Healthcare Organizational Change You Can Measure, and Believe

THE QUESTION before the capacity audience at NYU Wagner’s annual Kovner/Berhman Health Forum lecture on March 31, 2009, concerned measurable ways of changing the culture — what people expect from each other and from themselves — in large healthcare institutions and other kinds of complex organizations. As one panelist said, it’s not unlike guiding a malfunctioning aircraft safely down into river.

Denise Rousseau, professor of organizational behavior and public policy at Carnegie-Mellon, told the audience that change measurably spreads through large institutions when workers trust the people pushing it forward, and when it also alters the things people do rather than asking people simply to adjust their attitude. Rousseau invoked Sully Sullenberger, the USAirways pilot who saved all his passengers after a bird struck his plane late last year. Sullenberger, said Roussau, works as a “risk-based practitioner” and had learned something beyond,” procedures and checklists” for a flight out of control; he knew to maintain “a mindful attitude” toward the people whose fate he had to try to steer after losing control. 

The question of how to pace organizational changes in huge organizations with many layers of habit and turf is unavoidable and especially critical as the world confronts auto-industry bankruptcy and global financial reform.

Bernard Birnbaum, New York University professor of radiology and Senior Vice President,
Vice Dean and Chief of Hospital Operations, NYU Langone Medical Center, is working to transform the medical center all its operations, took the audience of more than 200  healthcare executivesother organizational leaders and students and faculty through the intricate work of measuring work flow in order to unequivocally make it better.

“Change is coming up the wazoo,” he said at the start of his remarks. NYU-Langone Medical Center aims to prevent infighting between academic and medical interests, make patient care open and efficient, establish itself as one of the world’s most trusted hospitals, and revamp its digital and physical layout to lock in these goals. This requires, Birnbaum said, a full investment of “the people in the trenches” — the doctors, nurses and staff — as experts who can analyze the ways they work and eliminate steps that add no value to patient care.

Naming these steps and goals involves careful efforts, Birnbaum said.

The event at the Robert F. Wagner Graduate School of Public Service at New York University was moderated by Anthony Kovner, Wagner Professor of Public and Health Management.
Birnbaum’s presentation guided the audience through a variety of change processes, such as the medical school’s crafting a new vision statement in the summer 2007,, distribution of that draft statement in March 2008), and the current work of embracing Toyota’s lean manufacturing principles and the six-sigma metric that CEO Jack Welch propagated at General Electric. Lean (as it’s called) and six-sigma are the vehicles Birnbaum uses to steer.

The best paths emerge through rapid-improvement events. As Birnbaum described them, those events consist of evidence-seeking brainstorming sessions in which employees identify their work flow and hold it up to critique. “These can break and repair processes that nobody as the guts to attack,”  he noted. “We started it with 30 employees and now as people start hearing about these, it’s Welcome Back Kotter- ooh, ooh, ooh, when are you going to get to me?”

By starting with leaders – six “black belts” who would assess conditions throughout the center and 24 “green belts” leading their own work areas — Birnbaum said he hoped would “scale the change to the vision.” Some changes would show up as cost savings in future budgets. Others would qualitatively enhance work at the center- a radiologist, for instance, would have the equivalent of an extra day a week when bureaucratic snags vanish from the workflow. And all would make staff feel invested and appreciated. 

To ensure a soft landing, Rousseau reminded the crowd, means constantly soliciting feedback and redesigning anything that the entire organization doesn’t affirm. “Is this an improvement that we should institutionalize, or is it a deviation?” she recommends asking. This means the tough work of spreading information and opinion across facilities and work groups, so that everyone feels entrusted — and ready– to take the helm when things go out of control.

And Birnbaum agreed: “You can never communicate enough.”

Pilot Sullenberger had that down, too.