Matrix: Mental Health System Transformation

Programs and Activities

Mental Health Transformation State Incentive Grant Program

Transformation: A Strategy For Reform of Organizations and Systems

Challenges and Lessons Learned

A variety of potential obstacles may immediately or eventually impede the transformative process. Some of these obstacles result from inaction by key parties. Such obstacles include the lack of a clear vision, nonexistent or poor leadership, lack of critical mass, lack of parties’ incentives to move forward, and lack of participation. (Spodark, 2003). Stakeholders may be hesitant to move forward due to fear of the unknown, the view that there is no need to change, and fear of a failed attempt to transform. (Hagner, 2000).

Frequent Barriers

Haines et al. (2004) suggest that the three primary reasons large-scale change efforts fail are:

(1) an analytic, piecemeal approach to system-wide problems (with multiple conflicting frameworks and mindsets);

(2) a focus primarily on the economic alignment of delivery (an artificial “either/or” mindset); and

(3) a focus primarily on cultural attunement and people issues (another artificial “either/or” mind set).

Guidelines Based on Experience

In his Leading Discontinuous Change: Ten Lessons from the Battlefront, David Lawrence, former CEO of the Kaiser Permanent Health Care System (KP), identified the following “lessons learned” drawn from his experiencing overseeing KP’s transformation efforts. These practical guidelines can be helpful to those undertaking similar, large-scale transformation initiatives.

• Do not expect people to embrace easily the need for change.

• Sometimes it is better to experiment than to plan.

• Pay close attention to the timing of change.

• When the need to remove people becomes clear, do not put off the inevitable.

• You cannot succeed without a senior team that thinks and acts as a team.

• Give coherence to the change process by clearly articulating a central mission and a consistent set of themes.

• Even though the content of change may be radical, the building process must be methodical.

• Think of change as a campaign that must be waged simultaneously on a variety of fronts.

• This race may not have any finish line, so keep looking for reasons to stop and celebrate along the way (Power, 2003)

Information Technology: Means for Transformation

Kaiser-Permanente (KP) is investing large sums of money and effort to implement KP HealthConnect, a suite of medical information tools to lead American health care into a new age (Weiland, 2004). The transformation will improve interactions among clinicians, members, and the organization as a whole; clinician-clinician interactions; and clinician-patient interactions. During 2004, each local KP affiliate launched the KP HealthConnect suite of systems. The program stressed creating an environment that fosters the creative use of the tool, observing the impacts of that creativity, and widely propagating the successful ideas while pruning out the unsuccessful ideas or the old processes. In this effort, transformation will occur when a user or group of users figure out how to use the new tool to do something completely new, something perhaps that could not have been done before. Progress toward this transformation is continuing at KP today. A number of lessons have been learned that will assist other organizations in its continuing transformation efforts (Wiesenthal, 2004).