Rae Woods (00:10): From Advisory board, we are bringing you a Radio Advisory, your weekly download on how to untangle health care's most pressing challenges. My name is Rachel Woods. You can call me Rae. In healthcare, we talk about change management a lot. We talk about this kind of conceptual idea that through careful stewardship, we can make the process of change a little bit easier. And that's true whether you're talking about an entire shift in strategy or maybe implementing a specific new solution. But change, true structural, foundational change is hard. (00:47): It's not impossible, but I also know it's a lot easier to talk about change than to actually do it well. That's why we're going to be focused on the idea of getting better at change, specifically when it comes to digital strategies and integration of new digital tools. There are so many new technologies coming out every day, and I know that many feel behind or maybe are feeling pressured to innovate, innovate, innovate, and as organizations add more digital tools to their arsenal, leaders will have to guide their staff through that change. That's why I've invited John League to this episode of Radio Advisory. He's the managing director of Advisory Board's Digital Health Research. Hello again, John. Welcome to Radio Advisory. John League (01:34): Hi, Rae. Rae Woods (01:35): I want to admit to you that, gosh, I've been kind of stocking some of the things that you've been writing. You are one of the smartest people that I know, and I noticed you put some commentary out on LinkedIn. I'm actually going to pull it up really quickly. You wrote that, "Change management as a term is a distraction at best and a hindrance at worst for the actual work of managing change." Pretty bold statement, my friend. Got to ask, what motivated you to not just kind of have this realization, but put this out there in the market and say, "Hey, we're getting change management wrong." John League (02:25): Well, first I would say, Rae, if I'm one of the smartest people you know, you need more friends. But the other element there is we've reached a point where we're not going to have less digital whatever in healthcare in the future. We'll only have more. And so as we think about what does that mean for how organizations spend their money, how they spend their time, how they orient their people, we've got a big hurdle to get over here, a series of hurdles to get over here. And one of the things that I always see is this term "change management" thrown around almost like a band-aid. Rae Woods (03:13): Yeah. John League (03:13): We're going to use change management to fill in the spaces that we haven't actually fixed with our processes or our alignment around what problem does this actually solve. And we talk about it in a way that is deceptive. I think it's a bait and switch. I think we just assume, "Oh, we'll just have some change management." Right? Rae Woods (03:35): Yeah, and I might even throw consultants under the bus for a second. Of course, I'm not talking about us as healthcare consultants. John League (03:43): No, no, no. Rae Woods (03:43): But many, many times in our careers, I'm sure you and I have seen the same thing, which is a slide that you put in front of a client that talks about all of the different points of inflection when you're doing a project. In the case of your work, John, as you said, you're talking about digital infrastructure, but we all have seen this slide where there's all these different points on a timeline and then there's a bracket at the bottom and what does that bracket say? Change management. Change management is the thing that happens. And it's a throw away term as opposed to your point being something that's maybe more meaningful, maybe something that's real. John League (04:23): Yeah, because usually what people are actually talking about when they say change management is they're talking about change mitigation or change containment. Let's not let the change get out. Let's not let it be more disruptive than it has to be. And I understand that, and that is absolutely essential when we're trying usually to build the plane while we're flying, especially in healthcare, especially as we introduce more digital tools and digital ways of interacting. But I think we discount the actual problem we're facing when we talk about, "What is it that we're trying to change?" Rae Woods (04:59): Yeah. You just said a phrase that really perked my ears. You just said that there's this kind of fear of making the change more disruptive than it's going to be. And let's be honest, one of the most disruptive things we ask health leaders to do is change their technology. And I don't even necessarily mean launching a new EMR. We've all lived through tech changes that make our calendars more complicated, make our lives more difficult. Would you say that change management is by definition harder when we're talking about digital strategy? John League (05:37): That's a great question because what I want to say is, "No, of course not. It's exactly the same." And in many ways it is. Rae Woods (05:45): As if you were doing compensation changes or anything else. John League (05:48): But at the same