Change Management 2018: The New Rules
For an industry inundated in change, progress has been hard to find.
This article first appeared in the January/February 2018 issue of HealthLeaders magazine.
The narrative goes something like this: Scathing IOM report comes out in 1999, healthcare industry enthusiastically embraces improvement as a core part of its mission, and the industry gets better.
If only it were that simple.
The IOM report was one among several heavy levers (PPACA, meaningful use, ICD-10) that pushed hospitals into a new age of relentless improvement.
CEOs started to use words such as "Kaizen" and "value stream analysis." Internal and external quality measures multiplied exponentially.
Today's hospitals are an expanding web of concurrent improvement programs, all supposedly mapped to a single big idea to move the organization forward.
Change management has become so big, however, that leaders are beginning to question whether they are leading change, or if it's leading them.
Consider the seminal statistic: mortality. A 2016 study in the BMJ set medical errors as the third-leading cause of death at an estimated 250,000 per year in the U.S., significant growth from the 98,000 estimated in the IOM report almost two decades previous.
The counterargument to those statistics is that healthcare delivery has increased in scope and complexity since then, and that many processes within health systems have indeed chased down certain types of errors significantly (e.g., central line–associated bloodstream infections).
The root cause of this organizational disease is not effort, but skill, specifically change management. Hospitals have ramped up improvement projects on a massive scale that is potentially unfocused and unmanageable.