I saw that there is some interest out there for change management in health services. I use change management in my industry (not health) and thought I would add my 2 cents.

What is Change Management?

Change management in the health services shouldn't be any different than it is in any other industry. According to the Concerns-Based Adoption Model, there are two things that should be monitored when implementing change. They are:

Levels of Use, and

Stages of Concern

Most programs are never really implemented. You hear about this government program or that new school initiative failing and then we come to the conclusion the "X" is a bad program. The fact of the matter is they maybe "X" was never really implemented as intended. Believe it or not, this happens quite a bit. I've been told that such and such a public school has implemented a particlar program. I ask around, "is it true that such and such a high school is now using program "X". "Oh yes!! They are! It's great! However, when I make a visit to the school and see for myself, I quickly discover that the school hasn't really implemented "X" at all. They have maybe 50% of it right. But then they have gone and changed it to suit their own needs. This isn't always bad. But if a program is not implemented as it was intended, then it can't really be called by it's original name. What if some other school also implemented program "X" but twisted 50% to meet its own needs. Again, that is quite ok. However, when you say that school A and school B are both using program "X", the problems start to arise. People will want to compare the success of the program at each school. The problem with that is that they are really two different programs that can't really be compared at all.

The real danger is when one school has a negative experience with program "X" and they go around saying that program "X" sucks!! To be fair, it is their version of program "X" that sucks. The implemented it wrong.

So, how would it be different for change management in health services? Only the program is different, not what you are looking for. Levels of Use is a tool that those responsible for implementation can use to measure to what extext program "X" is actually being implemented.

For example, let's say a hospital was going to implement a new customer service program. One would first need to identify exactly what kind of change in customer service is expected. All these expectations would be written down as action statements, such as nurses will smile when talking to patients. This is an action statement that can be easily measured by observation. If the actual change you are looking to implement is not observable by the human eye, then you will have a difficult time measuring the change, if there is any.

Finally, we must deal with what the Concerns -Based Adoption Model calls the Stages of Concern. The stages of concern is guide that measures people's response to change. After all, any kind of change involves people changing and people don't like changing very much. When people confront change, it isn't surprising that they go through a series of predictable stages, spending shorter time in some and more in others. Sometimes they even go back and forth. Knowing where someone is in the change process can help the change facilitator address the concerns. When people's concerns are addressed they feel better. It's surprising how often people are not really heard.

Let's use change management in health services as an example. Imagine that a new software program is being implemented at a hospital to manage patients. Furthermore, lets say that the learning curve is high and everyone is having a hard time learning the system. The anxiety level will be very high as staff begin to worry about whether or not they can learn it. Or, there may be even greater concern about making a mistake and being accountable for a series patient mix up due to lack of knowledge about how to use the new program. Now, the staff will likely manifest this anxiety be resisting the new program. They will say things like "this new program stinks". "This program is not as good as the one we are using now". After hearing these complaints, the person implementing the new software program and training the staff will be compelled to defend the new program and emphasize how great it is. To the untrained change implementer, everyone's complaints about the crappy new program are really expressions of their anxiety and have nothing to do with the program itself. The skilled change facilitator will see this right away and address the staff's real concerns and not what they 'appear' to be.

So there you have it. Change management in health services is not much different than it is in any other field. The principles of change management are the same everywhere.