time, we have to get our heads around the fact that often we think technology, just because we have it, is going to solve a problem. And we ignore the other elements around people around process, and then the technology. Those go in an order when we talk about them, not just because it's alphabetical and very conventional that way, but because it has to start with the people. And usually we get that backwards. We start with the technology, and so now we're going to change the process and then whatever is left over, that's the responsibility of the people. And what that completely ignores is all of the stuff that can't be just solved with a process or a new implementation. Rae Woods (06:35): So what I'm hearing you say is that folks are starting with the wrong goal or the wrong problem in mind. Why else are organizations getting digital change management so wrong? So wrong that, John, you decided, "I'm going to write down all my feelings and publish this thing on LinkedIn," which by the way, we'll add your post to the show notes, John. John League (06:56): I think one of the things that's so challenging here, Rae, is the ways that organizations deal with this, and it is often centered around, "We will hire a consultant," or, "We will rely on our vendor to take care of this." Rae Woods (07:12): Yeah. John League (07:13): And usually what that means, even if the vendor can come in with some sort of change management solution, what the buyer really wants them to do is implement a process that will go around the middle managers, that will go around the people who are actually responsible for the end users and try to short circuit whatever sort of necessary change is true. And if I say that, and there are folks listening who are like, "Oh, I don't do that, that's not what happens at all." I would challenge you to ask your vendor how often that happens. Rae Woods (07:43): Yeah, yeah. John League (07:44): And I promise you they say it's true. Rae Woods (07:46): So there's a change avoidance that we need to kind of push back on because let's be honest, we are talking about implementing a change. Digital transformation is no small task. Another kind of thing that comes to mind for me that I'm just remembering some of the smart things that you have told me before, John, starting with the right problem, not being distracted by a shiny object, what kinds of challenges do you see in the market when it comes to that starting point that organizations have? John League (08:21): I think part of the problem, Rae, is that a lot of organizations start either too broad or too narrow. And by what I mean too broad, they start with, "Hey, let's get some AI." Rae Woods (08:32): Yeah, yeah, yeah. You've told me that before. John League (08:36): Or, "Hey, if we had a CRM that could do these things, that it would all be fine." Rae Woods (08:40): Or, "You know what would solve this? Is a chatbot." John League (08:42): Right. "Let's just buy a thing and we will spread it across all of our problems and just sort of cover it up like Spackle." The other way that manifests though is thinking about it too narrowly in that we atomize processes, we atomize transactions, and we only focus on automating one teeny tiny piece of what is actually a very long workflow or process to get something done. And what we wind up doing is we just move the problem to the next choke point that we haven't automated. Rae Woods (09:18): I completely understand why getting the starting point right is essential. And when I say starting point, what I'm hearing you say, John, is that we've got to have the right problem and we've got to be willing to embrace that change management is going to be a part of the way we roll this out as opposed to something that we throw off to the side or give to back to the vendor or give to that consultant. When it comes to implementation, what else are organizations getting wrong? John League (09:49): Rae, I have some thoughts here, but can I phone a friend? Rae Woods (09:55): Sure. John League (09:56): I spend a lot of time researching this. Let's bring in somebody who actually spends a lot of time working directly with organizations to do these implementations and get over those hurdles. Rae Woods (10:09): Who should we call? John League (10:10): Let's call my friend Matt Matousek. Rae Woods (10:16): Matt, welcome to Radio Advisory. Matt Matousek (10:17): Hey Rae. Rae Woods (10:20): Matt, you lead digital transformation at Optum Advisory, so that means that you work at the hip with healthcare organizations every day, right? Helping them to design and ultimately implement their digital strategy. I've been talking with our good friend, John, about the concept and importance of change management. I actually don't want to lead the witness here. Matt, from your experience working with healthcare executives, how essential, how important is change management on the path to digital transformation? Matt Matousek (10:55): It's vital across the board. It's probably understated that it's vital. I know John, and I know John's point of view on some of this. I've read his LinkedIn posts. Rae Woods (11:06): He's pretty vocal about his- Matt Matousek (11:07): He's very vocal about