Patricia D. Kennedy-Scott is amazed that her biggest challenge today as regional president of Kaiser Foundation Health Plan of Ohio is the very same thing that challenged her almost 25 years ago.
“The challenge is we’re all very comfortable where we are, particularly when an organization is thriving and doing well,” Kennedy-Scott says. “People have a hard time understanding why should I change if the organization is doing well and I’m doing well. Helping people see the future as they live the present is always the biggest challenge.”
As one of eight regions comprising the $37.8 billion health care provider Kaiser Permanente, her organization sees a lot of change, but many circumstances can drive change in an organization — technology, regulations, macroeconomics. With those changes comes another challenge — showing her 2,000 people that the organization and their roles within it have to change, as well.
“Human beings are comfortable where they are,” she says. “You have to give people motivation to change. You can’t motivate people to change by creating or waiting for this burning platform.”
She says that most would say you have to have that burning platform in order to change something, but Kennedy-Scott doesn’t subscribe to that. Instead, she says leading change is a constant process in which you always have to be identifying new problems, finding solutions and then communicating those to everyone to move forward together.
“One of the reasons some of the tech firms do so well is that people who work in those types of environments naturally think that way,” she says. “They’re looking for the next challenge or change so they can see the future or envision the possibilities in a way that is comforting and not threatening.”
Identify the problem
When Kaiser members said they wanted an easier way to see and consult with their doctors besides the standard appointment process, Kennedy-Scott knew she had identified a problem, and that’s the first step in leading change in an organization.
“There has to be an underlying problem that is currently in front of you or that you can see as you look at technological changes and environmental changes,” she says. “The first thing you have to do is convince people that there is a reason to change.”
As you identify a problem, you have to be very specific in what you see as the true issue.
“All problems will have a number of dimensions,” she says. “One might be a financial dimension. One might be a people dimension in terms of the impact it may have on your work force or on your members. … In defining the problem, you really have to be very crisp in what you’re trying to solve, too.”
When Kennedy-Scott identifies a problem, she wants employees to own the problem, which means building understanding around it and showing people how it benefits both them and the people you serve.
“You’ve got to define the problem in a way that people are engaged, committed and they understand it,” she says. “When you describe problems in ways that people can’t understand, they simply cannot get behind it. They don’t believe it. It breaks down trust, and it affects the ability to move people forward toward a common change.”
People will buy in to things they can relate to. In the case of Kaiser’s members wanting another way to interact with their doctors, Kennedy-Scott asked her employees to think about their own experiences going to the doctor.
“When I say, ‘Wouldn’t you like to see your doctor without getting on the phone, making a call, getting in your car, driving to your provider — oh by the way, you have to leave work — wouldn’t you want that to be easier?” she says. “Can anybody argue with that? So you’ve defined the problem in a way that you can get people engaged in coming up with solutions.”
Getting people involved in the process helps increase your chances of success in implementing a change, as well.
“If you can help people get their arms around the future, what it looks like, to play out scenarios, so not to say to people, ‘This is the future; this is what it’s going to be,’ but rather give people facts, data, play out scenarios, talk about other industries to help them embrace change, I think you can be successful in overcoming the challenge,” she says.
Once people own the problem and are buying in to it, then you need to find a way to solve it. Kennedy-Scott says you can form work groups or look at other industries or organizations and also gather data.
“You come up with a solution,” she says. “Not a solution — the best solution. The best answers to any problem will have more than one solution. There has to be a plan B. There always has to be a plan B. I think that too often in problem solving, folks don’t appreciate the value of a plan B, particularly when the answer seems really good.”
For example, a few years ago Kaiser of Ohio wanted to have electronic medical records in a central system so doctors and nurses all had access to the same information, in real time, regardless of which facility you visited. But the technology and financial resources weren’t yet available, so Kaiser implemented a less efficient system that was doable with the resources and technologies it had. It was the best solution for what the company had at the time, so it became plan A.
“If you’ve done a really good job at being very specific in defining the problem, plan A becomes obvious,” she says.
While it’s important to have backup plans, you have to be careful that you don’t try to implement those plans simultaneously.
