Learning how to make change happen

LEADERSHIP in change management is a skill set health practitioners must learn to be effective advocates for their patients and colleagues, according to clinicians who learned their leadership skills on the job.

Professor Sabe Sabesan, Senior Medical Oncologist at the Townsville Cancer Centre and Clinical Dean at Townsville University Hospital, and Dr Lynden Roberts, a senior rheumatologist and Clinical Associate Professor at Monash University, have shared their practical guide and framework for clinicians wanting to effect change in their work environment via a Perspective published by the MJA.

“The first people to observe and notice a problem or the success or failure of any model of care or system change are essentially the clinicians,” Professor Sabesan told InSight+ in an exclusive podcast.

“Clinicians will feel the tension, because something has changed suddenly, and they see something is not working. It affects their morale, it affects their workflow, and it affects the efficiencies. So, clinicians bear the brunt of any change.”

It is not necessarily easy for a clinician who sees a problem to then effect a change.

“This is where the tension starts,” said Professor Sabesan. “The next step for the clinician is to actually take it up with someone or take it up through a system. Then it really depends on the culture of the organisation.

“If the culture is not good, I think most clinicians give up because the brick walls pop up very quickly, and clinicians don’t know how to navigate those brick walls.”

Encountering those situations in their day-to-day practice led Professor Sabesan and Dr Roberts to develop a framework to help clinicians navigate those “brick walls”.

“In the last 18 years, we have had a lot of trial and error,” said Professor Sabesan. “Our clinicians need to acquire some skill sets, while advocating for system change.”

The first step to effective collaboration was to clearly understand the nature and magnitude of the problem, Sabesan and Roberts explained in their MJA article.

“Fine tuning and articulating ‘why this needs fixing’ is a key activity so that you can convince stakeholders and take everyone positively on the journey to change,” they wrote.

“Make sure that the problem is worthwhile,” Professor Sabesan told InSight+. “We should be able to articulate why that problem needs to be fixed.”

Step two, they wrote was to involve as many stakeholders as possible, while building a coalition.

“In management circles, they always believe that none of us are complete leaders,” Professor Sabesan said.

“If we are all incomplete leaders, what we need is a complete team of people. It’s important to identify all the people with different skill sets, different perspectives, who need to be involved.”

A co-design approach to developing feasible solutions and implementation plans was the next critical step, Sabesan and Roberts wrote:

• Is the innovation supported by research and published guidelines?
• Are there clinical experiences and perceptions?
• Are there patient experiences, needs and preferences?
• Is there local practice information?
• Is the innovation implementable?

Using levers specific to clinicians – patient advocacy, workforce advocacy, standards compliance, and finally, if necessary, escalation through, and involvement of, formal line management, regulatory bodies, politicians and political bodies, and media – as well as negotiating skills, were critical to successful change implementation.

“Sometimes, despite having all those levers, people still don’t listen, maybe because they have a different priority, or maybe they don’t care,” Professor Sabesan told InSight+.

“This is where the escalation comes in. The only thing I caution about the escalation is normally escalation means there will be a damage to a relationship. So, before escalation, I would say ask yourself two things – one is the importance of a relationship, and the other is the possible impact on your career.

“That’s where the courageous leadership comes in.”

Self-care during change management was also crucial to success, Professor Sabesan said.

“When we lead change, sometimes, it takes a lot of your time. It can take years, and sometimes, it consumes your weekends. When we are taking on a challenge or leading change, we’ve got to make sure that the boundaries are set carefully.

“Invest in your families, and also make sure we invest in ourselves with exercise, sleep, rest.

“But part of the self-care also involves understanding the partners you are dealing with. If I’m negotiating with someone, I make sure that I understand the other person’s perspective, because they might be under different pressures.”

Professor Sabesan told InSight+ that regardless of the quality of the culture in the health workplace, a framework like the one he and Dr Roberts proposed would make success in change management more likely.

“If you don’t follow the framework, you fail from the beginning, regardless of the culture,” he said.

“In a good culture it is going to be easier because everyone is going to come on board. But even culture that is not fantastic, if we follow this framework, and apply the clinician levers judiciously and cautiously, you will see the outcome.

“And hopefully, by all the clinicians acquiring these frameworks, you create a critical mass of leaders who are skilled enough to lead change rather than giving up too early.”