The Secrets of a Change Agent

   When I first heard the term change agent, it sounded like one of those new-age business terms people invent to sell books. Looking for a functional definition, I went to answers.com and found that a change agent is an event, organization, thing or, more usually, a person that acts as a catalyst for change. In business terms, a change agent is a person chosen to bring about organizational change.

   Change processes have the potential to become major milestones in an organization's history. Think about your own agency--you may have seen changes that were clinical (introduction of 12-lead EKGs), operational (system status management), service-based or other. Due to the dynamic environments surrounding EMS systems, many find themselves in nearly continuous states of change. The scope of this change reaches from smaller projects to corporation-wide transformations.

   So how do you go about becoming a change agent in your EMS world? Here are some ways:

• You can be a change agent by reading the trade and academic journals to see what clinical best practices other systems are implementing and taking those to your medical director or medical advisory board for implementation.
• You can be a change agent by taking the time to attend EMS conferences and listen to what speakers tell you about management techniques.
• You can be a change agent by focusing on coalition building. Identify and involve leaders, experts, decision makers and other important persons from all levels of your EMS agency (field, supervisory, management and executive) as early as possible in any change process. It is this element--getting the involvement of others--that serves as the foundation for any change.

Getting Community Buy-In

   As change agents have the potential to deal with initiatives of all shapes and sizes, they need an ability to get all affected people involved, to ensure their support and commitment. This requires a high level of job competency as the basis for acceptance, as well as "soft" skills, or emotional intelligence. It also includes the ability to communicate, and to understand and take into account the opinions and doubts of others.

   Change projects involve a great variety of factors and forces. These include the existing state of the EMS agency, and the values, beliefs and routines of the people there. Many change projects can challenge their organizations' cultural frameworks and status quo. This can lead to resistance and denial.

   Employees affected by a change initiative must not feel like they are just tools for change or the subject of change. It is not enough to have a convincing vision--real commitment can only be gained by giving people the chance to become actively involved and contribute their own experiences. Every employee needs to know that his contribution to the project is important and valued. In this way, people develop a sense of ownership for the project, which in turn may serve as a source of motivation when it comes to the inevitable problems.

   Change is not always going to be easy to bring to your EMS agency. One of the largest hurdles you will have to tackle is employee--and perhaps in some cases management--resistance. Change usually brings about the "10/80/10" rule: 10% of employees will actively embrace the change, 80% will be fence-sitters, and 10% will actively fight it. Your job is to recognize and understand this. The 10% against the change can influence and negatively impact the 80%. Focus your efforts on influencing the negative 10%--they are the threat to change.

   It is human nature to view change as either an opportunity or a danger. People thus respond to change on multiple levels--personally, professionally, socially, organizationally, etc. By understanding these concepts as well as your own EMS agency (what change it's seen in the past, how that change has been implemented, what social dynamics are at play), your effectiveness as a change agent will increase multifold.

   You don't have to be appointed or elected to a position of responsibility to be a change agent for your EMS system. Anybody can be a change agent--what are you waiting for?

Ask Questions

   A tremendously important action of an effective change agent is questioning the organization. I don't mean questioning in an antagonistic manner, but rather that all elements of the EMS agency--even those traditionally thought to be off limits--should be scrutinized to evaluate facts from different perspectives.

Raphael M. Barishansky, MPH, is director of EMS for the Connecticut Department of Public Health. A frequent contributor to and editorial advisory board member for EMS World, he can be reached at rbarishansky@gmail.com.