- Traditional Change Models
- Disparate Change Groups
- Uncontained Change
- No Standard Change Approach
- Tools Focus
- Reliance on Benchmarking
- Changes Are Not Based On Data, Good Data, Or The Right Data
- Changes Made Based On Symptoms, Not Causes
- Systems Versus Processes
- Focus On People, Not On Process
- Lack of Context for Solutions
- Adding Versus Subtracting (Patching)
- Poor Implementation
- No Emphasis On Control
- Management Versus Leadership
Disparate Change Groups
In most hospitals there are multiple change groups and modes in operation, to name a few: local management-sanctioned change, clinical quality groups, nursing leadership, compliance groups, operations groups, senior executives, medical quality groups, and so on.
Each team formed is typically woefully underresourced and must fight to get meeting time (and often space), and often multiple teams are focused on resolving problems in the same target process. Project 1 can’t get team time because another team meeting for Project 2 involving the same people is meeting at the same time (sometimes even related to the same process issues).
Quality improvement (typically limited to clinical quality) is managed separately from operational improvement. The quality organization is usually a disconnected silo, too often focused primarily on regulatory compliance, and often plays second fiddle to any operations group. Many a quality group has asked how they might get support from operations when they want to run a project. Surely this is the tail trying to wag the dog. Would it not be more appropriate for the operations group to be frequently approaching the quality group in search of the skills and resources for operational improvement projects?
Quality groups instead spend valuable time canvassing to get the right people in the room and aren’t empowered to recruit the organizational manpower they need. Oftentimes they just shy away from the difficulty of getting an individual in the room at all and resort to “cubicle projects.”2
Even in operations the functions are siloed, and broad-scoped, cross-functional change is difficult to come by. Take, for example, a typical emergency department, where ED staff function almost entirely independently of the registration staff working side by side in the same process. Due to this siloing of functions, operations, and change groups, change is made in a nonunified way and breakthrough changes (usually found in aligning the handoffs from function to function) are rare.