it. The cultural piece of change management is super important. I think I read a stat that, through McKinsey, that 90% of large organizations go through some sort of technical or digital change or the last five years, something like that, and they often fail. They don't meet the expectations of value or cost savings. The reason why they are failing is the misalignment between the technology business, the technology leaders and the business leaders. Rae Woods (11:41): And I might say the technology leaders, the business leaders and the people leaders. Matt Matousek (11:45): Correct. I think it starts with what's the goal of the organization. Rae Woods (11:48): Yeah. Matt Matousek (11:49): What's the problem that you're trying to solve? That's super important. And that sometimes comes from technology, sometimes comes from business, but oftentimes not aligned. Their MBOs are different, their strategies are different, and if they're not aligned and not aligned at the top, failure is imminent. Rae Woods (12:08): Why is it so important? I hear you saying that getting the change right is essential, right? You said failure is imminent if we don't get this right. But my question is why is this so important now? I'm thinking that we could have had this conversation five years ago. We probably could have had this conversation 5 years ago and talked about the importance of managing change across digital transformation. Is it just as important today as it was 10 years ago or is there a reason why this should be a bigger focus for our listeners today? Matt Matousek (12:41): Well, if you think about the types of change that are happening technologically, a lot of it creates, I would say, uncertainty into a job force regarding the technology that's coming is replacing a lot of workforce, human workforce. Jobs that typically have been done, keystroke types of jobs that have been done by human beings are now being transitioned to AI and automation. And so organizations are in a unique situation where they have to think about skill training, up skilling and leveraging humans in a different way while being efficient and proficient and effective in the implementation of their technology to drive out the costs and reinvest into whatever their product or service might be. (13:34): In our space, it's healthcare, so it's serving people, caring for people. And as we think about healthcare as a whole, it's always been people-to-people kind of industry. It's always about caring for others. And the best connection is through people. So I just think about how difficult it must be for some organizations to think about that they have all these people that are aligned to a mission of caring for other people, whether it's a back office person or a frontline care worker, their mission is to help people. Rae Woods (14:10): And that can sometimes come in conflict or create some fear around technology. I spend a lot of my time working with physicians, and I'll say I still hear a lot of fear around AI, in particular gen AI in particular. I do hear much, much more excitement, much more willingness to embrace new technologies. And you make a good point, Matt, that we're really in the early stages of innovation here. Friend of the pod, Tom Lowry, a former head of AI for Microsoft, has talked about this hockey stick moment that we're in right now when it comes to generative AI changing so, so, so quickly. So it makes sense why this is perhaps more important today than it's ever been. (15:47): John, you're still on the line. John League (15:49): Hello. Rae Woods (15:50): You asked to phone Matt to help answer not just why our organization's getting this wrong, but what do they need to do to get digital transformation right? And more specifically the role that change management plays in this. John, Matt, is anyone actually doing this well right now? John League (16:13): From our perspective, and you've actually had these folks on the pod Rae, I think Duke Health does a really good job with this in terms of thinking about, "What are all of the factors that we need to account for?" If you listen to that conversation, you can see how very deliberately they have focused on both, "Whose perspective do we need about the problems we're trying to solve?" And once we've figured that out, we've done all of our obligatory model development and testing and deployment thinking about what is the impact on the frontline worker, on the end user like Matt was talking about, and how do we communicate that to them? How do we both upskill and set expectations correctly for that? I think those are things that we often overlook as part of the bigger process that not only makes the folks who are using the technology willing to adopt, but also gives that flywheel another turn. But what I mean by that is we get them to use it so that we can then evaluate it and improve it over time. Rae Woods (17:26): Yes, yes. John League (17:26): If we do all of this implementation and we don't take account of the folks who are actually using it and the perspective of their adoption and what they're struggling with, we're never going to get to make the geometric improvement that I think we're all hoping is possible with