Abstract
The healthcare environment requires that all stakeholders are aware of the need for change, as well as the best process of implementing that change. As such, it is important to note the specific challenges that face those working in healthcare, as they pertain to the organizations themselves. This paper covers the basics of the challenges that face healthcare organizations to highlight some of the specific challenges that are present in this industry. The specific issues of changes in pay for quality and the changing characteristics of clients are used to highlight why change can be challenging in healthcare. It will become evident that change is challenging because of the number of stakeholders involved in making change, the nature of the clients, and the rapid pace at which change must occur to provide the best care for patients. These are all issues to consider when creating a change implementation plan for the healthcare environment.
As with any environment, healthcare providers need to make significant changes in order to continue to provide the best services, to stay relevant, and to improve outcomes for clients. Change in the healthcare environment aims to ensure the health and safety of patients with a focus on reducing costs and improving both short- and long-term outcomes. As such, it is important to understand the nature of change in the healthcare environment to ensure that the changes that are made are beneficial and accepted by each stakeholder in the process. The purpose of this paper is to outline why change is difficult in the healthcare environment, and to focus on two main points that are affecting healthcare providers currently – changes in pay for quality, and changes in client characteristics. This overview will provide insight into how these changes are a challenge for those working in healthcare.
Challenges Affecting Change in the Healthcare Environment
One of the biggest issues that relates to change in the healthcare environment is that it is a continuous process. Stakeholders, including nurses, physicians, and healthcare administrators, must stay abreast of a number of different issues to ensure that they are providing the best service to patients (Hayes, 2014). This includes understanding the law, which has been increasingly challenging with the implementation of the Affordable Care Act, medical advances, best practice research, and economic information that has an effect on providing healthcare and insurance. This continuous change is important because it requires a huge number of resources to conduct properly, and in the cases of nurses and physicians may take time away from the care of patients, even if it is in their benefit in the long-term.
Another issue with change in the healthcare environment is the process of change itself. In this sense, every change, however small, will affect a large number of stakeholders. There are a number of approaches to implementing change, including the process of unfreezing old behaviors, introducing new ones, and re-freezing them (Al-Abri, 2007). Whilst these process guides do give insight into how to introduce changes with minimal disruption or adversity in the environment, it is important to note that any change will have a significant effect on the organization itself. Al-Abri (2007) notes that there are several reasons why an implemented change may fail, including a lack of vision from senior management, a lack of integration with existing processes, and ill-conceived implementation plans. Whilst these are issues in any type of organization, the fact that healthcare providers have the lives of patients in their hands means that managing change effectively is literally a life or death scenario.
Changes in Pay for Quality
Pay for performance processes are designed to motivate healthcare providers to improve levels of care in exchange for a financial reward. Measurements of clinical and process outcomes are assessed to make a judgment about the quality of care being provided. Medicare is one of the biggest programs that focuses on pay for performance outcomes, which aim to both improve the quality of care and reduce the amount of unnecessary healthcare costs (Hayes, 2014). There are payments for better care coordination between different providers, for example, and a set of ten quality outcomes that increase the amount of financial compensation a provider will get for each discharge on their books (Hayes, 2014). These incentives have had mixed results, but due to the fact that they are related to changes in healthcare law it seems likely that these pay for performance initiatives will continue to affect providers for some years.
There are a number of challenges with implementing pay for performance initiatives in healthcare environments. The first one is deciding which criteria to apply for the program, as there are many different types of provider which have different aims. The quality of an end-of-life care unit will be judged very differently to the quality of an emergency room, for example. There are also challenges when implementing these types of program as they are organization-wide protocols that affect a large number of stakeholders, not all of whom will be happy with the process. This requires technical planning, including implementing the initiatives in line with existing quality improvement programs and technologies, and personnel planning, including informing every stakeholder about the changes and how it will affect them directly (Hayes, 2014). As such, it is a complex process that provides a large number of challenges to the healthcare environment, and changes must be planned in sufficient detail to ensure the safety of everyone involved.
