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The Bumpy Road to Change

Carrie Vaughan, for HealthLeaders Magazine, April 9, 2009
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Sometimes "culture transformation" efforts work beautifully for hospitals. Other times . . . not so much. How can you make sure your organization falls in the former category, and not the latter?

Culture change. That ubiquitous phrase is seemingly at the heart of every hospital turnaround effort or quality improvement program or employee satisfaction initiative. Talk to any hospital executive with a success story, and at some point he or she will start explaining how transforming the culture of the organization was a key element of that success.

Changing an organization's culture is like stretching out a rubber band, says William Powanda, vice president at Derby, CT-based Griffin Hospital. "You can take it and stretch it out, but the memory wants to pull it back."

Griffin Hospital decided to change its organizational culture to a patient-centered, consumer-focused model in 1985 and began implementing the Planetree patient-centered model of care in 1991. Today, Griffin is formally designated as a patient-centered hospital and has been named to Fortune's "Best 100 Companies to Work For" list for 10 years running. But Powanda still won't say the hospital's cultural transformation is complete. "I don't know that there is another end," he says.

So why do some hospitals' cultural transformation efforts fall flat, while others are successful?

What went wrong?
In 2004, Copley Hospital decided to implement Planetree. Just two years later, however, the 25-bed critical-access hospital in Morrisville, VT, put that effort on hold. "There was an awful lot happening," says April Tuck, senior director of human resources and corporate compliance officer. "When I started one CEO had left. We had an interim CEO. The hospital was getting ready to make some very small and targeted cuts in terms of redundant staff—mostly management positions—but these were actions that Copley wasn't used to," says Tuck, who joined the hospital in 2006.

There was also a nursing strike in 1998, and a new CEO came on board. In addition, Copley was becoming much more of a regional entity, she says, as the population and demographics changed. "We were getting more folks from outside of Lamoille County moving in, and they came to Copley with higher expectations of healthcare settings," says Tuck.

Copley's staff members had good intentions, Tuck says, and they were working hard toward the end goal. But ultimately, she says, there was just too much going on "to implement an all-encompassing program like Planetree."

Susan Frampton, president of Planetree, says the only time she has witnessed culture change efforts fail outright is when there is CEO turnover early on in the process. If the organization is further along in the process, there is usually enough momentum to carry it forward. "There is enough support within the organization to convince the new leader that employees are invested in it and not to interrupt the process" she says.

Still other culture change efforts seem doomed to fail from the start. Here are some common mistakes that organizations make:

Lack of a strong accountability system. Culture change efforts often start unraveling during year two when the initial excitement about the effort wears off, says Quint Studer, founder and CEO of the Gulf Breeze, FL-based consulting firm The Studer Group. Then it becomes apparent there's no system in place that holds leadership accountable for driving the change and leading by example.

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