Kathleen Wessel (Host): To drive lasting transformation and change, align clinical teams, improve processes, and strengthen a strategic vision from day one, leaders need to invest in adoption, not just implementation. Welcome to AHA Associates Bringing Value, a podcast from the American Hospital Association. In this series of podcasts, we speak with AHA Associate Program Business Partners, check in on their efforts and learn how they support AHA hospital and health system members.

I'm Kathleen Wessel, Vice President and Business Management and Operations at the AHA, and today I'm joined by Meg Johnson, Director of Care Operations at Tegria. And Robbie Bullough, Senior Director of Consulting at Class Research. In this episode, we explore why structured change management is strategic imperative in healthcare.

We'll discuss how it drives sustainable transformation, protects ROI and builds trust across teams and patients. Tune in to learn how you can apply these principles to lead change more effectively in your organization. Meg and Robbie, welcome to the podcast.

Meg Johnson: Thanks for having us.

Robbie Bullough: Thank you so much, Kathleen.

Host: We are going to jump in, but first I want to learn more about both of you. I got a two-parter here. So, Meg, we'll start with you, but I'd love for you to share with us, a little bit about your role and how you collaborate with Class. And then Robbie, we'll shift to you second, but if you could tell us a little bit about yourself, and how you see Tegria and Class working together and how all of this kind of comes together to support AHA member organizations.

Meg Johnson: Yeah, so first let me tell you a little bit about Tegria. We're a global healthcare consulting and services company. We partner with provider and payer organizations to help them maximize technology, improve performance, streamline operations, and advance care. We do this by delivering customized end-to-end solutions, ranging from strategic advisory to managed services.

My focus is on adoption and learning, supporting people and teams going through change. And my experience over the past 17 years is really the full spectrum of that work, ranging from executive level alignment, all the way down to one-on-one training support. Tegria is a partner member of Class. We leverage their independent research driven insights to better understand the state of healthcare and the needs and challenges that organizations face, as well as our own performance.

We're also a proud member of the Class Arch Collaborative, focusing on enhancing the clinician EHR experience. And as a Class member, we're dedicated to helping organizations solve their problems using data and best practices. So when Class identified an industry-wide gap around change management, we were happy to join that conversation that led to the development of a change management framework.

Robbie Bullough: And I'm Robbie Bullough. I'm a Senior Director of Consulting at Class. I've been at Class for about five years and change management has been a big part of a lot of the work that I have done with vendors and firms and with provider organizations. Class is an independent research firm. We're focused only in healthcare, and we help healthcare providers make informed technology decisions.

We interviewed tens of thousands of healthcare providers and executives, around the United States as well as globally, and want to be able to help them to improve the world's healthcare. Meg mentioned the Arch Collaborative. Tegria is one of 33 vendors and firms that are members of the Arch Collaborative, along with about 170 health systems across the United States.

And every summer we host an Arch Collaborative Learning Summit and last year it was at this learning summit that I heard lots of health systems just talking about some of the challenges that they were having with change management and various aspects of change management, including the training and implementation struggles they were going through.

It really, that's where I recognized, hey, there's an opportunity here that there needs to be some thought leadership. They're begging for help here and can we provide that for them? And so last November, Meg representing Tegria joined colleagues from eight other consulting firms, who provided their change management experts.

And we brought them all together here in Salt Lake City, Utah, and locked ourselves in a room for a couple of days and said, let's try to help provide some guidance and solve some challenges here for these health systems. And what emerged from that, Meg and her colleagues were able to put together a framework around change management and really have a great discussion to provide some best practices around this, to help healthcare systems.

 And this change management framework that Meg and the other change management experts came up with when we got together, has five stages in it, and it's cyclical in by design because it's something that's repeatable. And so it starts with the preparing stage where they create awareness, goes into the engaging stage where the, they expand the involvement, executing stage when the go live actually happens.

The fourth one is the sustaining stage to ensure that long lasting change. And the fifth and final stage is adapting where you respond and revise your plans as you go back into then preparing for the next round of the changes there. And communication is at the center of all of this. It's part of every single one of these stages of this change management framework that Meg and her colleagues helped create.

