Managing Complex Change in Behavioral Health Organizations

Recently I spoke with friend and colleague Matt Hoffman, Managing Partner from Afia Health. I’ve had the pleasure of working directly with Matt and the Afia team for the past three years, and for many years before that at the National Council for Behavioral Health. Many of you are familiar with their work as technology consultants working with behavioral healthcare organizations on everything from electronic health record (EHR) selection and implementation, primary and behavioral healthcare integration, revenue cycle management, and data analytics or data-driven quality reporting. At the core of what they do is help organizations manage complex change, which is essential to grow and thrive in today’s ever-changing healthcare environment. For more than a decade, Afia has developed a change management framework that if followed, almost guarantees success. There are five essential elements to creating a successful project management plan for any new project. Governance: Is there direction and vision from appropriate, empowered leadership? Does decision making align with the strategic goals of the organization? People: Are the staff engaged in the change? Are the right people in the right seat? Does the organizational culture encourage the desired behavior? Processes: How will organizational processes be impacted? Are there outliers? Are appropriate incentives in place to ensure the intended process is used? Technology: Are the needed tools and equipment in place? Do all staff have this technology? Do the tools have the functionality staff need to efficiently perform the job at hand? Execution: Is there a detailed project plan in place? Are the right resources assigned? When projects fail, it’s because one or more of these elements is left out or overlooked. The other key element to successful project management is to take the time to put together the project plan before starting a project and make sure you have dedicated staff to lead the effort. We do that, right?! Unfortunately, given the nature of our industry, we’re often forced to make huge changes on a quick turn-around, often responding to external forces outside of our control. We jump in and get busy “doing.” But how often do we take a step back and make sure we’re “doing” the right stuff? The ONLY way to make sure we’re managing change effectively and efficiently, optimizing all resources, is to make a plan and manage through it. Organizations are going to spend the time and money, either upfront planning, or at the back-end fixing. Take the time to plan well. Another aspect of managing change we often get wrong is handing off major projects to someone eminently qualified and capable, who already has 150 things on their plate. We all have limited resources – time, money, people. And no matter how capable your people are, if we keep piling on, there is a finite limit to how much one person can handle. And just because a person is good at “doing” one thing, doesn’t guarantee they’re good at overseeing others do the same work. Project management is a skill-set and organizations would be well-served hiring specifically for it. Finally, projects should have quantifiable, measurable metrics. Progress shouldn’t be determined by how we “feel” like things are going. Following a well-planned project allows clarity and transparency regarding deliverables, timelines, and accountability. I asked Matt what advice we should give behavioral health leaders struggling with executing complex changes in their organizations. Write it all down. Do you know all the major initiatives your organization is working on? During your next leadership meeting, ask your team to write down all the major projects they’re managing, yourself included, and then review together. You’ll be shocked by how long the list is. Create a structure for governance. Define the projects that need to rise to the leadership team and a process for routinely reviewing them that’s simple and quick. You don’t need to manage the little things; trust and hold your people accountable to do that. But you and your leadership team should be discussing the priority projects on a regular basis to catch problems before they overwhelm or stall a project. Look at the data and do something about it. Develop Key Performance Indicators (KPIs). If something is in the red, talk about it, fix it, and move on. There are great tools out there, and great technology to help successfully manage complex projects. There are also outside consultants and other resources to support leadership teams as they implement structures to successfully manage change. Put together the right team, track progress, and let’s get things done!


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