Six big changes shaking up healthcare

And four “constants” that will help us weather the storm.

By Quint Studer

Working in healthcare today can feel like being adrift in uncharted highly treacherous waters. Thanks to health reform and other disruptive forces, it’s hard to know what lies over the horizon. It’s tough to predict and plan for next month, let alone next year. Whether you’re a leader or a staff member, this uncertainty generates massive stress.

We have to get better at providing quality care, but the good news is healthcare professionals already want to do that. The solution is to create organizational cultures that harness and maximize that hunger for continuous improvement. When people have the right structure and the right tactics, they can create miracles.

But first lets identify six big changes that are shaking up our industry—as well as four “constants” that will bring us safely through to the other side.

The Six Big Changes
CHANGE #1: The nature of change itself has changed. The most profound challenge healthcare organizations have had to deal with—and the one that’s requiring the biggest adjustment—is the industry’s move from episodic change to continuous change.

Think about the annual budget process. This has always been a tedious and grueling process. But in the past, when the budget was done, the organization had a good, solid 12-month game plan in place. Today that 12-month game plan can actually change very early in the new fiscal year. Payments may change, volume may not be what was projected or expected, or supply costs may be higher than what was anticipated. In essence, a budget is now just a guideline that requires continuous monitoring and change.

Another great example is how Joint Commission visits are handled. In the past, The Joint Commission would tell a hospital or health system that they were coming to visit. To ready themselves for the visit, the organization would prepare rigorously by testing knowledge, auditing processes, checking records, and so forth to ensure compliance. This is episodic change. Now, The Joint Commission will show

up unannounced, so an organization is expected to be

ready. We’ve been forced to move to a state of continuous readiness. This is a good change, but it is stressful and hard to accomplish.

CHANGE #2 : New rules are disrupting the external environment. Although uncomfortable, disruption is a very effective way to force change. One can disrupt the environment—via a new invention, a new technique, a new tool—in a way that completely challenges the status quo and causes us to rethink and start over.

Reimbursement has been—and remains—the biggest change. As healthcare expenditures grow, they consume an ever-increasing portion of the U.S. gross national product. In fact, if they continue to escalate, healthcare costs would eventually become the entire GNP. This cannot be allowed to happen—thus, we are seeing disruption through a drastic change in what Centers for Medicare and Medicaid Services (CMS) will pay for as well as the amount it will reimburse healthcare providers.

Healthcare providers now have a more complete understanding of reimbursement changes and an understanding of what must happen. We now know that winning healthcare organizations are able to achieve higher quality with lower costs.

CHANGE #3: Healthcare technology is making what was once impossible possible. The healthcare industry is a hotbed of innovation. Right now reimbursement changes are driving an explosion of technology and applications that will help us manage our own health, as well as allow others to look at the state of our health, even from a distance.

CHANGE #4 : Transparency is driving accountability. Today, I can get on my computer and go to the or web sites to find out how well a hospital manages pain or what core clinical outcomes look like.

Anyone can go to the Hospital Compare web site ( to look at the metrics of various hospitals. Within minutes one can find a “snapshot” of the quality of hospitals in an area and across the nation by looking at how they rate on timely and effective care, readmissions, complications and deaths, use of medical imaging, survey of patients’ experiences, number of Medicare patients, and information about how much Medicare pays hospitals. This is transparency.

CHANGE #5: Research is proving the connection between great leadership and great clinical outcomes. Research is and has been an essential part of healthcare. Without it, we couldn’t achieve new clinical outcomes. What’s new, however, is vital research on operational performance. It shows that when leaders lead a certain way—and that includes the use of so-called “soft skills”—patient outcomes improve. The more engaged the employee is, the better the patient safety and the better the success in process improvement. This means less rework and fewer workarounds. Other research shows the more objective a leader evaluation tool, the better the patient experience. In the past we wouldn’t have been able to prove many of these connections.

CHANGE #6: There’s a big push for integration. In this case, integration means efforts to put as many providers on a single asset sheet as possible. Trying to get everyone on the same page and the same team, either through an employment contract or some type of agreement, is a drastic change and one that takes time.

…and the Four Core Constants

Passion. Passion is demonstrated and lived out each and every day by healthcare providers. You see it in the nurse who clocks out but stays to sit with an ill patient. You see it in the physician who carefully and caringly explains to a family their father’s deteriorating condition. You see it in the hospital staff who pull together to bring a Christmas tree and presents to a sick patient’s family.

Passion is no different today than it was in the beginning, and it continues every day in healthcare. As an industry, we are blessed with an abundance of great people filled with passion.

CONSTANT #2: Fortitude. Working in healthcare has always been challenging, but with all the change happening, it’s even more complex today. It takes great fortitude to thrive in the midst of these changes.

Change is difficult all around. It is hard for the people experiencing it. It’s hard for the people on the receiving end (the patients). But it may be hardest of all for the people tasked with managing it. The good news is that the healthcare industry is taking steps to help leaders channel their fortitude in ways proven to lead to successful change.

CONSTANT #3: A willingness to learn. Every day in healthcare people save lives, handle disease with dignity and help family members cope with death. Yet in the middle of all the intense emotions that come with their jobs, people continue to learn. Whether it is mastering a new technology, learning a new procedure, or studying what’s happening with a disease or illness, healthcare people consistently exhibit that a desire to learn is in their DNA and that quality patient care is their ultimate goal.

A desire to do work that has purpose, is worthwhile and makes a difference. While people may initially feel their work meets these criteria, this feeling can be fragile. That is why it’s so important, when asking them to make significant changes in their day-to-day work, leaders explain the why behind the changes (rather than just giving orders). And the real why is never just saving money or complying with government regulations—it’s improving the well-being of the patients we serve and saving lives.

What may be helpful to realize is that healthcare professionals are not being asked to reinvent the proverbial wheel. Yes, we need new skill sets, but they build on the skill sets we needed in the past. We’re not being asked to learn different behaviors and techniques— we’re being asked to improve the existing ones. Not different. Better.

The good news i s the timeless values we possess—passion, fortitude, willingness to learn, and the desire to do worthwhile work and make a difference in the lives of others—will drive us to master the skills we need. It’s those values that will pull us through the tough changes with our passion and dedication intact.

Quint Studer is the author of A Culture of High Performance: Achieving Higher Quality at a Lower Cost (Fire Starter Publishing, October 201) and the founder of Studer Group.