Larkin, Pierce & Gino (2012) suggest that pay for performance initiatives also provide a number of psychological barriers and issues for stakeholders, which is something that can happen with implementing change, particularly if the change is more controversial. The suggestion is that, if these changes are not implemented properly, there can actually be increased costs from pay for performance because of the psychological challenges that it presents. In this sense, it has an impact not only on the providers, but also on the firm’s complimentary activities and the psychological well-being of providers who are now challenged to improve their standards of care in every dimension (Larkin et al., 2012). The psychological aspects of implementing change are often overlooked, but provide an enormous challenge when implementing changes in the healthcare environment because of the direct impact that they have on a number of stakeholders.
Changes in Client Characteristics
Another challenge relating to change in the healthcare environment are changes in client characteristics. As with any other type of change affecting healthcare, this challenge is ongoing and needs to be addressed consistently in order to provide the highest levels of care. One major change is the aging population, which is a trend that looks set to continue for the foreseeable future (Hayes, 2014). Older populations have different healthcare requirements to younger ones, and healthcare needs to adapt to meet these needs. Another challenge facing providers in the United States particularly is obesity, which is another trend that seems set to continue indefinitely. There are a number of different issues affecting the obese population, and it also requires a healthcare provider to focus on preventative strategies to a high level. As such, this is a challenge because it affects a number of different elements of the organization.
Chambers, Glasgow & Strange (2013) present a dynamic sustainability framework that deals with the issue of sustaining healthcare outcomes and dealing with ongoing change in healthcare. This framework highlights the difficulties of managing the changes in client characteristics but still providing top quality care. The framework is based around ongoing assessments of client characteristics, ongoing assessments of evidence-based practice, and creating a change management plan that is appropriate to a number of different scenarios, tailored to the specific needs of the healthcare organization it concerns. This framework is designed at managing the problem that occurs when there are a number of changes in the healthcare organization, and highlights some of the challenges that implementing change presents. It is important to be aware not only of the changes in client characteristics, but also in how they should be dealt with in a way that suits all stakeholders.
The fact that the nature of clients in healthcare is changing rapidly also presents the challenge of speeding up the translation of healthcare research into actual practice (Kessler & Glasgow, 2011). The time it takes to implement change in this regard has long been part of the challenge facing healthcare organizations, but is something that cannot be rushed due to issues with patient safety. Considerations need to be made as to how to implement change based on research as quickly as possible, especially considering how fast populations alter, but this needs to take into account the training, change management plans, education, and pilot schemes that are required for successful change implementation (Hayes, 2014). This is one of the biggest challenges that face healthcare organizations in terms of change because of the complexity of the nature of the problem.
Conclusion
There are a number of different challenges associated with implementing change in a number of different organizations, but in healthcare change is particularly challenging. This is because healthcare deals with people’s lives, and because there are a number of different stakeholders that need to be taken into account when making the change. One challenge is the increasing number of pay for performance initiatives, which are challenging because they are complex to implement and affect a number of stakeholders. They are also a challenge because they are somewhat controversial, and change that is not accepted by each stakeholder is unlikely to be successful. Another challenge facing healthcare are changes in client characteristics, such as the aging population and the increase in obesity. These issues need to be addressed by healthcare providers, but are challenging because they are ongoing and are susceptible to change over time. As such, it is important to be aware of these issues and the difficulties with implementing them, as they can have large-scale impacts on healthcare.
References
Al-Abri, R. (2007). Managing Change in Healthcare. Oman Medical Journal, 22(3), 9–10.
Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci, 8(1), 117.
Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan. Retrieved from https://books.google.ca/books?hl=en&lr=&id=-jMdBQAAQBAJ&oi=fnd&pg=PP1&dq=change+management+healthcare&ots=50XidwpCRs&sig=kXZvqURhSCp7UIafAw7CDqrw4Ao
Kessler, R., & Glasgow, R. E. (2011). A proposal to speed translation of healthcare research into practice: dramatic change is needed. American Journal of Preventive Medicine, 40(6), 637–644.
Larkin, I., Pierce, L., & Gino, F. (2012). The psychological costs of pay-for-performance: Implications for the strategic compensation of employees. Strategic Management Journal, 33(10), 1194–1214. http://doi.org/10.1002/smj.1974
