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Transformational change in health care systems: An organizational model

Lukas, Carol VanDeusen; Holmes, Sally K.; Cohen, Alan B.; Restuccia, Joseph; Cramer, Irene E.; Shwartz, Michael; Charns, Martin P.

Health Care Management Review:
doi: 10.1097/01.HMR.0000296785.29718.5d
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Abstract

Background: The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims.

Purposes: This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care.

Methodology: Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care.

Findings: Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization.

Practice Implications: The conceptual model holds promise for guiding health care organizations in their efforts to pursue the Institute of Medicine aims of fundamental system redesign to achieve dramatically improved patient care.

Author Information

Carol VanDeusen Lukas, EdD, is Senior Investigator, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, and Research Assistant Professor, Boston University School of Public Health, Massachusetts. E-mail: carol.vandeusenlukas@va.gov.

Sally K. Holmes, MBA, is Project Coordinator, Boston University School of Public Health, and Investigator, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, Massachusetts.

Alan B. Cohen, ScD, is Professor and Executive Director, Boston University Health Policy Institute, and Investigator, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, Massachusetts.

Joseph Restuccia, DrPH, is Professor, Boston University School of Management, and Investigator, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, Massachusetts.

Irene E. Cramer, PhD, MSSA, is Project Manager and Investigator, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, and Research Assistant Professor, Boston University School of Public Health, Massachusetts.

Michael Shwartz, PhD, is Investigator, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, and Professor of Management, Boston University School of Management, Massachusetts.

Martin P. Charns, DBA, is Director, Center for Organization, Leadership and Management Research, Department of Veterans Affairs, and Professor, Boston University School of Public Health, Massachusetts.

The project was funded by the Robert Wood Johnson Foundation through its evaluation of the Pursuing Perfection Program. It was approved by the Institutional Review Boards at Boston University and the VA Boston Healthcare System.

© 2007 Lippincott Williams & Wilkins, Inc.