“You have to be very clear in your own mind what you’re trying to achieve,” she says. “Sometimes leaders get caught up in the strategy du jour, and you have to really have the discipline to understand whether the strategy du jour is one that makes sense for you.”
Kennedy-Scott points to Apple as an example of a company that stuck to its guns and resisted temptation.
“They resisted the strategy du jour at points in time, and they pay the price in terms of short-term market position but long-term they didn’t,” she says. “They stuck to their strategy, and it’s paying off for them.”
When she wants to know if a solution or strategy is best for the company, Kennedy-Scott asks herself if it meshes with the mission. So when members were complaining about wanting a new way to interface with their physicians, she asked herself if finding a solution to that problem would mesh with the mission of providing high-quality health care to members and serving the greater community. Because it directly affected members, it did mesh. Kaiser created a system where people could schedule Web chats with their doctors to talk about issues and symptoms, and while it’s not conventional, it still fulfills the mission.
“Being true to your mission doesn’t mean continue to do the same old things the same old way,” she says. “The mission of an organization has to have life through the vision of the organization. I look at the vision as really being the road map that is influenced by the environment, so as your environment changes, you have to look at the vision and your goals and the mission, of course.”
This is especially key right now as companies are tempted to venture into areas that don’t support their mission as they react to the tough market. As the leader, you are completely responsible for ensuring that you keep any new strategies and solutions aligned with your mission.
“That’s your job to wake up every morning and look at every decision and ask yourself, ‘Is this aligned with our mission?’” Kennedy-Scott says. “If it isn’t, you have to have the courage to take on whoever it might be that’s proposing this and take it on.”
Communicate the change
Once you’ve identified the best solution for your problem, then you have to tell your employees what that is so they know what is changing.
“One of the primary mistakes leaders make is you think you can say it once and people get it,” Kennedy-Scott says. “No. You tell them. You tell them again. Then you tell them again. And then you remind them that you told them. And you use different words and you use examples.”
She says most people learn by using examples, so you have to provide those so that they truly understand. Tie the change into the mission and the vision of your organization so they can better understand why this needs to happen.
“You can’t tell people enough what the vision is, what the direction is what the problem is, what the solution is, and you do that verbally, and you use every type of medium you have available to you — written communication, e-mail, voice mail, whatever is available in the organization,” she says.
When you’re repeatedly telling people what’s happening, realize that some don’t need that reinforcement, so don’t get offended if they’re annoyed by you.
“Some people will say, ‘If she says it one more time, I’m going to scream,’” she says. “That’s good. By them saying that, they are an informal leader for you because they understand it and they’re saying, ‘I’ve heard her say it,’ if others are saying, ‘She never said it.’”
It’s important to use these informal leaders to help bring people on board and move the change along.
“If you believe that the senior leadership team can be effective in communicating a message throughout your organization, you’re missing the point,” Kennedy-Scott says. “They absolutely cannot. There has to be a way of relying on informal opinion leaders to get the message out there.”
There are other ways to identify informal leaders in your organization.
“You don’t have to be in an organization long to figure out who they are,” she says. “It’s the person that at the big meeting with all of your managers who’s always raising their hand. It’s going to be the person who is standing by themselves at an event, and people come to them. They don’t stand around for long — people will come to them.”
Bounce ideas off of these informal leaders and use them to spread the word when you need their help. Kennedy-Scott says that informal leaders know how to leverage information and how to engage people around that information, so talk to them when you notice these traits coming out.
Lastly, you have to make sure the information cascades down to the lowest levels.
“The third mistake that could be made is if you believe that it’s you, your direct reports and your informal leaders, you’re still missing it,” she says. “There has to be cascading.”
Some people need to hear the information from their boss or direct supervisor, so you have to have your direct reports and informal leaders cascading that information down to whoever reports to them so people hear it from the person they’re used to getting updates and information from. Not every organization is like this, but many are, and regardless of which way yours is, make sure you pass it down.
By doing all of these things, you can successfully communicate the change and get people on board with you.
