in terms of those tools, then great, know that about it.
Speaker 3But we know from a guiding principle perspective that we need to start with the top.
Speaker 3Again, folks in leadership need to understand what is happening and they need to be comfortable enough that they can speak to it.
Speaker 3So we're going to arm them with those tools, but we're going to center them so that they're the ones providing that message.
Speaker 3So you have your CEO at the town hall speaking to this project If she needs the PowerPoint slides so that she feels comfortable, or she wants one to three talking points with frequently asked questions.
Speaker 3Then you build out that toolkit so we have all those pieces in place. So, as she shares that information and then provides it to her directors, they have a toolkit of resources that they can go back to and know that they're well-armed to answer those questions but that they can then cascade information down to their managers and say here's your primary contact and they know it's not stopping with them. They don't need to answer all these technical questions about that epic upgrade, but they know enough to know who to contact and they feel that we as a project team are well supporting them so that they are empowered to be that face of this transformation for their organization. And we're there to help them when those hard questions come up, when those HR issues arise, that they don't feel like they're out in the cold in terms of getting their teams through it, because it's one thing to get yourself through the change, it's another thing to get your whole team on board and singing from that songbook.
Speaker 1Yeah, absolutely. The executives are going through the change as well. At the same time, they have to be cheerleaders, right? So, debbie, what do you do for a platform lack of better word, a platform lack of better word to help the employees raise their questions or alarms during that change management that something's happening and it's not working up to the leaders that are able to reset the change or refocus the change so that it's going to work with their workflow? And for me, I'm thinking, which happened all the time when I was installing EHRs was the clinical teams right? So it gets decided that the EHR is going to be set in a certain setting all the way down and you realize that's not how it actually is going to work in real life. And where do you go to have that communication go back up?
Speaker 2Yeah, feedback loops are really, really important, and I think it goes along with communication really well.
Speaker 2So, number one, making sure that for the average end user, that the average employee, the masses of an organization, places like a SharePoint site that houses all of the information, with an FAQ repository so that, as questions come in or concerns come in and we get answers out to those individuals, we then can house those same answers in a shared place for others to be able to get the information.
Speaker 2More importantly, though, things like Q&A sessions or lunch and learns are really, really great outlets for employees to be able to come to a safe space and say I have a concern about this. Or, as I was going through my training and I was in the playground or whatever, getting used to this new software platform, I found that A, b and C didn't really work that well for my workflow on my team in my department, and we're able to then, as an OCM team, when OCM is hosting things like lunch and learns or Q&As, we can then take that back to our project team and say, hey, we've got people speaking up and saying this isn't working right. Let's go ahead and reevaluate and see where we sit.
Speaker 1In terms of oh, go ahead, lily.
Speaker 3You had to add yeah, I just wanted to add that whatever you develop in terms of your feedback loop needs to have a functionality so that you can drive down to that individual level, so that we know. Debbie suggested the following and said this isn't working. So we can follow up with Debbie and say okay when you say it's not working does the functionality just not work at all or does it not match your clinical workflow?
Speaker 3Like, what is the problem? Because we can do twofold If we've done a series of consultations, we can reflect that back in our communication and also, as we roll it out, we can say okay, we've heard a range of concerns. Here's some of the issues that have arisen. Here's how we've addressed them. From you know, your colleagues have brought forward the following ideas.
Speaker 3Great. Then they can know that there's a dialogue and a feedback loop going on there. But also, if Debbie raises something, we need to be able to reach out to her, find out what that issue is, so that we can systematically collect all those issues, decide if the approach is changing.
Speaker 1If it's not changing, we still need to communicate that have you all been seeing any innovation in terms of ai or newer technology that's being used for ocm, for potentially the the younger crowd in my head? Let me explain. My head goes to chime, where one of their um speakers this past fall uh, actually was part head of their DE&I program and they were using TikTok videos essentially closed within their own organization, to help train their staff about DE&I and how to appropriately address people and so on. And so, in terms of change and that being, you know, a driver for organizations, are you seeing anybody being innovative or using AI or platforms like that to get across to their employees?
Leveraging Video and AI for Engagement
Speaker 3I think it's an interesting challenge and I think it's still evolving in that space. I also think there's technologies that we've had for a while that people are now using in different ways. So the use of video to communicate in large scale organizations has existed for a long time but folks comfort level with video and their willingness to center individual clinicians to make those videos personal engaging has really shifted and I think that's where there's a lot of opportunity is that it's very different to have those you know, sort of very dry videos that are like here's a how to versus that engagement where you get to see that ER, doc, clinician talk about why this particular issue is so important and why they really think this project is invaluable.
