Kevin Haeberle, a senior vice president at Integrated Healthcare Strategies, makes eight key points on preparing employees for accountable care organizations.
1. ACOs involve a basic change in mindset. In an ACO, employees need to start looking at their jobs differently. For example, "right now they want to keep patients in the hospital, but with ACOs they want get them out," Mr. Haeberle says. Employees may also have to take on new tasks, such as proactively reaching out to patients in their homes. "You have to deal with a fundamental change in the process," he says. The HMO era of the 1990s also required a fundamental change in thinking, and many hospitals didn't make the transition.
2. Planning usually ignores the people side. When hospital leadership plan for a new initiative of any kind, they usually don't sufficiently think through its effect on employees. "The workplace culture will change, and there will have to be protocols in place to guide employees through it," Mr. Haeberle says. Not paying attention to these challenges is a key reason why five years out, many once-promising initiatives falter.
3. Changing the culture will require spending. Getting people ready for a major change in the culture, such as introducing a new EHR system, requires significant spending to train employees and plan and phase in new strategies. The cost of getting employees ready for an ACO could be in the millions of dollars for a mid-sized hospital. Much of the spending will be in "people's time, energy and effort," Mr. Haeberle says.
4. ACOs require new work patterns. "Healthcare is highly structured. It relies on protocols and methods to deliver care," Mr. Haeberle says. "Employees do the same thing over and over again and do it well. So when you say, let's do something different, it's challenging." The assumption is that employees are going to gravitate to the new systems, but first they are going to fight it.
5. An ACO is like a merger. Mergers bring together two different employee cultures, which is often a very difficult challenge, says Mr. Haeberle, who has been involved in many mergers. Imagine the challenges faced by an ACO, which can bring together many different organizations. Although the ACO is looser-knit than a fully integrated organization, people from each component will need to work closely together to achieve the expected efficiencies.
6. Start talking to employees early. Hospitals need to start getting employees ready for ACOs because it takes months to change a work culture. Successful implementation of EHR systems, for example, takes 12-18 months. Mr. Haeberle says employees facing a new initiative tend to go through stages very much akin to the five stages of dying: denial, anger, bargaining, depression and acceptance.
7. Get employees used to changes. ACOs can benefit from the lessons learned in successful transitions to new computer systems. "If the hospital says, we're going to bring in computers and simply distributes them one day, there will be a backlash of irritableness and negativity," Mr. Haeberle says. Instead, "bring in 10 new models in advance, put them in a room. Let people visit the room, look at the computers and use them. Then introduce the computers to the organization in phased stages."
8. Clarify where savings would go. A principle goal of ACOs is to produce savings that will be shared by each component organization. Management needs to tell employees, "If we achieve our goal, here is what we’re going to do with the extra money," Mr. Haeberle says. Employees do not necessarily expect the money to go into their paychecks, but they would like to see it to go toward some improvement, such as buying better equipment.
Learn more about Integrated Healthcare Strategies.
1. ACOs involve a basic change in mindset. In an ACO, employees need to start looking at their jobs differently. For example, "right now they want to keep patients in the hospital, but with ACOs they want get them out," Mr. Haeberle says. Employees may also have to take on new tasks, such as proactively reaching out to patients in their homes. "You have to deal with a fundamental change in the process," he says. The HMO era of the 1990s also required a fundamental change in thinking, and many hospitals didn't make the transition.
2. Planning usually ignores the people side. When hospital leadership plan for a new initiative of any kind, they usually don't sufficiently think through its effect on employees. "The workplace culture will change, and there will have to be protocols in place to guide employees through it," Mr. Haeberle says. Not paying attention to these challenges is a key reason why five years out, many once-promising initiatives falter.
3. Changing the culture will require spending. Getting people ready for a major change in the culture, such as introducing a new EHR system, requires significant spending to train employees and plan and phase in new strategies. The cost of getting employees ready for an ACO could be in the millions of dollars for a mid-sized hospital. Much of the spending will be in "people's time, energy and effort," Mr. Haeberle says.
4. ACOs require new work patterns. "Healthcare is highly structured. It relies on protocols and methods to deliver care," Mr. Haeberle says. "Employees do the same thing over and over again and do it well. So when you say, let's do something different, it's challenging." The assumption is that employees are going to gravitate to the new systems, but first they are going to fight it.
5. An ACO is like a merger. Mergers bring together two different employee cultures, which is often a very difficult challenge, says Mr. Haeberle, who has been involved in many mergers. Imagine the challenges faced by an ACO, which can bring together many different organizations. Although the ACO is looser-knit than a fully integrated organization, people from each component will need to work closely together to achieve the expected efficiencies.
6. Start talking to employees early. Hospitals need to start getting employees ready for ACOs because it takes months to change a work culture. Successful implementation of EHR systems, for example, takes 12-18 months. Mr. Haeberle says employees facing a new initiative tend to go through stages very much akin to the five stages of dying: denial, anger, bargaining, depression and acceptance.
7. Get employees used to changes. ACOs can benefit from the lessons learned in successful transitions to new computer systems. "If the hospital says, we're going to bring in computers and simply distributes them one day, there will be a backlash of irritableness and negativity," Mr. Haeberle says. Instead, "bring in 10 new models in advance, put them in a room. Let people visit the room, look at the computers and use them. Then introduce the computers to the organization in phased stages."
8. Clarify where savings would go. A principle goal of ACOs is to produce savings that will be shared by each component organization. Management needs to tell employees, "If we achieve our goal, here is what we’re going to do with the extra money," Mr. Haeberle says. Employees do not necessarily expect the money to go into their paychecks, but they would like to see it to go toward some improvement, such as buying better equipment.
Learn more about Integrated Healthcare Strategies.