Written by Becky Gourde, MPA, program coordinator, National Rural Health Resource Center/Rural Health Innovations Think of the last time you were faced with a change and felt resistant to it. How did you feel? What do you suppose accounted for your resistance? If you’re anything like the rest of us, you probably resist change when you feel you’re losing control over a situation, when you feel your identity is threatened, or when you feel you’re at risk of failing. As leaders of rural health networks, it’s often your responsibility to guide diverse stakeholder groups through periods of change as you work together to accomplish new goals. Maintaining the full engagement of stakeholders is crucial to the successful navigation of a transition. People often have several common questions as they try to wrap their heads around an opportunity for change:
Creating a shared vision People don’t change just because someone tells them to do it. The two main reasons people decide to take on new behaviors or actions are (1) they have the motivation, and (2) they have the ability. Particularly for network leaders, change management strategies will be most effective when you focus on increasing stakeholders’ motivation and ability, rather than simply telling people what to do. Before you can understand what motivates your stakeholders, you need to have an awareness of their goals and anxieties. The vision that you establish should help them meet their needs while reinforcing that the network’s intended destination is one that’s worthwhile to them. A vision workshop, such as the format developed by RHI for rural health networks, is a helpful method for articulating priorities and gaining consensus on a network’s desired future state. Managing loss When facing a significant transition, network members and stakeholders can feel losses of control, power, influence, relationships, or even personal identity. There are a number of techniques that can help ease the losses felt by individuals as they enter a transition.
Maintaining commitment through communication The way you communicate information with stakeholders can have a profound effect on their decisions to stay engaged through periods of change. While communicating during transitions, network leaders can ensure that all voices are heard and stimulate participative conversations. As you engage in dialogue, remember that understanding is more important than agreement. Reaching consensus on an implementation plan will likely be challenging, but the challenge will be even greater if there isn’t a common understanding of the circumstances. Encourage stakeholders to spend time listening to and acknowledging other viewpoints without necessarily coming to an agreement on solutions right away. Even those who are instrumental to a solution often begin the transition by complaining. It may appear tempting to allow complainers to disengage from the process. Instead, prepare yourself upfront for the likelihood that the early stages of planning and transition will involve some negative or uneasy feedback. It’s important to encourage the continued participation of critics, as these stakeholders can be key influencers when designing comprehensive action plans. Implementing and reviewing your plan for change Of course, it’s tough to reach the destination of your vision if you don’t have a plan for getting there. Implementation plans or action plans are an opportunity to develop collaborative processes and maintain the commitment of results-oriented stakeholders.
Colorado Telehealth Network How one network maintains engagement while implementing change The Colorado Telehealth Network (CTN) in Greenwood Village, CO, provides broadband connections for Colorado’s health care delivery systems. Ed Bostick, the executive director of CTN, shares with us how their network has been involved in a collaborative process to engage stakeholders while implementing change in their communities: “Colorado’s health care providers are finding themselves at varying degrees of readiness regarding the integration of primary care and behavioral health services. Telehealth is a tool that can support this shift; however, there is no one-size-fits-all telehealth solution for Colorado. Recognizing these concerns, the Colorado Telehealth Working Group (CTWG) convenes a monthly meeting to discuss issues that may result in barriers to the adoption of telehealth or its implementation. The members of CTWG are voluntary and represent a wide stakeholder group comprised of behavioral and physical health organizations, hospitals, health systems, the State of Colorado, payers, insurance plans and consumers. CTWG hosted a mini-summit in October 2015 to begin identifying and addressing barriers to telehealth adoption and implementation in Colorado. Fifty-one individuals attended the mini-summit, representing 37 distinct organizations operating in Colorado. Attendees examined how telehealth impacts integration of physical and behavioral health, policy and payment reform, clinical outlook and vision, operational outlook and vision, and telehealth innovation. A follow-up consensus conference was held in February 2016 to identify implementation strategies for the development of telehealth service lines. Eighty-six individuals representing 55 organizations in Colorado and Wyoming participated in the conference. The group identified barriers to telehealth and then recommended solutions to those barriers for patients and providers.” -Ed Bostick, executive director, Colorado Telehealth Network In summary
Facilitating conversations with groups of stakeholders, such as through in-person planning events and other collaboration techniques, is a valuable part of effective change management strategies. In the case of the Colorado Telehealth Network, the mini-summit and the follow-up consensus conference provided opportunities for many distinct entities to come together and establish a shared vision, discuss how a change would impact their areas of work, identify barriers that could get in the way of reaching the shared vision, and develop an implementation plan to bring them to the desired future. Engagement from diverse groups helps ensure that all perspectives are taken into account before implementing a change, and their involvement early in the process allows you to start influencing their motivation and ability to change right off the bat. Further reading The topics covered in this article are based on the research and works of Peter Senge and William Bridges. We encourage you to explore their materials as you continue to implement change within your networks.
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