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Managing performance improvements in a hospital full of patients can seem daunting, but it's a skill that can be learned. You will make mistakes, but the secret is to learn from them and correct how you implement changes. As we have seen from the experiences of Virginia Mason Medical Center, Cleveland Clinic, Mayo Clinic, and Memorial Hermann, it can take years to transform a culture. You can't do it overnight, but you can do it over time. Deming would say, "Maintain constancy of purpose."

I think we can agree that even the best of changes meet resistance during implementation and sometimes fade away within a few months. The reasons for these failures are varied, but often it's a simple lack of change management.


On the surface, change management is pretty simple. There are three stages of change:

  1. Current state. Where are we now?

  2. Transition. How do we get from current state to desired state? How do we make sure that we align strategy, process, organization (i.e., people) and technology to get to the desired state?

  3. Future state. Where do we want to get to? What will it look, sound and feel like when we have achieved our goals?

It doesn't matter if the change involves implementing Lean Six Sigma or some other change, getting from here to there is never a straight line.

Ask yourself: "What percentage of results depend on people changing how they work?" If you're implementing a medical records system in a hospital, the answer is probably 90 percent. If you are changing an information system to prevent a certain kind of input error, the answer might only be 5 percent. The more the change depends on people, the more thought needs to be given to the care and feeding of the change. Everything depends on how the culture accepts, adopts or adapts the change. It doesn't matter how great a change might be, if the culture doesn't accept it, it is doomed.


While it would be impossible to discuss cultural transformation and change management fully, here are a few key insights on how to proceed:

  1. Plan. Engage the stakeholders. Identify the sponsor, champion, and process owner.

  2. Inspire. Paint a convincing picture of how the change will be beneficial for everyone—patients, families, clinicians, payers, etc.

  3. Launch. Initiate the change. Engage the stakeholders.

  4. Support. Sustain the improvement.


First, identify the stakeholders and their readiness to implement the change using the QI Macros Stakeholder diagram (Figure 12.1). I have found that successful implementation of change requires three levels of support: sponsor, champion, and process owner (Figure 12.2).


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