The story seems so trite it’s almost not worth even going there.   Executives return from a conference hot with a new idea on how to transform the organization; a flurry of hopeful spending and activities ensue that lead to approximately nothing.

“The performance improvement efforts of many companies have as much impact on operational and financial results as a ceremonial rain dance has on the weather. While some companies constantly improve measurable performance, in many others, managers continue to dance round and round the campfire – exuding faith and dissipating energy. This “rain dance” is the ardent pursuit of activities that sound good, look good, and allow managers to feel good-but in fact contribute little or nothing to bottom-line performance.”

The quote above was taken from a seminal article on change, “Successful Change Programs Begin with Results,” in the Jan-Feb 1992 issue of the Harvard Business Review, by Robert Schaffer and Harvey Thomson.  They continue….

“Companies introduce these programs under the false assumption that if they carry out enough of the “right” improvement activities, actual performance improvements will inevitably materialize. At the heart of these programs, which we call “activity centered, ” is a fundamentally flawed logic that confuses ends with means, processes with outcomes. This logic is based on the belief that once managers benchmark their company’s performance against competition, assess their customers’ expectations, and train their employees in seven-step problem solving, sales will increase, inventory will shrink, and quality will improve. Staff experts and consultants tell management that it need not – in fact should not – focus directly on improving results because eventually results will take care of themselves.”

Although the reference comes from business, innumerable examples in healthcare abound.   Just think of any “we are going to teach you and then you have at it” methodologies that are all the rage (Studer, Planetree, Baldridge, conventional Lean, etc.).  For a big fee the trainers fly in, fly out, pat themselves on the back, conduct a monthly follow-up call, and your staff is left trying to shuffle through the notebooks and figure out how to make it work for them.   Just keep up the faith, pay our fees, and the results will come soon….

Schaffer and Thomson claim these activity-focused change efforts tend to fail for several reasons:

1. Not Keyed to Specific Results – focus is on how many activities were conducted, not on the results thereof
2. Too Large Scale and Diffused – “throw it on the wall and surely something will stick” thinking; “Lean Fires” often spring up across an organization after a training, consuming valuable time and optimism, but rarely, if ever, achieving a meaningful outcome
3. Results is a Four Letter Word – “give it more time, don’t focus on the short-term vs the long-term”; “build it and they will come” (we all love the movie, but not a way to implement change)
4. Delusional Measurements –  success of the program is judged by the number of staff trained or the number of Kaizens undertaken;
5. Staff and Consultant Driven – capability of most consultants is limited to installing discrete, often generic packages of activities, which relieves them of the hard work of having to improve;
6. Biased to Orthodoxy not Empiricism – little opportunity to learn/adapt and apply lessons to future needs; advocates convinced they know the answers urge more dedication to the right “steps”

Training and coaching are a good, repeatable business model for the consultants.  But it gets messy when putting the training into practice with teams of humans, who all come at things from a different perspective.  At that point, things tend to break down and the coaching checklist doesn’t have the answer to get it going again.

Schaffer and Thomson go on to discuss the difference in a Results-Driven Transformation.

“In stark contrast to activity-centered programs, results-driven improvements bypass lengthy preparation rituals and aim at accomplishing measurable gains rapidly…executives set improvement targets…unit heads participate in several workshops and work with consultants but always maintain a clear focus on launching the improvement processes that would enable them to achieve their goals.”

Characteristics of a Results-Driven Approach include:

1. Companies introduce managerial and process innovations only as they are needed – “managers carefully prioritize the innovations they want to employ to achieve targeted goals.”
2. Empirical testing reveals what works – introducing innovations linked to short-term goals sequentially enables rapid discovery of the effectiveness of new approach
3. Frequent reinforcement energizes the improvement process – “There is no motivator more powerful than frequent successes”
4. Management creates a continuous learning process by building on the lessons of previous phases in designing the next phase of the program – perhaps the most important aspect of a results driven approach is the learning that occurs in each phase.

Putting the Ideas into Practice

“Taking advantage of the power of results-driven improvements calls for a subtle but profound shift in mind-set: management begins by identifying the performance improvements that are most urgently needed and then, instead of studying and preparing and gearing up and delaying, sets about at once to achieve some measurable progress in a short time.”

“In the course of accomplishing results, management introduces many of the techniques that promoters of activity-centered programs insist must be drilled into the organization for months or years before gains can he expected: employees receive training in various analytical techniques; team-building exercises help teams achieve their goals more quickly; teams introduce new performance measurements as needed; and managers analyze and redesign work processes in a natural sequence.”

“But unlike activity-centered programs, the results-driven work teams introduce innovations only if they can contribute to the realization of short-term goals. They do not inject innovations wholesale in the hope that they will somehow generate better results. There never is any doubt that responsibility for results lies in the hands of accountable managers.”

Where to Learn More

The article by Shaffer and Thomson referenced above is a great place to expand your understanding of how to implement a results-focused change program.  They present several case studies and in the concluding paragraphs outline organizational approaches that have worked in the past.

In our experience, the most important lesson is that a transformation effort has a far greater chance of success if you begin the effort by building belief with rapid and meaningful success.  Without belief, staff will look upon all new change programs as flavor-of-the month.

But when you can show them project results that improve their work lives, the care provided to patients, and have an impact on the viability their workplace, belief will quickly line up behind your efforts. Without that belief, everything you attempt will look like flavor of the month and a lot of money will be wasted waiting for the elusive load activity to stick on the wall!

A Lean Rapid Improvement Event or a Kaizen are great places to start.  At SigmaMed we offer what we call Rapid Improvement Training projects to solve a problem, build belief, and teach a team the basics of team-focused performance improvement.   It doesn’t matter where you start, but you need to get started quickly and focus on results!