Sustaining Provider Change Teams

Even Change Teams that start out with energy and enthusiasm can lose their momentum and get stalled. To get your project moving again, check for the following pitfalls:

Not Understanding and Involving the Customer

NIATx research found this to be the most important of the five NIATx principles. If the change project does not address customer needs, you won’t see improvement.

Consider doing one or more of the following:

  • Conduct another walk-through
  • Set up a focus group
  • Conduct a survey to identify the problem from the customer perspective

Making Multiple Changes Simultaneously

Your walk-through might have uncovered several things that your team wants to change immediately. Resist the urge to change everything at once. A Change Project has a specific focus: one change, at one location, with one population, at one level of care. By limiting your focus in this way, you don’t have to guess which change contributed to the success or failure of your change.

Making one change at a time also allows you to avoid other pitfalls, such as resistant staff.

Resistant Staff

Staff members may resist change, particularly if they feel it is imposed upon them, may make their jobs harder or easier, or if it’s happening too soon. Work to engage staff members by helping them identify and test their own improvement ideas. Show how the Change Team is using data to inform the change process, and share that data widely. If an individual continues to resist change in spite of your efforts, management needs to adjust as necessary so that everyone is accountable for the success of the Change Project.

Not Holding People Accountable

Both the Change Leader and the Executive Sponsor are responsible for holding team members accountable. State expectations about Change Team member roles and responsibilities clearly at the beginning of the project. Secure a commitment from each team member to follow through on tasks. Failure to hold all members accountable causes resentment within the team.

Improvements Are Not Affecting Bottom Line, or Not Focusing on a Key Problem

If the improvements don’t improve the bottom line or fix a key problem that is important to the CEO, then change may happen initially, but sustaining momentum is difficult. This is often the issue when agencies get a quick positive start, but can’t sustain changes or lose momentum and interest.

Waiting for Aim Measure Results to See If There is Improvement

Team members or providers may get frustrated if they have to wait for for quarterly reports from the state or payer to see the impact of short term changes. Measure the success of a rapid-cycle change project with a simple data collection process—perhaps as simple as using pencil and paper. This way, the team sees results quickly and will also know if they are tracking the right data points for measuring change.

No Authority to Change the Cause of the Problem

State or system-level change teams often falter when they attempt to address a problem that is outside the Executive Sponsor’s scope of authority—this is trying to change someone else’s process. If the effort to influence change is ineffective, have the Change Team refocus and try to impact something within the Executive Sponsor’s scope.

Insufficient Support from CEO

If the Change Leader is enthusiastic about the Change Project, but lacks support from the agency CEO, successful change is difficult. To help this situation, the state or system-level convener needs to get involved directly with the leadership of the organization. Another strategy is to help the enthusiastic Change Leader identify things within his/her control. Consider using performance management as a way to get the attention of a disengaged CEO.

Ineffective Change Leader

Leadership counts. If a Change Leader is disorganized, indifferent, unable to engage the staff, or in some other way unable to assume a leadership role, then it’s time to assign a new Change Leader. Declare the current Change Project complete and convene a different group with a new Change Leader.

Not Including the Right People on the Change Team

Missing key members can lead to Change Team dysfunction or failure. If a Change Team is not working together well, you can disband the team and reassemble it with new members and a new focus.

Coach or Peer Mentor Assistance

As convener, you may have difficulty in identifying what problem is stalling a Change Team. It may be even more difficult for you to intervene directly to address the problem. Technical assistance from an expert process improvement coach or peer mentor can help a Change Team get unstuck and start making successful improvements again.

Further Reading