I think that's been incredibly beneficial. I'm grateful to Meg and Tegria and, and all of her colleagues that helped with this. And, every health system that I have shared this with and talked to about this, they have found this to be very transformative and beneficial for their organizations.

Host: Completely agree on the need for change management. I think there's been just so much, just different types of new tools, new resources, new approaches coming at hospitals, health systems that they're really struggling with how do we adopt, how do we select, but then how do we adopt all of these to make them very useful?

So, kudos to all of you for really focusing in on and locking down on this change management framework. In today's healthcare environment, why is it critical to build a change management into transformation strategies from day one? We talked about that earlier and talk to us about what are the risks if we don't approach it from that perspective.

Meg Johnson: I like to think about it like this. If you had a chance to ensure that transformation would be successful, you would want to do that, right? So there are studies, research that shows that effective change management can make it seven times more likely, that you'll realize your outcomes and ROI that you're seeking.

So in healthcare IT in particular, we are used to seeing project plans. We wouldn't start a transformative project without one. A change management plan is just the equivalent groundwork that enables not only the participants in the project to do that work, but also prepares the rest of the organization to engage when the time comes for them to be active participants. In the absence of a change plan, there's risks to the project itself. If everybody's not aligned, you potentially see delays, rework, budget overruns. Those are things that are really immediately visible, but there's also risks to the organization itself like decline in morale, reduced productivity, lower quality of work.

You just see stress, confusion and, change fatigue. and I think that's actually where one of the biggest risks, I see a long-term consequence really is if it doesn't go well, you have then built a legacy of failed change, which is very hard to overcome and can stick around in an organization for years.

You really don't get multiple attempts at large scale transformation. So it's important not just to think about today's priorities and initiatives, but also what you want to be able to do in the future.

Robbie Bullough: Yeah, and I would add to what Meg has talked about. You know, in the report we tried to have a section to call out some of these risks and consequences. Things like, there's expensive third party costs when you have to bring in a fixer to try to fix some of these things that you didn't plan for at the beginning.

There's redundancy costs when you have to, maybe keep a legacy system longer. There's a lot of training costs for additional trainers and training centers. There's a real cost to turnover within your own organization if you've burned people out and if there's, implementation fatigue, from some sort of change that you've had. But these are all costs and risks that come later. It's really hard to quantify a hard ROI around this is why we're doing this change management because these are all costs that happen when you do it the wrong way. It's kinda like, what's the ROI that my washing machine didn't break this month?

Like, I don't know how to say that. And this sits close to home in the Bullough family cause we've replaced a washer, dryer, fridge and dishwasher all in the last couple of weeks. And so, know now what the cost of that was to replace all those, but during the time you don't know what's the cost or what's the ROI of the fact that these things continue to work.

It's kind of like that where these costs and these risks and these consequences of not doing the change management early on and doing it the right way. Those are all costs that come later that are important to recognize.

Host: Excellent analogy, Robbie. I think we can all relate to that on some level. And I really appreciate from both of you kind of that context on why early planning is essential. So let's shift to who and kind of who's involved in this. Transformation isn't just about technology, it's about the people.

So who needs to be involved early on and how can leadership alignment and stakeholder engagement, reduce resistance and build momentum across the organization?

Meg Johnson: Transformation in healthcare is just complex. It impacts so many different types of people and in different ways. So for transformation to really be successful across all those groups of people needing to do something different and keep doing it different; there needs to be alignment and engagement across all of these different groups of stakeholders.

They might need different framing about why or what's in it for them. Why should they change, to really understand uniquely what their needs are, how those should be addressed. Like if they're going to need unique training on a new system or a workflow. And they might have different barriers or resistance.

They've got different needs. And so the, that might manifest in different ways. But all of those things can be built into a change plan. So it really begins then at the top with an executive sponsor. They play a very critical role in building support across their peer group of leaders, but then also in cultivating and reinforcing support as it starts to trickle down to mid-level or frontline leaders.

Successful changes have active and visible sponsors and not just at the beginning. They have to stick around and be visible throughout the life cycle of whatever change is occurring. But sponsors really aren't enough on their own. We really do need that representation from all the stakeholder groups.

