I recently visited a medical practice which could be the perfect case study of how process change can fail when not accompanied by "culture" change.

This group was the merger of several small practices into one larger facility. The goal was to gain efficiency by sharing resources such as check in, triage and check out. All important goals that seemed not only doable, but necessary in a new larger combined practice.

The process change was led by a dedicated group of managers committed to finding efficiencies in the new merged practice. While there was some buy in, it did not include all those affected by the change. The staff and physicians were accustomed to operating as small entities with close personal contact between staff. The new environment changed this model as some processes were centralized.

So where did it go wrong? I speculate that the biggest culprit was underestimating how difficult major change can be for individuals and organizations. The importance of individual practice culture was not fully considered. Assurances that the staffing would not change as part of the consolidation likely preserved current processes and limited flexibility.

This doesn’t mean that the proposed changes weren't good ideas or important. They were the right thing to do and are common place in larger practices. The challenge in this case was how to change the culture before the move. How to get everyone excited about the new processes. How these changes would improve their workflow and make them more efficient. Ultimately, how to develop ownership and buy-in from management, physicians and staff so everyone had a clear vision of the goal.

Another aspect of cultural change related to the patients. They were accustomed to visiting the same small practice for years, seeing the same faces, and expecting the same results. The population in this case was primarily elderly and rural. They were part of the practice culture, and equally reticent to change.

So what steps could have been considered to change the patient culture to make them more accommodating to the new practice culture? Could patients be participants in the development of the process change via representatives and volunteers. Could small changes occur prior to the move? Was each patient visit prior to the move accompanied by an explanation of the change and why it was important?

This is a reminder of the importance of clear management, engagement of a wide constituency in change and never underestimating the importance of culture.

Steve Clayman