Speaker 3Folks want to hear from their own senior leadership, as we know.
Speaker 3So those internal messages, if we can not bring them all in one room, but if we can still convey the importance of their work or, even better, if there's a patient journey out there somewhere that we can highlight, that connects them back to the why, because a lot of people that work in this area, you know it does really hit their core values.
Speaker 3So there's a reason they're doing this. And if we can hit that from an AI specifically, I think some of the low hanging fruit opportunities are in that chat bot space. So if we think about service desk or sort of, you know, answering their questions, if there's an electronic health record implementation, you know if there's an opportunity for folks to open a little window on the side of their workstation and get a question answered that way, I really see a divide in terms of some folks are very willing to do that and some really want to get somebody on the telephone to speak to. But if we can even siphon off 10% of those calls to somebody who's getting their issue addressed in real time through a chatbot, that makes a huge difference in terms of the volume that we're dealing with when we're dealing with moving an getting their issue addressed in real time through a chatbot. That makes a huge difference in terms of the volume that we're dealing with when we're dealing with moving an entire organization.
Speaker 2I think too yeah to your point, lily. As soon as you said chatbot, I was like, yep, that's it. So does everyone remember Clippy from in Microsoft? Like way back in the day, clippy, it was on your screen and you could click on Clippy and he Microsoft. Like way back in the day, clippy it was on your screen and you could click on Clippy and he can tell you things.
Speaker 2That's what I think of when I think of modern day AI. I think of like that was our AI back in the day, and there are things that you can get bolt-on programs for Epic. There are bolt-on programs for various other platforms that we use within business not necessarily just healthcare that do that same thing. It's something available. It's a chat bot in a very convenient place on your screen available to answer those basic questions for you or direct you into the right space to get your answers. And to Lily's point, that's where we see movement from an OCM and even a training standpoint in the space of AI. It's getting those basic, generalized questions or concerns answered for people in a very point, and click at my fingers way right now to increase efficiency and save the time for the live person to have that actual call that verbal conversation for that more difficult conversation for that more difficult topic.
Speaker 3Chatbots are big. I'll just give you one other AI use case just in terms of right sizing, the right use case for the right situation. So I was talking to a nurse who is really a leader in this space about, you know, use of AI in the actual clinical context and one of the things she was talking about is, you know, the technology had the ability to provide a prompt to the nurse to say inform the physician. Hey, you know the following situation is occurring this person is at a false risk, inform the physician. You know this situation is going on with the patient. Inform the physician.
Speaker 3And she was saying if you turned on all those AI prompts, then there would just be a wall of inform the physicians coming through on particular patients. And she's like we're already engaged in active partnership with the physicians. You know, we're already rounding with them, we're already in dialogue. You'd you know some. Maybe the falls prompt for this particular clinical area makes logical sense. But if you turn those all on for me yes, I'm fully aware I should be in contact with the physician.
Speaker 1That's alert fatigue at that point right. Um, I'm stepping away from OCM because I also like to get to know you all, and and so do our listeners. So, debbie, what is your most favorite thing to do outside of work at Divergent?
Art, Hiking, and Organizational Change
Speaker 2I will have to say working out. I'm a bodybuilder and power lifter. Um have been for about 10 years. I grew up dancing, so I've always been very athletic. But, yeah, I'm real into working out. I live in Southern California, in San Diego, so if I'm not in a gym, I'm definitely at a beach or hiking. There's a lot of good hiking down here and I really enjoy hiking, but, yeah, staying active. I think I don't sit still well at all.
Speaker 1I tell people I'll sit still when I'm dead or sick. Yeah or down. Yeah or down for the count for sure.
Speaker 3Lily, what about you? I've I've gotten into art recently since the pandemic, so I just finished a charcoal drawing class, which was a real challenge, and then had done an acrylic class before that. So it's been exciting to challenge myself creatively and I think it sort of calms me down for the work that we do here, because I find one of the biggest challenges is actually centering myself so that I can hold space for other people, because you know, people have a lot of big emotions around some of the stuff that we're working through, and to challenge myself to learn new things helps me ensure that I'm actually showing up and centering them in terms of their experience of learning. It's very humbling to be a beginner with a new media. Charcoal itself really annoyed me just the sensation of the material, but I was really happy with the results.
Speaker 2That's funny. My best friend said the same thing about charcoal.
