Former CEO of General Electric, Jack Welch, said, "If the rate of change on the outside exceeds the rate of change on the inside, the end is near."1 Your ability to change and adapt determines your success. To develop winning strategies and help your bench technologists not only survive but also thrive, you should understand the types of change.
The Rate of Change
Change as a constant is old news. Improved methods, smaller instruments, lighter materials and more accurate point-of-care testing (POCT) have been progressing for decades. Much of the innovation since the introduction of personal computers into workplaces has been driven by Moore's Law, coined by Intel co-founder, Gordon Moore, in 1965, who predicted the processing capacity of integrated circuits will double every 18 months.2 Data management systems, information access, middleware, cloud storage and other technology has transformed laboratories.
But what's new is the accelerating rate of change. Harvard Business Review blogger, Rita McGrath, pointed out that this trend appears across the board. For example, it took decades for electricity and telephones to be adopted by most households, but only five years or less for cellphones and tablets. "Innovations introduced more recently are being adopted more quickly," she wrote. "Firms with competitive advantages in those areas will need to move faster to capture those opportunities."3
Speaker and business strategist, Robert Stevenson, agreed, adding that our knowledge is doubling as quickly as every two years. "For companies and people to succeed," he wrote, "they need to embrace change... What is considered excellent today may be considered average tomorrow."4
Medicine isn't immune to these trends. The rapid pace of change was a theme on Class Day in 2013 for new graduates at the Harvard School of Medicine. Said Dean and keynote speaker, Harvey Fineberg, "The face of healthcare has been rapidly transforming during your years here, and that pace of change is very likely to further accelerate."5
Laboratories in turn will have to reign in cost, maintain quality and keep pace.
Types of Change
Many changes are expected or desirable that relieve stress on a system and improve productivity, such as an incremental improvement in a chemistry reagent. Change that is unexpected and stresses a system presents a challenge, originating from three different directions: from the outside, toward ourselves or toward others.
Management consultant and author, Percy Dastur, classifies these as Types I, II or III. A Type I change that is imposed from the outside is resisted, he points out, because we perceive a loss of independence. But change occurs dynamically. "In any given 'Change Situation,'" he wrote, "all three occur simultaneously depending on the viewer's perspective."6 Thus, all change involves a loss of independence and is resisted at some level.
Many times, change is intended to improve efficiency. This kind of planned change falls into several categories:7
- Management. Managers leave all the time, and a decision has to be made to hire from within or from outside.
- Competition. The marketplace can often trigger organizational change, such as adding new services.
- Cost Cutting. A constant in today's healthcare, cost cutting is often devastating to staff, because payroll expense is seen as "low hanging fruit" by accountants intent on a quick fix.
- Process. Process change (e.g. LEAN can have a long-term effect on efficiency, especially in reducing waste).
The above can be combined to create turmoil and stress. For example, competition (Type I) can compel your hospital to cut costs (Type II) that force your laboratory to make a decision to outsource an essential service (Type III). What's new in today's business environment is that this kind of turmoil is happening faster and more often.
Choose to Thrive
Your laboratory won't change with you alone; it takes everyone's willing involvement. To accomplish this, as consultant and author, Dawn-Marie Turner, wrote, you must "create a structure of involvement that facilitates decision-making at the right level, by the right people, at the right time."8 Involving employees in decisions is a challenge in any organization with a hierarchy with power consolidated at the top -- especially if they don't think their opinions affect outcomes.
It's true that ultimately change happens to employees regardless of their involvement, but their participation in decision-making mediates feelings of losing control according to one study published in the Journal of Business Psychology.9 More damaging is a corrosion of trust with change -- most damaging with reorganization.10
Here are tips to deal with types of change:
- Identify the change. It's helpful to use the above scheme to identify what the change is and who it affects. From what perspective is the change viewed? All change is Type I, for example, to someone. To succeed, Type II change must happen.
- Be honest about involvement. Buzzwords like "involvement" likely don't mean employees get to decide outcomes, but it does mean a say in how they choose to adapt.
- Communicate early and often. The more people know about what's really going on, the less tempted they'll be to fill in the gaps themselves. For example, a weekly briefing on recruitment efforts can help during a staffing shortage.
Management has a choice to maintain trust. Initial resistance to change should be a clue to involve staff instead of an obstacle. For example, if a schedule restructuring is needed to do more with less to increase your outreach, a loss of control over personal schedules is inevitable; it helps to identify who this type of change affects and why.
Identifying types of change and recognizing that the rate of these changes is likely to increase can start frank discussions about what this means to your organization. Honesty about how your internal changes affect others (e.g. new rejection criteria as regulations change) can improve teamwork.
Surviving is a passive response to change, and thriving is an active choice -- one made by each of us. By understanding the types of change and how our response to it generates change of its own, we can be positively involved in outcomes and continue to improve patient care.
Scott Warner is laboratory manager at Penebscot Valley Hospital in Lincoln, ME.
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9. Bordia P et al. Uncertainty during organizational change: types, consequences, and management strategies. (abstract) Available at: http://link.springer.com/article/10.1023%2FB%3AJOBU.0000028449.99127.f7. Last accessed: 2/11/14.
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