To implement successful change you must, unequivocally, understand the culture of the environment you are looking to change. Culture and change management are inextricably connected. Culture is a made up of a series of repeated, engrained, and expected behaviors and, in short, can be described as the “the way things are done around here.” Since Change Management requires changes in behavior, understanding the invisible forces that promote behaviors (i.e. culture) enables the creation of a Change Management Plan that resonates, anticipates pushback, and promotes long lasting behavior change.
What change management is not, is seeking permission to change or focus at one level of the organization. It is a clear and attainable plan that brings key stakeholders along for the change journey; to listen to and seek out feedback throughout the process, and to tailor outcomes to meet the needs of the overall organization.
The Participatory Medicine Manifesto exemplifies both the “how” we need to transform our care delivery, and the “why” it is fundamental to the dynamics of healthcare. Most leaders focus on the what and the how, thinking that these items will carry the ball. Leaders often avoid the why because it tends to be more of an emotional message – and people are less comfortable with those (Kantor, 2020). It is a strategic vision for change that fosters engagement, collaboration, and shared purpose among stakeholders.
To make the Manifesto a widespread reality the key is unlocking personal and organizational emotional intelligence. It is not only our own self awareness, but the empathy that comes with genuinely connecting to the people — the patients, the caregivers, the providers — around us. It is about social awareness and the ability to “read the room” for resistance — which can stem from not understanding the purpose or the plan. People don’t resist change, but they do resist being changed (Kantor 2020).
To address this, the focus must be on communication transparency. Timely and effective communications is the crux of successful change and the way we can advance the utilization of the Manifesto. Implementing the three C’s: Collaboration, Commitment, and Clarity, allows us to comfortably course-correct and adapt as changes occur and new information is gathered to mitigate the fear of resistance (Center for Creative Leadership, 2023). It’s important to ensure that the “how” and “why” are understood by all, prior to and in the pursuit of driving change that sticks.
Countless research has shown this very point – that the mere sharing of knowledge about change before the implementation is associated with workplace social capital and feelings of respect are indicators of greater job satisfaction (Turja, 2022; Jakobsen et al. 2020). In healthcare, this does not just fall to professionals. It is the responsibility of all of us…we are all someone’s patient and we all would benefit from the tenets of the Manifesto.
As stated by Belasco & Stayer, Flight of the Buffalo (1994), Change is hard because people overestimate the value of what they have—and underestimate the value of what they may gain by giving that up.
With more than two decades of experience, Shari Robbins is a seasoned healthcare operations leader specializing in workforce optimization and process improvement. Alongside her consulting career, she serves as an adjunct professor at Northeastern University in Boston, teaching Organizational Behavior, Change Management, and Workflow Analysis to students in the MS in Health Informatics Program.
I would like to offer a different perspective about culture change in the context of healthcare and participatory medicine,.
My working definition of culture is similar: culture is the way a group of people think, talk, and act. However, my framing is very different: my focus is on patients participating in their healthcare rather than on organizations focusing on their employees, policies, and procedures.
In an organization, leaders often have a significant impact on the culture in their organization, and transparency and communication certainly play a big role. However, in societal terms (and, arguably, also within organizations) culture is created, changed, and maintained from the bottom up rather than the top down. It doesn’t happen because of a big thing, it happens as a result of an accumulation of little things.
I see the SPM Manifesto as more aspirational than operational. It consists of slogans rather than tools. It reminds me of the soccer coach who tells their team that, in order to win, they will need to pass more accurately, control the ball better, and score more goals. While this is true, such coaching advice will not actually change player behavior much and will not change skills at all. Changing the way a team plays to improve ball control, pass accuracy, and goal scoring requires imparting – and then practicing – specific skills.
If the goal of SPM is to help patients by promoting the practice of participatory medicine, then SPM needs to provide tools and support for the boots-on-the-ground participation in the processes of healthcare by patients and families as well as clinicians and clinical institutions.
Mission statements and manifestos sound good but, by themselves, do nothing. Good ideas are useless without robust implementation.
If SPM is committed to supporting meaningful patient engagement in healthcare, SPM needs to recognize that it has already done the work of getting the idea of participatory medicine accepted in the mainstream, and move on to giving patients and clinicians tools they can use in the real world of health care.