Change Management
Dr. Know
How Barry Arbuckle found 1,000 answers to change the way MemorialCare Medical Centers’ 10,000 employees do business
By Mike Cottrill
Smart Business Los Angeles | December 2007
When it came time for Barry Arbuckle to get his staff at
MemorialCare Medical Centers to implement a new electronic
medical records system, he was reminded of a lesson learned from
his predecessor.
“Be prepared for the thousand questions they’ll likely never ask
you,” says Arbuckle, MemorialCare’s president and CEO.
“Because if they ask you and you don’t know, you lose momentum
and you lose credibility.”
So Arbuckle’s job was pretty simple when it came time to overhaul the entire medical records process for the health system: He
needed every answer possible to sell each facet of the change to
every employee — all 10,000 of them. After all, when you’re fundamentally changing the way people do their jobs, the onus is on
you to give them the answers on why they should buy in.
“All of the sudden, you’re saying, ‘Change, it’s a fundamental
swap, and you have to trust me that it’s going to be better,’”
Arbuckle says. “Well, quite honestly, in the first couple of weeks,
it’s hard, and there’s that propensity to say, ‘I’m going back to what
I’ve done for years, it’s worked for 15 to 20 years, by golly, I’m going
back to it.’
“Many of these people have done it the old way their whole
life. Now we’re going to require them to change, and we’re
going to take away every other means they had, that’s a big
change, and you have to sell them on that.”
Rather than make employees feel like they were forced into
changing, Arbuckle wanted to build buy-in for the new system to
make sure employees felt like the adaptation wouldn’t just be good
for MemorialCare but would also be good for them. To do so, he
used a three-step process. He started off by including employees in
looking for the answers on how to adjust, then used that information to push a consistent message about the new direction, and
finally, followed up to make sure his staff had the right resources to
make the change. As a result, MemorialCare implemented the new
system on time and on budget, putting the $1.4 billion health system ahead of the technology curve.
Involve your team
“If folks understand why you are making the decisions you are
making, they are more willing to go along with you on your journey as opposed to jumping ship and going elsewhere,” Arbuckle
says.
The first step to that is acknowledging that even though you need
to have all the answers for employees, you probably don’t have
them.
“You have to know what you don’t know and acknowledge it,”
Arbuckle says. “Sometimes, when you get to a leadership position,
it’s easy to forget that. I’m a leader because I know more about this
than most other people, but, my God, there are so many things I
just don’t know.”
So when Arbuckle started the process of overhauling the records systems, he began by involving front-line people in the
process before he implemented anything new.
“It’s got to be a vision that they also share,” he says. “It can’t
be, ‘I’m being asked to do this because the hospital thinks it’s
a good idea,’ there has to be, ‘I’ve been part of deciding that
this is what we’re going to do because it’s what we want to
accomplish.’”
The talk of a new system actually wasn’t started by Arbuckle but
by MemorialCare’s volunteer physician’s society. Because physicians can’t be employed by a hospital in the state of California,
Arbuckle has formed the volunteer group because he knows they
are passionate about making medical care better.
Once the idea had been kicked around by the physicians,
Arbuckle took it to other members of the team. He made it a point
to get a diverse group of people, grabbing people from each
department and each portion of the hierarchy because it’s important to make sure that every demographic is represented. When
that group was formed, they became the eyes and ears for the
staff, hearing vendors pitch new systems and voting to eliminate
systems they thought wouldn’t work. The group was even invited
to go to other hospitals to see working systems in place so they
could ask about the things that concerned them.
“We said, ‘Let’s go out to a hospital like ours and see really how
the system works,’” Arbuckle says. “‘Let’s have some side conversations and ask them, ‘If you could do it all over again, what
would you do differently, would you spend more time doing this
or that?’ And they got some grand ideas. It really added to our
intelligence in terms of what to do and what not to do.”
Not only did it make employees feel involved in the process, but
it gave Arbuckle a cheat sheet for those thousand questions that
may never be asked.
“That’s useful because then you are able to articulate their reasons
for decisions to board members or to employees whose livelihood
you are potentially impacting,” he says.
To continue to get his staff thinking about the best system,
Arbuckle even hired a former chief information officer of a hospital that had failed putting together a new system. The idea was to
really let everyone get a close look at what would work best and
what wouldn’t so they could articulate which system was the best
fit. The employees had to make the change, so their opinions mattered more than anything.
“It was millions of dollars, but they selected it, and then they
helped us build buy-in with our colleagues,” Arbuckle says. “The
fact that they helped convince people who weren’t necessarily
computer-ready to jump on this, that’s all that really matters
because I don’t use that system. It’s easy for me to say, ‘This one’s
big, this one’s popular, our neighbors chose this one,’ but that does-n’t work, particularly when you are asking folks to fundamentally
change.”
