Managing Organizational Change

Oachs and Watters Chapter 21

Lake View Hospital is a 25-bed critical access hospital located in rural Minnesota. Lake View's director of primary care and specialty services and the president/CEO identified a need to restructure their physician and Advanced Practice Provider (APP) coverage model to improve physician and APP recruitment (providers), ensure provider retention, and serve their patients and the community better. Changes related to health care reform, surveys of patients' expectations of services, and the expectations of new providers looking to practice in a rural setting all factored into their decision to explore the need to make significant changes in our delivery models. Several complex challenges were identified early on and were discussed with their provider partners. They engaged in brainstorming, scenario planning, and other productive conversations on what changes they should work toward and why they should try to make them. All these changes happened during a relatively short period of time and after a long period of providing services at the status quo.

Summary of Changes Implemented

Provider contracts and recruitment. They restructured their provider contracts across the medical clinic to align with the organization's strategic plan and to better serve their patients. The goal was to be transparent with the providers and create standard contract models for current providers and for the providers that they were working hard to recruit. These changes were achieved through collaboration between administration, consisting of Lake View's president/CEO, director of primary care and specialty services, and director of finance, and their team of eight providers at the time. They also modified their provider recruitment strategy to take more ownership of the process internally at Lake View, and to connect with more providers across the state to share what they were working on at Lake View. They had many challenges to work through with their current providers to maintain internal equity, respect current employment terms, past agreements, and compliance requirements.

Physician call obligations. Prior to this recent restructuring, Lake View's physicians covered hospital call 24/7/365 on a rotating basis. This was taking a toll on their long-term physicians after decades of covering this obligation and was seen as a burden by the newer physicians who were beginning their careers and starting their families. New physicians who were being recruited by Lake View also saw this call obligation as a negative to joining Lake View's practice in contrast to some of the outpatient only practices available in the region. The administration team and physician team again worked collaboratively during internal team meetings, offsite retreats, and with individual discussions on how to best solve this dilemma. Their goal was to eliminate overnight hospital call, but still ensure the appropriate call coverage to operate and grow the inpatient services that their patients were requesting. They evaluated and considered many different creative and innovative coverage models (e.g., hospitalist program, telemedicine, contracts, etc.) before all deciding on their current call coverage model. They had to work closely with their emergency department physicians throughout the process and to ensure success with their newly agreed upon model. They decided on a model where the primary care physicians cover call from 7:00 a.m. to 6:00 p.m. seven days a week and the ED physicians cover the ED and inpatient unit from 6:00 p.m. to 7:00 a.m. They implemented a successful communication and handoff process from the ED physician to the primary care physician to ensure seamless patient care and quality. The change was identified as a significant factor in successfully recruiting two high-quality and sought-after physicians looking to sign with an organization in the Lake View region.

1) What were the leadership practices that Lake View used to promote innovation and reduce resistance to change for each of the two problems above?

2) Make a list of reasons that people resist change. For each reason, suggest a way to reduce resistance.

3) Based on the scenario above.Differentiate how a manager would approach this change versus how a leader would approach this change.

Use information from the book "Umikers Managent Skills for the New Health Care Supervisor" By: Charles Mcconnell Edition 8th 25