![[PHOTO] Light streaming through a key hole illuminating an old iron key.](../images/ph_findings.jpg)
As different as Jean Senator Limited (Canada locations: Halifax, Montreal, Toronto, Calgary and Vancouver) and First Memorial Hospital (Scottsdale, Arizona) are, both entered the transformation process with Moravec and Associates. Jacques Jutras, Chief Executive at Jean Senator Limited (JSL) remembered the employees' sentiment as they got underway: "The staff was very engaged in the dialogue on the steps forward - and very uneasy about the potential outcomes. They had not universally accepted that this was going to result in an improvement, although they certainly recognized that we can't stay the same."
Robert Greenhill, Senior Vice President, Patient Services for First Memorial (FMH) recalled: "It was an arduous start. The recent staff cuts were still fresh in everyone's minds. Most still were struggling with their own job security, and ambivalent about how they would support redesigning healthcare delivery. As the program unfolded, however, they came to understand that their primary goal in the refocusing was not, as some feared, reducing costs, but improving patient care."
In a renewal, repositioning, restructuring or transformation, employees' input, as well as their understanding and trust, is needed from the initial planning through to implementation and achieving results.
FMH accomplished this through regular meetings including Greenhill, focus groups, and phone calls and face-to-face discussions with key people including the assistant director, financial management, the practice coordinator, director of patient care services, and the clinical pharmacist. This meant lots of listening.
"We have a flexible workforce," says Greenhill, "and a recognition that not only is institutional revival okay, but it's essential to our future viability within the health care industry. However, as in all shifts and changes, as the message about the effort cascaded through the levels, we encountered pockets of denial and resistance."
"You can't make the change happen out of HR, Training, Organization Development, Quality or any other department," says Jacques Jutras of JSL. "If anything is going to happen across the organization, the CEO must champion the system-wide transformation, and senior management must own it." Both Jutras and Peter Boland, CEO of FMH, assumed that role. "My job," says Boland "is to be the advocate, the cheerleader for the will to win, the communicator to the people about what it all means from a broad-brush standpoint and to be on call."
"You don't do this just by setting up a new management structure, shuffling professionals and technicians out of one set of boxes and putting them in new ones," Boland says. "A lot of learning by both physicians and staff, leading to a transition to new behaviors, has to happen."
Jutras agrees. "While there is a tremendous fear of upsetting the familiar, operations status quo, we have to be cognizant of the fact that the world is changing fast and is increasingly less predictable--only the institutions and businesses, whether big or small or local or global, that can successfully adapt to and take competitive advantage of markets survive." Boland adds, "Gone is the 'build it and they will come' growing of a institution"
Perhaps the most important lesson that both FMH and JSL have learned in the journey to align their organizations with their strategic plans is that initiative-by-initiative, reactive efforts will almost always fail. Only a complete top-to-bottom, process-wide transformation - with all the complexity and cross functional challenges that come with transition - has a chance to succeed.
Nor can efforts be truly effective without the senior executives and vice presidents actively engaging the entire staff. As Jutras says, "While converting a business may appear at first glance to be about process, it is, in reality, a effort that focuses on the resourcefulness of the human side of the business - how people go about their work, how they perform, and how they achieve results." Jutras continues, "Courage, determination, leadership, helped by a little luck are as vital as ever to giving our firm new life"
Boland adds, "People are the heart and soul of any large-scale renewal. Giving them a clear galvanizing vision and forward strategy, and involving them, are the first steps. Then they have to hold themselves accountable for the design, building new capabilities, execution, and results. By making success measurable, focusing scarce resources on a few carefully selected goals, take charge of change and aligning performance management with accomplishments, an organization can turn itself into a more efficient, more effective, and more competitive market-focused healthcare organization."
(The names of the persons, companies and certain situations are disguised due to a confidentiality agreement. The actual client approved the case study)