Sir John Oldham, who calls himself a jobbing GP yet his impact on the healthcare systems is much more than that, published a Commentary in JAMA (4th March 2009 Vol 301, No.9 p965) on "Achieving large scale change in healthcare". http://jama.ama-assn.org/cgi/content/short/301/9/965 The healdines are:
- Status quo is not an option
- Optimism is necessary to overcome obstacles
- Everyone can make a difference
- Take calculated risks
Kate Goonan and colleagues published in ASQ in January "Journey to Excellence: Healthcare Baldridge Leaders Speak Out". They've done some excellent case study work on how organisations taking on the quality mantle can be successful. I like their 5 step model of transformation (Status Quo, False Starts, Traction, Integration and Sustaining). Which, after getting over the shock of this sort of deep and broad large scale change taking 3 to 8 years, is reassuring common sense. This paper is a precursor to a book on the topic http://www.asq.org/quality-press/display-item/index.pl?item=H1327 The context for this paper is the US and it is also quite organisational specific. Much of the large scale change I know people are working on is perhaps a little more systems based.
From the e-Government 2009 Awards we have a case study from Avon, Gloucestershire & Wiltshire Communities on how they have improved a child health system across a geographic region. For me this is large scale because it involved multiple types of organisations, with different perspectives, implementing changes with far reaching impact on an identified population. http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=19235
I'm watching a large scale change in process by following, and where I can also supporting, the IHI Surgical Safety Checklist "Sprint". With an aim of encouraging 4000 hospitals to test out the checklist wihtin a short period of time, this is large in geographic scale and in the numbers of teams and organisations involved. You can join in too: http://www.ihi.org/IHI/Programs/ImprovementMap/WHOSurgicalSafetyChecklist.htm I love the map mashup on the IHI website which puts your commitment on the map - literally.
"The Science of Large Scale Change in Global Health" is an other JAMA paper, this time published in Feb 2009 http://jama.ama-assn.org/cgi/reprint/298/16/1937.pdf by Joe McCannon, Don Berwick and Rashad Massoud. There are some great internationally focused examples in there. It is good to know large scale change can happen and is happening. though I have a few queries on some of the Roger's based theories as to whether they are the best lens through which to view what they are writing up. It's interesting work and their piece on how leaders can support large scale change is pertinent. I would like to see more from the leaders themselves on how they are doing it.
If leadership is your thing then a good blog post touching on leadership for large scale change can be found here: http://www.fastcompany.com/blog/seth-kahan/leading-change/creating-authentic-engagement-change "Creating authentic engagement for change" cover hints and tips that seem obvious on the page yet in practice are often much more difficult. It seems that what I'm finding about leadership is there are two camps about leadership for LSC (a) the hierarchical, structural approach, (b) the personal, emotional connection type approach. I suspect there is a continuum.
A new page on Wiki Answers looks at the topic "How can the process of small scale change differ from that of large scale change". The advantage of a Wiki is you can get in there and improve the answer! So feel free: http://wiki.answers.com/Q/How_could_the_process_of_implementation_for_a_small-scale_change_differ_from_that_of_a_large-scale_change
One thought I am left with after doing this month's catch up is how easy it is to describe what has happened and to make inferences from that as to how we can make something happen in the future. Much research and management consultancy wealth is based on the development of frameworks and models using this descriptive approach. These are, of course, very helpful. However, I am wondering where the research and practice is on developing and using more predictive models? For instance, I know and have used some of the predictive diffusion models which in my mind are more helpful than the Roger's work, though less easy to get to grips with. Similarly perhaps the shift to a more personal and behavioural approach to leading LSC is on the "predictive" side of the coin.
Maybe the seduction of the easy-to-understand model is getting in the way of the really tough work. Namely, finding our own meaning in our own piece of large scale change.