Think Bigger: A Call for Transformational Change

By Leigh Ann Myers  /  05 Feb 2013

Health care has been talking about improving quality and reducing costs for many years, and more than any other industry, we have a long history of collaborating on this topic. Rather than keeping successes in these areas under wraps, hospitals are willing to open their doors with a shared focus on improving outcomes rather than on “winning.” Go to any industry conference and you’ll hear the buzz and feel the support of your peers. But while there are a range of opportunities to learn about best practices – conferences, site visits, webinars, etc. – often times the key takeaways are the same and only address one piece of the pie. A recent PSQH blog asked, “Is incremental change enough?” I believe we should be thinking bigger and focusing more on the potential for transformational change.

At the 24th IHI National Forum,Maureen Bisognano opened with a keynote address about what’s needed to address the pressing challenges health systems are facing. Bisognano believes that in the next decade, we’ll face cost constraints and challenges we haven’t seen before, and said “It’s going to take a laser focus on quality, innovative models of care and patient-centered approaches, and it’s going to take spread.” She described a five-part checklist for spreading innovations and evidence-based best practices – setting a vision to build will, finding or creating the best ideas, creating the infrastructure for scale up, moving beyond the walls of health care institutions and leveraging teamwork to affect change.


The temptation to tactically tackle this checklist is huge, but we need to move beyond sharing successes concerning “incremental” change and spread the word about sound strategies for “transformational” change. Here’s what I mean:

  • Incremental change – Many health systems today are focused on improving incremental components of their environment, such as checklists, departmental efficiencies, providing correct discharge instructions, etc. Although all of these are necessary steps toward improving patient care and outcomes, etc., they should be incorporated into a broader strategy. While focusing on one-off goals will help in the short term, will it position health systems for the necessary and inevitable evolution of care delivery
  • Transformational change – Transformational change calls for a top-down redesign of the health system, and we’ve seen it done successfully in certain areas of the country. Health systems that participate in collaboratives, like Premier’s QUEST and Partnership for Care Transformation, are reaching new levels of patient safety and care delivery. New payment models are going to drive the need for transformational change—helping to redesign how care is delivered.

I realize transformational change is a major undertaking for most health systems. So the question becomes, how do we best spread knowledge about how to make that change? How do we present transformational change in a way that makes it seem achievable? Raise your hand if you’ve been in a conference session on improving ED throughput and nodded in agreement with everyone else in the room. Many of these success stories are excellent, but involve a lot of preaching to the choir. Health systems are ready for something new, coming from the leaders of hospitals that have seen success in major change.

I don’t have all the answers, but would like to see transformational hospitals embrace the healthcare industry’s advocacy of collaboration by hosting regional events and sharing successful top-down approaches to change – the overarching goals, strategies for achieving each and results. Breakout sessions should be included to address issues more specific and relevant to different C-levels, groups or departments, but the main takeaway would be driving the effort to move from incremental to transformational change.

What do you see as the biggest barrier to transformational change? Are most health systems ready for it?



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