Course 3: Improving Value in Systems (Modules 8-10) > 5- Culture can be Changed

5- Culture can be Changed

MODULE 8 | Section 5 of 11

Culture can be Changed

Not only can culture be defined, measured, and targeted, but culture can also truly be changed. The Institute for Healthcare Improvement (IHI) uses a simple framework to describe the essential elements for strategic improvement:

WILL → IDEAS → EXECUTION

You have to have the will to improve, you have to have ideas about alternatives to the status quo, and then you have to make it real — execution.1

 

Although this may sound obvious, think about how often we do not follow this process, and instead try to skip straight to execution. We see a problem and we think we could just change the electronic ordering process, or create a best practice alert, or some other intervention, without truly generating the will necessary to change and listening to the many ideas of those doing the day-to-day work.

In addition to national trends, change agents can use local trends, data, and stories to generate the will for change. Stories, especially when paired with contextual data, can be particularly powerful tools for convincing others that change is necessary.

“Stories make, prop up, and bring down systems. Stories shape how we understand the world, our place in it, and our ability to change it.” — Ella Saltmarshe, 2018

USING STORIES TO CHANGE SYSTEMS

We need to develop new processes of collective storytelling across sectors to navigate turbulent times and foster systems change.
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One example of using stories paired with evidence is the “Teachable Moments” series in JAMA Internal Medicine. This series attempts to improve recognition among trainees at all levels of the harms that result from the overuse of health care services. The brief articles, primarily written by a health professional trainee (in any program and at any stage of training), feature a “story from the frontlines” of when overuse, misuse, or underuse led to patient harms, and then a “teachable moment,” where the evidence is put in context with a scholarly review of the relevant literature and studies. Telling stories and pairing them with rigorous evidence is a strategy that captures both the hearts and minds of people and can help spur change.

ADDITIONAL RESOURCES

READ MORE ABOUT “TEACHABLE MOMENTS”

Too Much Medicine Happens Too Often

The Teachable Moment and a Call for Manuscripts from Clinical Trainees

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Teachable Moment

Explore this JAMA Internal Medicine series intended to educate medical trainees about the harms that result from overuse of health services

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KOTTER’S 8-STEP MODEL FOR CHANGE3

Harvard Business professor John Kotter developed an 8-step model for leading change, which has become one of the most influential concepts in business and change management.
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Explore Kotter’s 8 Steps fully here
“Help others see the need for change through a bold, aspirational opportunity statement that communicates the importance of acting immediately.”
“A volunteer army needs a coalition of effective people – born of its own ranks – to guide it, coordinate it, and communicate its activities.”
“Clarify how the future will be different from the past and how you can make that future a reality through initiatives linked directly to the vision.”
“Large-scale change can only occur when massive numbers of people rally around a common opportunity. They must be bought-in and urgent to drive change – moving in the same direction.”
“Removing barriers such as inefficient processes and hierarchies provides the freedom necessary to work across silos and generate real impact.”
“Wins are the molecules of results. They must be recognized, collected and communicated – early and often – to track progress and energize volunteers to persist.”
“Press harder after the first successes. Your increasing credibility can improve systems, structures and policies. Be relentless with initiating change after change until the vision is a reality.”
“Articulate the connections between the new behaviors and organizational success, making sure they continue until they become strong enough to replace old habits.”

In interviews with 19 hospital and health system CEOs, ALL of them said that a long-term talent priority for their organizations is hiring “physicians/clinical leaders who can connect as peers with other physicians in their organization to help drive culture change.”4 (From Deloitte, “Lens into the Future: Health system CEO interviews, 2015).

REFERENCES

  1. 1-
  2. Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007.

 

  1. 2-Rosenthal, E. How the high cost of medical care is affecting Americans. New York Times/CBS News. Dec, 2014.

 

  1. 3-Kotter Inc. 8-step process. Kotter Inc. Website.

 

  1. 4-Deloitte LLP. Lens into the future: health system CEO interviews. Deloitte 2015 report.

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