“Say it, say it again, look to your leadership team to support you, but do not rely exclusively on them,” Kennedy-Scott says. “Have a formal cascading process through which the message is delivered throughout the organization, rely on alternative sources of communication because people learn or absorb data differently, and know who your opinion leaders are and leverage them as best you can.”
Once you’ve told people what’s changing, then you need start implementing the change. During this period, you have to give people time to adjust, but that time varies based on what the situation is. If the outside environment requires you to move quickly, then they’ll have to do just that, but if there is no outside pressure, then you can implement more slowly so they can ease their way into the change.
“Listen to the market and external environment and use that as a factor,” she says.
For example, when Kaiser decided to create its systemwide electronic medical records initiative, Ohio was the last region to go through the transition, so it was able to learn from the others and didn’t need as much time to adjust.
“If people have had some of experiencing the change … that accelerates the time in which they need to adjust,” she says. “If they don’t have any way of experiencing the change, then it slows down the period of time that they need to adjust. But without regard to how much time we as individuals need to adjust, we have to listen to the market and external environment and use that as a factor.”
As people adjust, you’ll likely encounter some resistance, as well. When you see those people, it’s important to take a step back before making any rash decisions about them.
“Most people don’t want to be an outlier,” she says. “Most people want to run with the pack.”
If you notice some resistance, first see if that person has gotten all of the communication and isn’t missing any pieces of it.
“Is there something that they need in order to bring them along?” she says. “The first thing I ask myself is, ‘Does this person have the right information?’”
If you’ve told them and told them everything, and it’s been cascaded down, you can assume that they have the right information.
“The next place I go is, ‘If they’ve been told, do they understand?’” she says. “That is a learning issue. Do they have the skill set to interpret what they’ve heard and embrace that as learning?”
That involves intellectual and cognitive tools. For example, the central electronic medical records system required that professionals type information into the computer as they met with patients. Many resisted and complained because they had poor typing skills, so they struggled to be efficient and maintain eye contact with patients. To help give them the tools they needed to embrace it, smart sets were created. For instance, instead of typing, “The patient’s diagnosis is,” the person can type in “PTDX” which inserts that language automatically. Once they had help in the skill sets needed to embrace the change, they bought in.
If they have the information and the tools and still resist, then Kennedy-Scott assumes they would prefer to do something else. At that point, she discusses with them if Kaiser is the right organization for them.
Lastly, once you’ve led a change in your organization, recognize that you’re not done. Kennedy-Scott says you have to have continuous quality improvement.
“Just because it’s resolved for the moment doesn’t mean it’s done,” she says. “Once people get to a place where they’re comfortable, you have to start over.”
For example, after Kaiser of Ohio had implemented its central electronic medical records system and had been running it, a new national CEO came on board, and now he wanted a national central system. With more resources now available, people had to change again, but they had seen a glimpse of what this transition was like the last time, so they bought in more easily. And even after they adjusted to that change, then they had to make other changes, like adding secure messaging. Each time you need to change, use people’s experience to ease their reservations.
“They’re in a place where they’re comfortable,” Kennedy-Scott says. “They know it, they’ve seen it work, and that’s where they like to be. You have to use that history that they have in making that change to help bring them along.”
Ask questions to show people how they got through the last change so they’re more likely to embrace the new one.
“When you resolved that problem, look at the history of what happened,” she says. “How did we resolve that? So let’s start over again.”
Because this is a continuous process, you have to be actively looking for more problems that could come up. She says to talk to people in meetings and gauge where you’re currently.
“Are we planning for the next five years? Is this going to sustain us for the next five years?” she says. “If anyone around the table says, ‘Hmm, I don’t know,’ that’s an opening to start a discussion.”
Kennedy-Scott recognizes that as the leader, it’s her job to make sure that Kaiser constantly moves forward like this, so she’ll constantly be looking for new problems that arise and how to bring people along in solving them so that the competition doesn’t pass by her organization.
“What do you do next?” Kennedy-Scott says. “If you’re sitting at your desk just doing what you’ve been doing, then you’re probably not doing the right work.”
How to reach: Kaiser Foundation Health Plan of Ohio, www.kaiserpermanente.org