But healthcare leaders have absorbed the hard-won lessons from two decades of constant improvement.
Change management is now a blend of culture, process, investment, and a lot of pushing. If improvement is a collection of lessons learned, here are a few:
Know the difference between tools and values
An organization that tries to change merely by buying tools may see some results, but then must constantly "retool" when people or priorities change.
"We created a process that works today, but isn't going to work tomorrow, and working tomorrow is the key to sustainability."
—Kurt Barwis, president and CEO, Bristol Hospital
An organization that only approaches change from a soft cultural perspective may lack the process discipline to translate values into outcomes.
Jeff Thompson, MD, executive adviser and chief executive officer emeritus of Gundersen Health System, a regional integrated delivery system based in La Crosse, Wisconsin, says balancing tools and values is going to be different for every organization and its leadership team.
"To get change to move is a combination of the responsibility of senior leaders to set clarity on aspirational goals and activities that will get people excited about leaning into it," Thompson says, "and then giving them the tools to do that that are within their grasp and supported by the organization."
Thompson says as he advises other health systems about managing change, he often encourages them to keep the real purpose of the tools in perspective. A good tool makes change easier, not more complex.
So organizations may deploy Lean, for example, as a way to "actually get some traction in change management, so that the process will be more efficient and feel like a win rather than a burden to bear."
Make sure the measures aren't lying
Hospitals have multiple ways of lying to themselves about the progress they are making, or not making. It's a sneaky little trade secret that leadership teams may choose what to measure by what they are best at already.
And then there are process measures (Did we do what we were supposed to do?) versus outcomes (Did patients get better?).
Gundersen decided to follow advice set out by Jim Collins in Good to Great, which was to "confront the brutal facts."
Jim Molpus is an editor for HealthLeaders.