Leading Change from the "Insight Out"

In the interest of complying with JCAHO’s mandate for training and support on disruptive behavior, some institutions have used short web-based training or quick lectures on what constitutes disruptive behavior. Certainly this is an important first step, perhaps even enough to “check off” JCAHO’s training requirement, but is that good enough? Results from our September reader’s poll would indicate that it is probably not. Just 5% of respondents indicated that they didn’t know what the standard was for determining disruptive behavior, and another 10% said they weren’t sure how to report it.

Still, education is important because it allows us to draw a line in the sand (see the September 24 blog post) and clear up any confusion caused by the fact that disruptive behavior has become an accepted aspect of working in healthcare (the survey found that 25% of respondents said disruptive behavior was a tolerated part of the landscape, and 60% said that past reports were not acted on).

It follows then that education is just the start. In fact if education was all it took to change behavior, smokers wouldn’t smoke, we would all get 8 hours of sleep each night, and stop to smell the roses each day. Besides, you don’t go to your doctor just to get a diagnosis; you go to get a cure. In addition to telling people that there is a problem, there needs to be a time of equipping to solve that problem. But change, particularly behavioral change in healthcare doesn’t come easy.

In 2003, Deone Zell from Cal State Northridge wrote an interesting article in the Journal of Applied Behavioral Science. In it, Zell likens change in hospitals and high educational institutions to Elisabeth Kubler-Ross’5 stages of death and dying (denial, anger, bargaining, depression and acceptance). Both have an unusual bureaucratic, and highly distributed power structures. Professors and doctors are essentially individual contributors, yet they hold a great deal of power because their work brings grant money to the university, or patient volume to the hospital. Thus, they have a disproportionate ability to influence how and when things change.

They key to accelerating your way through these five stages, is to lead change from the insight out. Dr Rosenstein and I have collaborated with Eagle's Flight’s enormously creative CEO to create some fascinating ways to do this. More to come on this topic in our next edition.

In the meantime, please share your comments and insights on disruptive behavior below. The more we understand the how’s and why, the more we can integrate those understandings into our solutions.

Zell, Deone, (March, 2003), Organizational change as a process of death, dying, and rebirth
The Journal of Applied Behavioral Science; pg. 73