And so by gathering those people who are closer to the front lines, we are able to uncover resistance and issues sooner and allow ourselves time and space to address those concerns before they, they put a project or change at risk. Sometimes it's easy to identify stakeholders to bring to the table, but it can also be a challenge.

At Tegria, we've worked with several academic health systems where there are multiple organizations and leadership structures involved. In those cases, the organizations who've been able to fully embrace and even engage outside of their own organization as part of the process, they have been successful.

They opened the door, invited input early, even again outside of their own organization. And that is how they were then able to build coalitions of support that transcended their own reporting structures, really expanding their sphere of influence and leading to success.

Robbie Bullough: Operations needs to have a voice at the table. When you're making decisions, when you're designing things, at the end of the day, you want there to be strong adoption. And when that adoption doesn't happen, oftentimes we're blaming the Go Live. We're blaming training or something that happened towards the end of the process.

But oftentimes, this is why it's important to act early, that lack of adoption, you can trace all the way early on and when operations feels like something is done to them instead of with them; you're really going to have resistance and you're going to struggle with adoption at the end of the day. So operations needs to have that voice.

Don't just assume that you understand how the changes that you are about to implement are going to impact their workflows. Make sure that they have a voice and that they're part of that. Go spend time out with them and really understand how this change is going to impact them and involve operational leaders and voices in those decisions. Even as an individual, if I'm not the one in that room, but I know that I am represented in there by a colleague who can speak for me, and my workflows and, things like that, then I am more likely to be willing to accept this change because this is something that is happening in collaboration with me rather than just IT or somebody else at the organization forcing this change upon me.

Host: So can you help me understand some of the practical ways to embed change management into the overall business strategy and not consider it, as you say, just an IT implementation?

Robbie Bullough: Yeah. And goes back to your first question, Kathleen, about why this needs to happen early, because that's how this has to happen. At the very beginning of the process. Meg mentioned alignment. That's incredibly important to have at the highest levels, to have that leadership alignment so that you know what the messaging is going to be like, how we're going to communicate this and what the plan is going to be as we go through the rest of the organization.

And communication is important all throughout this, from those initial stages of planning and preparing for the change to when you start to engage your teams and those within your organization to when you're executing on this. And then you're not done once you just go live with this change. You want this to be sustainable and so you need to be able to get constant feedback and, to be able to sustain and adapt to that feedback and make this be something that is going to take hold.

It's important to be transparent and vulnerable upfront so that people are willing to be honest with you and provide that feedback. And so it really should just be something; change management can't be an action item or a checkoff item in the process of whatever it is that you're changing. It really is more, more fluid.

It's like a liquid that's going to take the shape of the entire container and it really should flow throughout.

Meg Johnson: Yeah, and I think, one of the most practical things any organization can do right now is to equip their leaders to lead through change, which allows them as an organization to just be more agile for any initiative that might be coming, whether it's IT or not. Change management relies heavily on sponsors, but I also had mentioned those mid and frontline leaders, that's where a lot of the work around change really occurs.

And so investing in those leaders so that they understand the role they play in any change, the tools that are available to support them, even the language that the organization uses, just to talk about change. Hard wiring those thoughts and building that change muscle now really makes it easier to activate those individuals in a change network later whenever it's needed.

Host: I must confess, I think I fall into one of those change management more of a checkbox. And I, it is a practice that I, myself need to become more and more adept at. So I think, this conversation is really helping me understand the full scope here. So I appreciate that.

When I think about communicating up to my own leaders and, others, how do organizations measure success of change management and efforts beyond just some of these technical metrics?

Meg Johnson: Defining success is one of the first steps in our process. Not only does it give us something to measure, but it's also invaluable to hear how a sponsor really articulates their vision of the future state. Do they envision a hundred percent adoption on day one, or would 75% of the way there be worth celebrating?

How soon are they expecting to see these results? You know, some metrics lag. And so, talking about this upfront can really help set realistic expectations, not just for the project leaders, but also for those impacted by the changes. Some changes really just need to be sustained for some time before you notice and realize the benefits.