Keep a consistent message
Though the inclusion process helped Arbuckle see the advantages of the new system, some of the staff still had to be sold on
the fact that a change was going to be made. That takes a consistent communication process that ensures every employee sees the
core vision.
“You have to articulate the end goal, ‘Here’s where we are today,
here’s where we want to get, and does everybody agree that that’s
going to require a change in between?’” Arbuckle says. “You kind
of get everybody understanding that this is where we want to get
to, there is a reason we are doing this, and the path that we’ve
taken to today won’t get us there.”
Arbuckle could articulate the change well from what he’d
learned by including his team in the process, but he still had to do
it over and over and over again.
“It was communication, and that’s an overused term, but we
probably overcommunicated,” Arbuckle says. “The number of
Web casts that I did on this topic out in the field, the number of
newsletters, meetings, social events and signs around the office,
quite honestly, it felt like absolute overkill. But it turned out that
it wasn’t, it was necessary because we had to just keep reinforcing why we’re doing what we’re doing.”
MemorialCare brought in a communications and education
expert to design the communication plan because it’s tough to
know how many times you have to tell 10,000 people something
before it sticks.
“It was like, ‘My God, we’ve got to say this again. Aren’t people
bored with this by now, I’m getting bored saying it,’” Arbuckle
says. “But it turned out to be very useful. The more we did it, the
more it became clear to them that this wasn’t just the project of
the month or of the fiscal year, this was a marathon process
where we were going to be steady and keep working toward the
goal. That communication helped remind people that we were
still out there, that they couldn’t forget about it. Just the consistency of the message is powerful.”
Not only does the consistency help the message resonate, but a
consistent communication attack can also alleviate the negative
virus brought about by the rumor mill. Arbuckle consistently
spoke with his people about the change at meetings and spoke
freely about the transition.
“I’ve learned over the years that people imagine and develop
their own reasons for why leaders are doing what they’re doing,
and many times, they are wrong, and many times, they can be disruptive,” Arbuckle says. “I always open myself up and say, ‘Ask
anything you want.’ I bring the core message with me, and I’ll take
that risk. Sometimes I’ll have to say, ‘That’s a good question, and I
can’t answer it today, but I will answer it when I can.’ But I find that
most of the time I can give people exactly what they want, reinforce the message, and we can move forward.”
Help employees adapt
Building buy-in doesn’t stop once the change is in effect, so
MemorialCare continued to sell employees on the process
even after the systems had been picked and implemented.
“Having them verbalize it is one thing, ‘Oh, yeah, I can make
that change, it looks like a nice system,’” Arbuckle says.
“Making sure they are actually understanding and willing to
embrace and accept change is the powerful finishing piece of
these projects.”
Understanding that some employees will take longer to
change — and some will have to make bigger changes than
others — is a big part of the last stages of getting employee
buy-in. For MemorialCare, that meant understanding that even
though the new systems got the thumbs up, extra time and
resources had to be spent training those who couldn’t just
jump into a technology upgrade. MemorialCare hired a clinical
training specialist who was deployed to every physician’s
office to see how each one handled computer systems.
“Part of that process was to assess where they were, where
they were personally in terms of their own ability to use a computer — would they need a side class on keyboarding and navigating a new menu,” Arbuckle says. “Most people don’t want
to admit that they aren’t ready for a change, or they’ll exaggerate a tad, and that turned out to be very powerful in working
with them privately to see what they needed to improve upon.”
Arbuckle was also concerned with the emotional aspect of
making a change. During the switch to the electronic systems,
MemorialCare employed a psychologist specializing in change
management who worked with employees who were set in
their ways. It might not be a realistic expense for every organization, but the main idea is to let people voice how the change
affects them mentally.
“It really turned out to be valuable,” Arbuckle says. “This fellow led sessions on change management, and some people
would say, ‘I thought I came in to talk about computers, and we
haven’t said the word computer,’ but it was so valuable to let
people discuss the problems they had with changing because
people aren’t always ready for it.”
More than anything, Arbuckle focused on the fact that it was
his job to do everything he could to sell his people on the
change. Getting 10,000 people to move in a direction is never
easy, so the goal is always taking the burden off them by making
sure they see the benefit of the change and then being ready to
sell them with the right answer to those 1,000 questions that may
come up.
“We never treated physicians or staff as people who had to do
this,” Arbuckle says. “We treated it like a sell, we had to pitch
the actual value of it to them again and again, and our job was
to help them get there.”
HOW TO REACH: MemorialCare Medical Centers, (562) 933-1800 or www.memorialcare.org
