Implementing Change

The CEO was thoughtful. “In my experience,” he said, “the three greatest barriers to performance improvement are culture, culture and culture.” His observation was absolutely on target.

As would-be change agents have learned—often at great cost—organizational culture ultimately determines whether or not performance improvement initiatives will be successful. Culture defines the work environment. The hospital can design the most efficient possible work processes, acquire the very best management information systems, and employ state-of-the-art medical technology, but unless the culture is prepared for change, improvement efforts will fall short. Management teams that must reduce costs and improve performance are immediately confronted with a daunting challenge that they will ignore only at their peril: how does one go about changing the organization’s culture?

Understanding Change Management

It is axiomatic that constructive change cannot be imposed from the top. The Dannemiller-Tyson change formula elegantly explains why this is true and points the way to successful change implementation.

The Change Formula:

C = V x D >R

Where:
C = Change
V = A positive vision for the future
D = Dissatisfaction with the status quo, and
R = Natural human resistance to change

If you have ever put forward a great idea only to have it rejected or ignored by the very people whom it would most benefit, you will appreciate the change formula. The formula says that constructive change will occur in an organization only when a positive vision for the future multiplied by dissatisfaction with the status quo (the relationship is not linear) is greater than the natural human resistance to change.

The hospital’s culture is defined by the beliefs of its governing body, executives, managers, staff and physicians; the assumptions upon which those beliefs are based; and the behaviors that rest upon those assumptions. Human beings are creatures of habit. Because established routines help us order our lives we naturally resist threats to those routines. By definition, cultural change requires large-scale modification of routine-based behavior. It may require re-evaluation of long held and deeply cherished beliefs. No matter how great an idea is, if the people who would be affected by it are reasonably satisfied with the current situation, they will not voluntarily change their routines. Conversely, no matter how dissatisfied people are with things as they are, unless and until they believe that change will materially improve their circumstances, they will not change either, preferring less than ideal conditions over the unknown.