There are some other standard metrics we use along the way to just help us understand whether people are aware of what's coming, they support it, whether they're capable of doing it. Regular surveys can illuminate how communication is or isn't flowing, and how groups of stakeholders are reacting to the messages, which is honestly, just a feedback loop that is necessary for our change management plan to respond and then adapt. Maybe we can have our sponsor be more active and visible. Maybe they can go round in a particular area, or we can support a frontline leader in a specific department with more refined communication.

So I think there's the ultimate measures of success and then also the ways we measure our success along the way so we can still course correct.

Robbie Bullough: I think that feedback loop is absolutely critical, and I don't care if it's a survey. If it's the rounding, if it's one-on-one conversations, whatever works best within the culture of your organization, because that's going to be different from organization to organization. What's important is having that ongoing method for gathering the feedback and then not just gathering the feedback, but applying it, and then communicating that back throughout the organization.

We've heard you. This is what you said, this is what we have done about that. Because that will then foster the ability to continue to collect that feedback, because I'm more willing to share that feedback now that I know that you truly are listening and you've demonstrated how you are applying that feedback.

So this should be an ongoing loop. This isn't a one-time feedback gathering. It's not a strict annual thing even. Being able to apply that and then share back out, share the wins that we're having as an organization and communicating what we're hearing and what we're doing to apply this.

Ultimately, measuring the success, your people are going to determine what that success looks and sounds like, and so getting that feedback from them will really be the proof in the pudding on whether or not this is successful.

Host: So what advice would you give healthcare leaders to ensure change is sustainable long after go live and what does the future of transformation look like for organizations just beginning this journey?

Meg Johnson: Well, I love that Robbie brought up the feedback loop. Because I think we need to help people shift away from project thinking mindset. So projects have a start and an end, and so do the resources that go along with it. There's that technical moment of go live, but the adoption of the change really happens over time.

And so defining that success upfront, acknowledging how long it might take to get there, but then also monitoring how we're doing towards that. Setting up the feedback loop to collect input on how it's honestly going, not just what the numbers say. That is a way then that you can tell the story of what's happening with the change.

 People relate to the more personal impact of any change. You know, how does this impact our patients? Maybe not just my work. And so it's important that we're able to share messages like that, to reinforce when people are doing things right, to acknowledge where we've got gaps or issues that we need to address, but to just be transparent and open with that communication, celebrating where there's success and acknowledging where there's work yet to be done.

Robbie Bullough: Meg mentioned, getting outta the project mindset that this isn't something with a start and an end date. And to me that's what's critical. We're not just managing change up to a go live date. We have to manage change through and beyond the go live. That's what makes it sustainable. When you have the start and end date mindset of a project, that's what makes these changes not be sustainable.

So taking, these things that we've talked about like the feedback loop and lots of these things that extend beyond the go live date is ultimately what helps this be sustainable. And I also want to point out that we're talking about any type of change that an organization can go through. The lens and the examples that we use are often, you know, IT implementations given the work that, that Meg and I both do, but this type of change we're talking about, this can be agnostic. This process that we're talking about, this framework that we've created, this applies if you are a health system that's just acquired a hospital or a set of clinics and you're going through this M and A activity. If you're doing an org restructure within your organization.

I recently worked with a health system that was creating a central staffing office, for all of their various hospitals. Any of those types of changes, this change management is critical. We're not just talking about implementations. We're not just talking about technology, but any type of change that an organization is going to go through that's going to affect people can be sustained if you follow these best practices.

Host: I'll add process redesign on there too. Because that that's a huge effort for most organizations just thinking about how flow happens through hospitals. So I honestly for both of you, I can't thank you enough for bringing this conversation to the podcast. I know I certainly have learned a lot and these are critical resources, so I appreciate all of the work that all of your teams have done on this important topic.

So Meg, Robbie, big thank you for joining us today, sharing your research, the framework, and helping our healthcare leaders drive meaningful lasting change. For listeners, if you'd like to learn more about Tegria and the AHA Associate program, please visit us@sponsor.aha.org. This has been an AHA Associates Bringing Value Podcast, brought to you by the American Hospital Association.

Thanks for listening.