The lit review on the results on hospital transformation projects revives an equal number of failures per each reported success. Why is it so hard? Why the healthcare is so resistant to the conventional industry business transformation approaches and change management frameworks that work just fine in aviation, exploration and other similar high-risk fields?
The 2009 Canadian study at St. Michael’s Hospital in Toronto reports 83.1% decrease in emergent volumes waiting for greater than 24 hours and a 49.1% improvement in length of stay for admitted patients as a result of optimizing patient flow based on the learning organization principles, change management and quality improvement activities. Study highlights an essential role of collaborative governance council comprising medical, administrative and clinical leadership. The project was implemented without external consultants.
The 2011 Kaiser Permanente study links their assessment results of high perfuming teams with the double-loop learning (both ways, top-down and bottom-up) phenomena in social networks. Instead of investing heavily in technology, they concentrate on using Communities of Practice to support informal knowledge sharing between staff, managers and physicians across sites.
The 2012 Swedish study on lean implementation in Stockholm Children’s Hospital reports staff’s frustration with the numerous modifications to the care process and resulted uncertainty about how work should be carried out. Authors conclude that lean’s applicability in healthcare may be challenged without sufficient inter-professional collaboration and professional development support.
In another Canadian study published in 2013, participants attributed success of the General Internal Medicine Care Transformation initiative in University of Alberta Hospital (reducing LOS by 20%) to improved teamwork and collaboration facilitated by the daily rapid multidisciplinary rounds for discharge planning.
Despite differences in specialties, sizes, geography and national healthcare policies, all studies remarkably consistent with identifying inter and intra professional collaboration across sites as a key to success. The “People, Technology, Processes” mantra does work in healthcare only with the first and foremost emphasis on the People part of equation. As 2011 Dutch study pinpointed, healthcare requires intensive wide-range interactions within and across departments, organizations and care sites which is served better by a dynamic interaction-centric approach instead of a static organization-centric transformation projects. The 2012 Norwegian study of the organizational change at the hospital level (pathway to elective surgery) also emphasised the importance of relationships between individuals in the clinical systems in implementing sustainable quality improvement. The authors conclude that changes resulting from community projects are more likely to sustain because they turn individual mental models into shared mental models and facilitate a double-loop learning.
This short summary does not attempt to summarise the extensive academic literature around change/transformation at the hospital level. It does, however, attempt to connect the dots by suggesting how sustainable improvement approaches might be operationalized in healthcare.
If we accept that learning in healthcare is social, then we need to cherish and support the existing peer networks and create multi-professional communities of practice as a backbone for knowledge mobilization to implement organizational change/transformation.
We connected organizational change projects to learning in community of practice and described how this approach creates a shared value for clinicians and administrators in our recent paper (http://www.current-oncology.com/index.php/oncology/article/view/1662 ) We are using this approach at the organizational level in the Ottawa Hospital now. Let us know if you have similar experiences. After all, learning is social. Let’s learn together!
Michael Fung-Kee-Fung, Chief of Cancer Transformation and Strategy at The Ottawa Hospital Cancer Program