digital and especially with AI. Rae Woods (17:44): Because change is not a one-time thing. It is not, "We are launching a new EMR and then we're done." It is something that is going to be constantly changing and evolving. The Duke example is an interesting one to bring up because if I remember correctly from my conversation with them, they started this a very, very long time ago, years ago. Matt, is anyone impressing you that has kind of come to digital transformation more recently? Matt Matousek (18:15): So Optum Health came to us and said, "Hey, we recognize that change in terms of technology with AI is inevitable for us to drive costs out of the business, enhance value-based care opportunities, improve outcomes," all of those things. They recognize that traditional change management methods are threefold. One, it's too slow, it's too costly, and it fails to prevent for future change. Rae Woods (18:46): Okay. Matt Matousek (18:47): We know that technology, we know that technology is evolving so fast you can't keep up with Yes, you barely keep up with it. Rae Woods (18:53): And frankly, technology can do so much today. It's hard to know what a particular platform vendor cannot do, right? Matt Matousek (19:02): Exactly. And traditional platforms, right? Traditional platforms have been a mainstay in their current state. Yeah, there's product improvements along the way, but for the most part it's a gradual improvement of a product because there hasn't been such a monumental shift in the types of technology that are advancing the applications, the systems, the platforms at the rate that AI is coming in LLM, machine learning, and it's remarkable how fast it's coming. So Optum Health came to us and said, "Hey, how do I build a resilient culture, readiness for change and adapting for change ongoing beyond just a point in time?" Really driving to a growth mindset as opposed to a stagnant mindset or a fixed mindset." (19:48): "And then how do we prepare for adaptable processes and systems to execute against that?" And so basically what they asked us to do is to come in and do an assessment and help them understand what we call the kind of five pillars of importance for change in our culture, process, skills and training, systems and value orientation. And what we do is go in and we survey many of the workforce and leaders to understand where they are today so that we can create a next best action for them to prepare for the success, communicate what that success is going to be, get alignment at the top, change the culture before the change has to actually happen technically. Rae Woods (20:44): Oh, interesting. Matt Matousek (20:44): Having a way to communicate that in a very tenored sort of way, cadence sort of way. John League (20:51): And I would offer that the advantage of that to what you just described, Matt, sort of obviates the need for change management at all. Because if what we are setting ourselves up to do is adapt and make the necessary changes as we go, change becomes what we do and not something that is imposed on us. Rae Woods (21:12): Wait, wait. I want to say that again. This is why I started off this conversation by saying you're one of the smartest people I know, John. You said that change is... John League (21:20): Change is something that we do instead of something that's imposed on us. Rae Woods (21:23): Imposed on us, yes. John League (21:25): Our orientation to it is better and our expectations for what it looks like, what it feels like and what needs to happen are much more open to all of the pressures and dealing with the pressures that we're going to have to face, especially in healthcare. Rae Woods (21:41): Matt, I want to admit to you that in my conversation with John before we called you, we kind of ragged on some consultants who kind of put change management off to the side, which to be clear seems to be the very opposite approach to what you have done. My question is, did it work? Matt Matousek (22:03): Yeah. So first of all, now I know why I'm not the smartest guy you know. I'm probably the top 10, I have the consultant tag next to me. So thanks John, really appreciate that success. This was a new and kind assessment. We built a wonderful roadmap for them, which then is now helping us as an organization. We're here to help people make these changes, not just give them ideas, but help make those changes. So we've been asked to help execute this change assessment in bringing into reality. So from that lens, it's an absolute success. The senior management has loved this and has now asked us to do more assessments across other parts of the business. Rae Woods (22:48): Is this kind of transformation that we're talking about only possible if organizations have significant plans to be digital first or are there frankly just smaller ways that organizations can benefit from digital transformation or benefit from smaller wins in nudging their people along? Matt Matousek (23:09): So I'll probably get on soapbox here a little bit. Rae Woods (23:11): We love soapboxes on Radio Advisory. Matt Matousek (23:13): You mentioned the word digital first. Rae Woods (23:16): Mm-hmm. Matt Matousek (23:17): So that's like nails on a