Speaker 3Yeah, I was like I feel a bit annoying. You know, good challenge for me because I, you know, I want to push myself and grow, you know, through that feeling of struggle.
Speaker 1I love it. I love it. I um. I'm not an artist, I'm a stick figure, but I enjoy um doing the like the new adult, like paint by number, you know, color and coloring. Um, I recently got my girls uh like the poster board size of the like the um coloring. So like I'll take a corner and we like lay on the floor and throw some music on I love like acoustic music and we'll just like sit there and chat and and that's my artist, yeah, yeah, uh, so, so, yeah, it's cool to check out that way and not be on tech or on a screen. Right, we need ways to check out um. So I ask everybody and we'll continue to ask everybody at the end of the podcast um what their superpower is and what they're they're bringing to this earth and will be giving away. So, debbie, what is your superpower?
Speaker 2Well, I'll preface it with my mom told me I should have been a lawyer. I'm real good at arguing things, real good at arguing things, probably why I am excellent in the space of organizational change management and training and development. Um, I'm I'm really good at being able to get in there, get to the root of what that is and convince you. My way is the right way.
Speaker 3I promise, promise who can say no?
Speaker 1to me with all the organization change management that comes with healthcare, it and I don't know, maybe I'm on year 17. I've lost count. At this point, I used to have no patience like at all. Like, what do you mean? This is the way to do it, and over the years, it's just like calm with like patience and able to like stay calm even when computers are being thrown at your feet, uh, by orthopods. Um, true story, and but um, so yeah, I, I get it. Um, that's awesome. Well, lily, what about you? What is your?
Speaker 3my superpower is making people feel heard which is different than saying that you've listened to somebody. And that's how I show up from an organizational change management perspective, but also in my life. So I also not only to make people feel heard but also to make their positions be advocated for. So to bring all those voices to the table, that voice of dissent, that person that is so angry they can't articulate it and they're throwing their computer. But there is something behind that and we have to have that full level of voices at the table. And my little brother has Down syndrome and he is nonverbal. So I have spent my life listening deeply to a range of folks and then advocating for their voices. And it's my favorite part of working in large organizations because it's amazing what we can do to actually advocate and drive, you know, true change in how we're operating and, you know, deliver that better patient experience.
Speaker 1I also get the sense that you can listen but also turn those people around to be the advocates as well and be the provider champion with some of your work.
Speaker 3Yeah, walk alongside you.
Speaker 1Yeah, I can see both of you being able to change them and then having this whole army behind you, right? So what, for this podcast, would be the one takeaway that each of you would give to our listeners? As we close it out, debbie, I'll let you go first.
Speaker 2Lily says it best right size your change needs at what needs to change, why it needs to change, and then having a very good organic understanding of all the players and how big or small that change needs to be, and don't make it bigger than it needs to be either. I think that that's another area. When we're like new to the OCM space, we kind of blow things out of proportion. Not everything needs to be a major change and, quite frankly, you can have a humongous change. You can be going from old school IDX to Epic, but 90% of your organization is already on board. You already won most of your battle. So right-sizing your OCM needs is really very vital your OCM needs is really very vital.
Speaker 3Yeah, and to build on that, being really precise and dialing up the volume on your rigor and your precision in terms of that planning process can ensure that you've right-sized. So, have you done sufficient rigor to know what this change is that you're implementing, who's impacted by it, what will be the result of it? Have you talked to everyone? Because, if not, is your rigor precise enough that you know what's happening and then you can plan accordingly, because otherwise there's the worst kind of surprises.
Speaker 2The last thing that you ever want to experience is being on a project call with 200 other people and you're a month away from a go live and someone is giving their status report of this one part of the project and somebody else speaks up and says that impacts me and I have not been told about it. That's the last thing you ever want to have to experience. So to Lily's point really truly understanding everyone involved and having making sure that you're having those conversations as early as possible with everybody out there to make sure nobody is missed.
Speaker 1Yeah, I love it. It's been so awesome to talk to you guys. I love change management. I love helping people through change, and I love taking the people with the feet in the mud and finding a way to flip them over to, you know, the biggest champions. It's part of my passion as well. So it's been awesome to have you all, and I'll see you guys soon because I have the pleasure of working with you every day. So, thank you so much, rebecca, thank you.
Speaker 3Rebecca.
Speaker 4Thanks for tuning into the Verge podcast brought to you by Divergent, a leading healthcare IT consulting firm. We hope you enjoyed this episode. Be sure to hit the follow button to stay up to date with the latest IT developments and the exciting ways tech is transforming healthcare today.