Leading Change: Insights from a Pediatrician and Parent

Take the action that makes a difference, change the norm

THE NECESSITY OF CHANGE

As a parent and pediatrician, I am acutely aware of the necessary changes every human must experience in their growth from infancy to adulthood. Not every individual makes the transition from one phase of the lifecycle to the next with the same degree of confidence, trust, or willingness to change. Human development and maturation offer some interesting insights and parallels to understanding the complexities of change and the challenges of leading change.

The following thoughts are not intended to trivialize the changes one can encounter in pursuit of a meaningful work experience. They merely represent one perspective on leaders and employees seen through the eyes of a pediatrician.

Consider the toddler about to be weaned from the nipple (natural or artificial) to the sippy cup and eventually to solid food. The greater the sense of security and comfort derived from the breastfeeding or bottle-feeding experience, the more difficult it is to move on to the next stage. The resistance can be fierce at times. I’ve seen a toddler literally tear at a mother’s clothing to suckle on her breast. The toddler is not hungry; he just wants to experience that sense of warmth and security after a stressful day at daycare.

Now consider the employee who has been informed that his job description has changed. He will have new responsibilities and must acquire new skills to fulfill them. To effectively lead this change, the leader, like a mother, must begin by anticipating the anxiety generated by completely disrupting the comfort zone of the employee/child. She must be patient, provide the necessary tools, educate, reassure, and guide to enable the employee to move forward.

As the child continues to develop, learning to share and to care about others are important steps in developing relationships and bonds with classmates. These relationships are key facilitators of a child’s transition from home to classroom, toward accepting and managing change. Similarly, the employee’s relationship with peers and leaders helps him move from resisting change to accepting, if not embracing, change.

To be clear, none of these steps can be viewed as “a one size fits all” concept. Each employee has a unique set of experiences, emotions, and expectations that influence the degree of resistance or acceptance and its manifestation. These factors determine who follows passively and who becomes an active participant.

Despite the underlying drivers of resistance or acceptance, the leader must adequately frame and explain the necessity for change. The leader must listen to concerns and determine what is most important to those who resist. Whenever possible, the leader should address those concerns openly and honestly and resist becoming bogged down in verbal sparring that consumes valuable time.

The effective leader helps those who are willing to follow and possibly lead to clearly understand the need for change and how it will be accomplished. Clarity and rationale, as well as the valued contribution of an employee, are strong incentives for adaptation or implementation of change.

THE COMPLEXITY OF CHANGE

A leader must continue to emphasize the value of the individual. She must constantly assert that applying one’s skills, sharing knowledge, and caring about colleagues relate to individual success, the success of the team, and, ultimately, the success of the organization.

When children enter pre-school, the transition from “me” to “us” begins. They learn to share toys and put them away when it is time for the next activity. They participate in clean-up after a creative session of finger painting. When they get out the musical instruments (triangles, tambourines, and tom-toms) for an invigorating jam session, they are experiencing the rudimentary act of trying to create something in unison, the early foundation for teamwork. When children are sitting quietly, listening to a story read by the teacher, looking for the buddy whose hand must be held as they march out to the playground, this is the beginning of sharing and working cooperatively with others.

As a child’s mental and physical skill sets develop, so does the ability to appreciate the value of others. This is especially true in team sports, extracurricular activities, boys’ and girls’ scout troops, and community service projects. They share with others the emotional joy of winning or disappointment of losing. Each experience offers the prospect of learning from mistakes and doing better. Each success reinforces the idea that hard work and dedication can be rewarding and that much can be accomplished when people act in unison, visualize a goal, and set out to accomplish it together.

Young people who are engaged in a team activity or a solo activity, such as playing chess, performing a solo dance, or using their allowance to pay for another student’s school lunch, have been guided and nurtured by a parent, teacher, mentor, or coach. Effective leaders can have a similar impact on adults in the workplace.

The adult whose job has thrust new demands on both body and mind can benefit from a leader or mentor who explains the reasoning behind the new responsibilities and provides access to the skills or knowledge to support these changes. Change may require working with new team members or interdepartmental collaboration and establishing the relationships that will most facilitate accomplishing certain tasks.

As adolescents must establish and navigate social, emotional, and functional relationships, selecting clubs to join, teams to try out for, and classes to take help to shape their vision of who they are and who they hope to be. Parents, guidance counselors, and teachers have a role in leading these changes.

Peer groups also play a major role in this decision-making process. Peers influence how, where, and when to study. They help determine participation in extracurricular activities, attendance at parties, and even dating choices. In the end, however, as they transition from adolescence to adulthood, young people must believe in themselves; they must understand their value and be willing to share it with others.

