It was also recognized that many of the failures of change programs in industry had resulted from the administrative needs to cut costs and improve productivity through the various “reengineering” programs that had been developed, without considering the impact on the people, both as sources of information on how to improve things and as the workers who would have to use the new system designed by the engineers. The VM projects took the longer-range view that quality and productivity both increased over the long run when everyone was involved in the transformation program (Kenney, 2011; Plsek, 2014).

The VM cancer center redesign, for example, presented quite a challenge if the goal was to make it effective and comfortable for the patient rather than just focusing on the doctors and staff. That involved bringing all of the diagnostic equipment and therapeutic processes into a single area instead of having patients run all over the hospital to get diagnosed and treated. It turned out that to accomplish this goal, the space occupied by the dermatology center was ideal for the cancer center, which meant that the leadership team had to work with the dermatology department to get them to give up their space. This was accomplished by working with them on the design of a better space for themselves and often took intense relationship building over a period of months and years. This process highlighted the conclusion that such changes only work and last when all the participants have developed Level 2 relationships, have learned to be open with each other and trust each other’s mutual commitment, and, most important, have been involved in creating and implementing the change.

This intensive approach over the next years enabled VM to transform many of its operations. For example, the emergency room was able to implement a process of sharply reducing waiting time and discomfort by providing immediate diagnosis and treatment. Primary care facilities were redesigned in ways to enhance a smooth workflow by co-locating several critical functions. Wards were organized around the nursing-patient interaction rather than nursing stations, to enable nurses to form better relationships with patients.

A patient safety alert system was created that was the medical equivalent of the Toyota production line process of “stopping the line.” In the hospital situation if any member of the treatment group saw a problem, he or she could stop the treatment process to get an immediate review. These patient safety alerts promptly brought all relevant team members and their leaders together in one place to rapidly begin to understand the issue and what needed to be done. This stimulated closer relationships across the entire medical center continuum.

If diagnostic or treatment errors occurred, the process was to openly identify them so that the systemic causes could be identified and fixed, instead of the more traditional process of identifying a person to blame. By involving everyone in a climate in which it was often “safe to speak up,” it was possible to identify the complex interactions that caused errors.

From Humble Leadership