Excerpt  from   “Stewardship:The Noblest Form of Leadership – Part II,”  Compass Clinical Consulting Profile in Healthcare Leadership Interview with University of Virginia Medical Center Chief Executive Officer, R. Edward Howell, by Cary Gutbezahl, MD.

Dr. Cary Gutbezahl (CCC):  Change can lead to chaos. One of the things that may hold some healthcare leaders back from getting started is not knowing where that chaos departure point is. Where chaos might lead to despair and people will try to go back to the way they were doing things prior to the change.

R. Edward Howell (REH):  I think that what holds a lot of leaders back is another element that I call the journey through hell. Others have different terms for it, but every change looks like a mistake in the middle of the change. You can graph it. There’s the point where you embark on the change journey.

The second point is that you have to get early adopters. Then what happens when you embark on the change and go into this valley—feedback valley—and you find out everything you’ve done is bad?

What too many leaders do when they get negative feedback is that they fail to follow through on the change they initiated. They go back to doing things the way they were doing them. They never give change a chance to work. Not every change is going to work, but leaders have to recognize the possibility of failure.

 There is a concept in leadership of courage, and accepting the possibility of failure is a necessary courage of leadership. What we need to do is go through the valley of hell and get to the other side to see if what we have done works. Has it achieved the results that were needed?  Do we need to make modifications? Or, worst case, go back to what we were doing?

What I’ve observed all too often is that in the middle of the valley of hell, organizations want to go back to the good old days. It almost takes on a spiritual nature of the good old days, but almost never were the good old days ever that good.

MAKING REAL CHANGE HAPPEN – ELECTRONIC MEDICAL RECORDS

REH:  We undertook a different kind of change here in the last year—implementation of electronic medical records (EMRs). I know a lot of other organizations are going to have to go through implementations of EMRs.

We had previously attempted to implement—unsuccessfully—EMRs. We reconfigured our attempts, took a new direction and went with a fully integrated EMR—inpatient, outpatient, 147 different clinics and 68 different sites.

How did we do this? We got together and discussed what we wanted to do and what the ramifications might be, going back to the change and turbulence we talked about earlier. When you put in a new screen and look at the information about your patient, you create turbulence.

We discussed two possible scenarios:

1.   Flip a switch and change all of our clinics in one day.

2.   Flip the switch over time and change all of our inpatient units so we could fully convert inpatient and outpatient within a five-month time period.

We knew the minute we flipped that switch that the leadership would be in the valley of despair.

We knew turbulence and discord would reign, but we were committed to get through it. Recognizing that you will create turbulence and discord is a part of true change-agent leadership. I use the biblical analogy of the parting of the Red Sea. I’m sure that somewhere in the trek across the Red Sea there were some folks that thought, “this just isn’t working out.” But Moses didn’t take them back.

You have to give change a chance.

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DOWNLOAD “Stewardship:The Noblest Form of Leadership – Part II,”  Compass Clinical Consulting Profile in Healthcare Leadership with University of Virginia Medical Center Chief Executive Officer, R. Edward Howell.