Karen DeViller had a challenge. A site director at the Edmonton, Alberta-based East Edmonton Health Centre, she had been asked to lead a team that would launch a decentralized refugee health program to meet the needs of a complex population. The request came with support from executives in the Alberta Health System, but it also came with lots of stakeholders to coordinate and no funding.
Healthcare providers are constantly trying to keep up with changes coming from all sides; policymakers, health system executives, and payers mandate new ways of working all the time. Often, executives and C-suite leaders ask teams to change direction without presenting a clear vision for what lies ahead. This never-ending struggle results in increasingly high levels of burnout among healthcare teams and team leaders.
Taking a step back, we know that staff in the caring professions are intrinsically motivated to do better for the people they serve. But how can leaders unlock their overworked teams’ potential? By learning unique leadership skills that will allow them to capture the hearts and minds of the people around them. By leading and organizing for change.
Every time I teach Leadership and Organizing for Change, I see powerful new examples of how leaders can make a difference by tapping into their teams’ deepest values. I see leaders like DeViller, who worked with her to team to use existing resources to redesign services. Her team viewed what they had as assets, employing four strategies from the course:
- Tap into our own motivations for change. In the community organizing practice taught by Marshall Ganz at the Harvard Kennedy School, he says that it’s important to tell your story of why change matters to you. As I noted last year in a blog post for the Institute for Healthcare Improvement about seven principles for leading change from the bottom up, stories connect people to the values underlying the work. Said a different way, stories help to motivate others. In this case, DeViller and her team shared their families’ stories of immigrating to Canada, which also connected them to the experiences of the refugees they serve. Sharing those personal experiences became a much more effective motivational tactic than relaying a new mandate from the C-suite.
- Grow our power through our relationships. In organizing, we don’t teach leaders to ask, “What is my issue?” Instead, we encourage them to ask, “Who are my people?” In other words, get to know your people, who they are, what they value, and what hidden assets they bring. In Edmonton, a core group of constituencies came together to create the Refugee Health Coalition, including representatives from departments across Alberta Health Services, local primary care networks, and various community health agencies that work with the federally contracted refugee resettlement agency. DeViller and the larger team held one-on-one meetings with “their people” to explore their motivations for health justice and elicit stories about what matters around the delivery of high-quality and culturally competent care. This built will for the project because it connected to people’s hearts and invited them to co-create the strategy.
- Develop shared purpose. Once leaders have recruited a team, they should kick off their first meeting by co-producing a shared purpose statement. Clarifying the compelling and consequential nature of their work together transforms their own interests into a desire to serve the common good. DeViller’s team collaboratively developed this statement: “Our team is motivated by the fact that many of our own families are immigrants or refugees, and we understand the importance of supporting this very vulnerable population.”
- Take action quickly to build momentum—and to learn. People are motivated by seeing results quickly. In quality improvement, this concept is captured in the Plan-Do-Study-Act cycle. In the refugee project, the team members reached some early milestones by negotiating changes to the funding contract between the healthcare service provider and the refugee resettlement agency. They tapped into existing resources that partner organizations brought to the table, recruiting a few primary care physicians to accept new refugee patients, and created a new process for screening and intake of new refugee families. Subsequently, those patients could receive care at an ambulatory care center in East Edmonton that houses multiple health services under one roof. The team still has more to do in this area, including formalizing processes through training and the development of a program manual that will clarify the various roles and responsibilities of each of the partners, but they didn’t make patients wait until everything was perfect to receive services.
What have DeViller and the team learned so far? They continue to face challenges, but they’ve learned the value of telling their own stories, meeting one-on-one with key stakeholders to get buy-in, and forming a core team. Initially, the team worked with partners who were interested in supporting the initiative. Now, it focuses on the right person or agency for this work. Building relationships takes time but is critical to the team achieving its vision of creating a service that embraces equity and improves patient outcomes.
The challenges healthcare leaders and teams face are complex. New requests will come down today, tomorrow, and the day after that. But learning and practicing this unique set of leadership and organizing skills can make change possible, meaningful, and even joyful.
Kate Hilton, J.D., faculty, Leadership and Organizing for Change Course, Institute for Healthcare Improvement