Leading for change - first know why

In health care, change has become the new normal. While the health system undergoes sweeping transformations, employees are expected to track countless measures, do more with less funding, and broaden the scope of their work into the community. Although these changes promise long-term benefits, the burden on team members has reached a tipping point.

Health care staff dissatisfaction and burnout are at an all-time high. In fact, in a recent survey conducted by IHI, health system leaders and managers cited “leading and organizing for change” and “improving joy in work/preventing burnout” as the two top challenges facing them today. These two challenges are intimately related, and they present opportunities.

If leaders can learn how to successfully lead change — including cultural change — they can increase satisfaction among their employees and quality for their patients. The right principles, which we teach in Leadership and Organizing for Change, can help leaders and managers at all levels strengthen engagement across professions, internal teams, external organizations, patients, and the community.

In our experience designing and studying social movements in health, we have found that these seven engagement principles are key when organizing people to lead change and face uncertainty, both in and outside of health care settings.

1. Know why you care. Motivating others to join in action requires answering two questions: (1) What will we do? and (2) Why should we do it? Knowing what we will do is a matter of strategy. Knowing why we should do it is a matter of heart. As longtime organizer and Harvard Kennedy School Professor Marshall Ganz teaches, we share our own motivations to ignite them in others. Sharing and eliciting others’ stories is a powerful way to inspire people’s passion and turn it into action.

1. Clarify purpose. On the basis of shared motivations, develop a mutual purpose together. When people perceive and — better yet co-create — a clear and consequential purpose, they work for their own benefit as well as the interests of the whole. A shared purpose enables individuals to become stewards of the collective good.

1. Share power. Listen to the wisdom of those who are closest to what needs to change. Those with lived experience of a problem have the power to solve it — and keep it solved. Unleash their agency to act. Sharing power means growing power.

1. Celebrate courage. Leaders foster the conditions for change by identifying exemplary behavior. Senior leaders should publicly celebrate innovators and early adopters who show courage and take initiative. Senior leaders should also model courage by embracing uncertainty and trusting others. In doing so, leaders cultivate resilience, share leadership, enhance agency, and increase joy in work.

1. Move to action — quickly. It is better to make a small-scale, low-stakes change and see what happens than to get paralyzed in preparation and analysis. In improvement science, this process is known as the Plan-Do-Study-Act (PDSA) cycle: (1) co-plan the test and predict results; (2) do the change and observe results; (3) study the data and compare with predictions; and (4) act on the learning to develop the next test. The PDSA cycle enables us to learn from an idea before knowing whether it will result in improvement.

1. Build a coaching culture. The change process is hard. The best change-makers seek coaching and give coaching, creating room for everyone to improve their skills over time. A leader who coaches takes responsibility to help others to achieve shared goals. A leader who receives coaching signals openness to learning from others.

1. Count engagement. Build a culture of (ac)countability. By all means, measure health outcomes. But don’t stop there. Count networks engaged, partnerships formed, leaders developed. Count new ways of thinking and acting, and new cultural norms forged. Develop a real-time measurement system for engagement.

These principles shed light on what it takes to engage people in times of change and uncertainty. They also increase the joy and leadership capacity of the health care workforce, and activate new partners in the community. The return on engagement is better collaboration, more effective implementation of change, a happier workforce — and ultimately better health. 

Written by Kate Hilton, Faculty, Institute for Healthcare Improvement (IHI) and a Founding Director & Senior Faculty, ReThink Health. Other contributors: Jackie Lynton of IHO People, Alexandra Nicholas of Ko Awatea, and Jessica Perlo of IHI.