The changes a working adult may experience in the course of a career are as disruptive and at the same time exhilarating as those changes experienced in adolescence, and they bring to mind the same questions: Of what value am I? Who cares about me? Where do I fit in? Who do I have a good relationship with? Will our team survive? These questions require thoughtful and direct responses from leaders.

A parent’s job is to nurture a child, to provide reassurance based on life’s lessons and knowledge of their world. The parent listens to understand the child’s perspective and, when possible, acknowledges its validity. The parent identifies the major influences in a child’s life and provides guidance on how to manage them and changes that are to come.

These considerations in the maturing, evolving child offer some parallels to the changes necessary for the evolving organization.

Similar to a parent, a leader must listen, engage, and empathize. When appropriate, the leader must validate an individual’s perspective, as well as provide feedback and direction for a more appropriate course of action. The movement from the current state to an uncertain future state that is necessary to ensure viability and improve functionality defines the necessity of change. It also involves determining the best way to effect that change.

Each organization must determine which of many change models will best suit its culture and needs. One of the most widely used is the Kurt Lewin model for organizational change. It begins with the leader’s willingness to change the organization’s current state. Next is the critical step of facilitating employee involvement in change by sharing knowledge with them and engaging them in the change process. Once that process is implemented, the organizational change is solidified.

A leader must articulate the fundamental practices that support the necessity of change and the imperative to evolve. These practices include:

• Identify the key drivers in the environment that necessitate change.

• Listen to understand the concerns of those who are expected to implement change.

• Be prepared to answer questions as directly and succinctly as possible. Don’t be reluctant to say, “I don’t know.”

• Be prepared with an implementation strategy that allows input from those who will lead the change.

• Facilitate and empower those expected to lead by providing accurate and focused direction.

• Provide reassurance that proven practices that work well will not be automatically discarded. Emphasize that success or complacency will not deter the implementation of change necessary to remain competitive.

These practices distinguish between acting with a sense of urgency and strategic focus versus responding with a chaotic, crisis-driven mindset that results, at best, in a temporary fix. At its worst, chaos breeds disfunction, inefficiency, and lack of confidence in a leader.

THE CHALLENGES OF LEADING CHANGE

These principles provide a framework for an orderly transition into a new functional state. This distinction was of paramount importance to me in the early 1990s. I was assigned to introduce physicians and members of our entire hospital network to a new set of utilization management guidelines.

The Millimen Care Guidelines were being adopted rapidly by health insurance payers and hospitals across the United States. The guidelines were developed from solid, evidence-based data and research. They had already been proven to result in more appropriate hospital admissions and lengths of stay. Now, it was time to introduce them to the physicians and hospitals in our state.

As l prepared to embark on this odyssey to the hospitals in our network, I knew that physicians and hospital administrators would resent a health insurance plan that tried to tell them how to care for their patients. I fully expected hostility at my presentations and joked with colleagues that I would be accompanied by three nurses at every presentation: one to help me distribute the stack of information about the guidelines, one to stand by the nearest exit, and one to wait in the car with the engine running just in case we needed to make a quick getaway.

Invariably, after I was introduced, two or three physicians would immediately begin to vent their frustration and anger with health insurers. I would ask, “How many other insurance companies have a representative who meets with you face to face to explain what they were doing and why?” This question was followed by dead silence. I then knew I could proceed with the presentation.

• My primary responsibility was to inform those who would be followers and leaders of change rather than focus on those who were most resistant to change. When physicians were ranting at the beginning of my presentation, I remained calm because I did not want to get into a shouting match that might convey an attempt to suppress or deny their concerns.

• I wanted to listen to their comments and use their concerns to better prepare for the next presentation.

• By my demeanor, I intended to establish a collegial, information-sharing process that would facilitate change.

At the end of each session, one or two doctors would thank me and express their appreciation for the presentation. It was at those moments that I knew I was successfully leading change.

REFERENCES

Angood P. All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare. Washington, D.C. American Association for Physician Leadership; 2020.

Bossidy L. and Charan R. Execution: The Discipline of Getting Things Done. New York: Crown Business; 2002.

Hussain ST, Lei S, et. al. Kurt Lewn’s Change Model: A Critical Review of the Role of Leadership and Employee Involvement in Organizational Change. Journal of Innovation and Knowledge. 2018; 3:123-127

Kotter J and Rathgeber H. Our Iceberg Is Melting: Changing and Succeeding Under Any Conditions. Chicago: Macmillan; 2005.

Ristino R. The Agile Manager’s Guide to Managing Change. Bristol, VT.: Velocity Business Publishing; 2000.

Excerpted from The People Value Proposition: See one, Do one, Teach one ... LEAD - A Physician's Journey to Leadership by Stanley E. Harris, MD, MA.