chalkboard. We don't think about it that way. How we think about it is a no service impact transformation, knowing that the technology is so advanced that the technology can a lot of times solve the problems that consumers need to have solved on behalf of a business. So when you think about digital first, oftentimes it's, "Hey, I got a problem. I'm going to go to a website or I going to make a phone call and let's get in and have some sort of interaction there." We actually think that that's the third lens in which you solve problems for consumers, patients, administrators, or whatever. It's a no service impact. (23:58): Be proactive in your solving of the problem with technology. Then it's a digital only lens. Let the digital application, service system and engagement with that consumer, that patient, that administrator, that interaction happen, and then it's digital first, meaning digital is one of channels that can help you solve that problem, but it may not be the only channel. So this is my soapbox. In healthcare problems become very, very difficult, too complex for, maybe, a technology to solve. So you need that interpersonal interaction with maybe a pharmacist or a doctor or a help desk. And so digital first is that first thing to help obviate understanding and solve a problem, but we also know that there's others there to help it along the way. If there's more complexity. Rae Woods (24:51): And I think, Matt, you're actually centering on John's key thesis, which is you have to start with the right problem in mind and starting with digital, to your point, Matt, is perhaps not always the first step that we should go at. And if that's the case, if we're looking at starting with real problems or real opportunities, then we can apply this framework that you've discussed to folks who have very, very big goals or folks who are looking for more kind of specific nuanced solutions. Matt Matousek (25:23): Yeah. To sum that up. It's really like proactive solving, simple engagement, savvy solutions at your fingertips, and then smart help, know where you are, whatever channel you come through for that help. Rae Woods (25:40): Matt, John, I want you to give a takeaway for our listeners. What is a lesson that they should take away or an action item that they can take back to their organizations to get better digital transformation and better change management in general? Matt Matousek (26:09): I think leaders really need to dig deep to understand where they are in their continuum of readiness for change. And that takes some serious soul-searching. People get stuck in their morals, in their systems about how they're winning today. They need to think about how they're going to be winning in the future, and that's an uncomfortable conversation now that has to happen. Rae Woods (26:34): Yeah. Matt Matousek (26:34): And so I think that's the biggest takeaway for me. John League (26:38): I think the biggest takeaway for me is to really connect change we're trying to bring about the purpose of our organization. When we think about following a shiny object or when we think about going digital first without doing that sort of soul-searching that Matt has been talking about, what we wind up with is change just because. When we think about the way that the needs of healthcare organizations are changing, when we think about the way that some of their purposes are changing as they look at different ways to orient to the community, how do you connect the change that we're trying to make, whether that's digital or otherwise, with the purpose that the organization is trying to serve. I think that's one of the biggest things that is probably missing from most of the really well-intentioned changes and implementations that are going on right now in healthcare. Matt Matousek (27:38): One thing I wanted to add real quick is our process that we talked about today. John League (27:42): Sure. Matt Matousek (27:42): We call our approach digital for MLO. It's that first touch with any sort of consumer engagement at all. We think about that process from that very first moment. If anybody would like to get ahold of me, Rae, if you could put a link in the pod, that would be fantastic, and I would love to chat with anybody that has any questions. Rae Woods (28:03): I am happy to do that for you, Matt, because I think this conversation officially cements you as one of the people on my really smart folks list. And John, keep the hot takes coming and we will talk to you next week. Matt Matousek (28:17): Thanks, Rae. John League (28:19): Of course. Thanks, Rae. Rae Woods (28:27): Getting digital transformation right is incredibly hard. I think you actually know that. What I want you to take away from this conversation is don't make it harder on yourself by getting the change of it all wrong and make sure you are leaning in headfirst into precisely why this is going to be hard for your people, for your business, and for your patients. Because it's only then that we can really embrace what technology can do for us. And remember, as always, we are here to help. (29:22): New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. We'll see you next week again with our friend John League.