Is Your Change Strategy Catholic or Buddhist?

Thursday, January 21, 2016 | Larry Sobal

It's funny how things converge sometimes. Recently I was reading a book, Scaling Up Excellence, on a plane going to visit a heart program. When I arrived, the leaders talked about their challenge to get improvements successfully spread throughout the organization. Perfect timing.

The authors of the book, Robert Sutton and Hugy Rao, told the story of a conversation about scaling where a person asked: What's our Goal? Is it more like Catholicism, where the aim is to replicate preordained design benefits and practices? Or is it more like Buddhism, where an underlying mindset guides people to do certain things, but the specifics of what they do can vary widely from person to person and place to place?

Having facilitated or participated in many innovation-focused improvement activities, such as Value Streams, Rapid Improvement Events, Pilots, Implementations, etc . . . . I have learned that coming up with a better “something” is the easy part. Getting people to accept or adopt the change (i.e. scaling the innovation) can be hard and painful.

Fewer than 40 percent of health care initiatives successfully transition from adoption to long-term, sustained implementation.

In health care we seem to be able to readily and quickly adopt many high profile innovations, such as new medical technologies, yet it's not uncommon that we also have a tendency to drop them into flow processes that may not have changed much since the 1970s. A good example might be radial access interventional procedures, which are often embedded into a process traditionally established for femoral access procedures, resulting in unnecessary cost and pre and post procedure time.

The challenges of transitioning from a decision to utilize an innovation (adoption) to skilled and consistent use of an innovation (implementation) are well documented in health care organizations. In fact, the Agency for Healthcare Research and Quality estimates that fewer than 40 percent of health care initiatives successfully transition from adoption to long-term, sustained implementation.

What I see is that innovation adoption success varies quite a bit from organization to organization. The typically cited reason for failure to scale up change include lack of sustained leadership support, inadequate resources allocated for implementation, lack of communication and training, failure to develop robust measurement and data feedback systems, misalignment of incentive structures, and cultural resistance to change, among others.

Now, I'm neither a Catholic nor a Buddhist, but the question being asked in the book also seemed to be a key question being asked by the heart program: What approach will be more effective in scaling improvement—pursuing standardization and consistency or allowing freedom and flexibility? Or is it a combination of the two?

There are many factors to consider including culture, governance, measurement, urgency, and implementation process. But the next time you are preparing to scale an improvement, one of the things you'll want to think very carefully about is where you should fall along the Buddhist-to-Catholic continuum. And remember that improvement scalings which adopt a Buddhist approach probably standardize some things and the Catholic spread approaches likely allow for some flexibility.

Exploring this question is important because you most likely don't have forever to figure it out. With the accelerating pace of change facing heart programs, such as the likely implementation of bundled payments, you'll need to gain these insights and competencies sooner rather than later.

 

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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