It is difficult for me to believe that almost two decades have passed since Reengineering the Corporation was published. In it, Jim Champy and co-author Michael Hammer define reengineering as “the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality, service, and speed.” More specifically, “fundamental” refers to how work is performed and the basic questions that need to be asked, “radical” means going beyond superficial changes in the way things are being done, “dramatic” indicates that reengineering isn’t about marginal or incremental improvements, and “process” refers to a group of activities that uses one or more kinds of input to create an output of customer values.
What we have in this volume, co-authored by Champy and Harry Greenspun, M.D., apply the same four basic principles to the challenge of reengineering the provision of health “and it must be done by clinicians. No angel of government, even under the auspices of ‘national health care reform.’ Can reduce the cost and improve the quality of health care without the work and leadership of clinicians. It’s time for all clinicians – physicians, nurses, technicians, physician assistants, and pharmacists – to assume their rightful role in directing change.” This is a key point. Champy and Greenspun insist, and I agree, that those who are centrally involved in the provision of health care should be centrally involved in the process of radical thinking by which to determine the nature and extent of reengineering initiatives.
According to Champy and Greenspun, the approach they propose is based on three “pillars”: Technology (“In any science-based enterprise, technology developments offer daily opportunities for redesigning work”), Process (“Whether or not new technology is applied, an organization’s work is best understood as a collection of processes”), and People (“No process can work properly without people trained as a team to execute”). Throughout their lively narrative, Champy and Greenspun focus on exemplary leaders of reengineering initiatives that vary in nature and extent but all of which rely (to varying degree) on the aforementioned three “pillars.” With all due respect to the value of various real-world examples, their purpose is to illustrate core principles rather than prescribe how those principles should be applied. It remains for each reader to make that determination.
However different the health care “reformers” may be in most other respects, they share in common what aspiring reformers must also possess. Specifically, “an ambition to improve the quality and safety of care in dramatic fashion; a deep respect for the experience of patients; a passion for improving the outcome of treatment; a desire to create a better workplace for clinicians; an appetite for change to create better medical practice; the clinical leadership required to bring about change; the persistence to overcome the inertia of current practices and processes; and a willingness to acknowledge their own shortcomings or detrimental behaviors.”
Jim Champy and Harry Greenspun offer a manifesto, not an operations manual. Encouraged as they obviously are by the successful reengineering initiatives they have observed in various health care organizations, they have no illusions about the challenges and difficulties that new initiatives by other organizations must overcome. In some instances, it will take years of effort to achieve success. That said, I am reminded of the Chinese proverb that suggests that the best time to plant a tree was 20 years ago. The next best time is now.
I am curious to know what Randy Mayeux has to say about Chris Anderson’s bestseller, Free: The Future of a Radical Price, at the next FFBS session. Meanwhile, I continue to encounter an increasingly greater number of promotions that (one way or another) seem to be offering something at no cost. Although all of them may be technically legal, some strike me as being misleading, if not unethical. Here are three of the categories in which many misleading offers can be classified:
1. Bait and Switch: Attract consumers by offering a product at a price that seems “too good to be true,” then apply great pressure on them to purchase another, much more expensive product. “Surely you want to purchase a vehicle that has an engine and a transmission.”
2. Bait and Betray: Attract consumers with an almost irresistible offer, including with it a disclaimer that cannot be read without a magnifying glass. “As the ad clearly states, there was a limited number available at that price. However, fortunately, we do have….” A variation on this has been perfected by financial institutions that arbitrarily increase fees and interest rates while substantially reducing available credit; they also aggressively solicit balance transfers, offering highly-attractive terms for which few consumers qualify.
3. Free but Only If: This is perhaps most popular among firms offering one, two, or even three credit scores (and perhaps even reports) but only if the consumer first signs up for monthly credit monitoring services on a “trial” basis, automatically renewable unless cancelled. Here’s another example of offers in this last category. In recent years, I have subscribed to SellingPowermagazine’s e-mail updates. The most recent one included an offer of a free white paper: It’s All about the Customer: How to align people, process, and technology to develop customer relationships. This seemed to be another document I could help to promote at the FFBS Web site so I provided all of the information requested (name, mailing address, e-mail address, etc.) but eliminated a check in the box to indicate that I do not wish to receive additional information. I did that three times and each time my submission was refused. I then cancelled my subscription. Obviously, the leaders at SellingPower are offering a white paper about improving customer relationships that they haven’t read.
Rule of Thumb #1: If anything seems too good to be true, it probably is.
Rule of Thumb #2: Before signing any contractual agreement, read the fine print as well as the terms and conditions of all offers, including those for a magnifying glass.
Rule of Thumb #3: “First time shame on you, second time shame on me.”
Cheryl offers: As practitioners of change leadership, our focus is not so much on the change management process itself as on what kind of leader is required to really create change that lasts. We love John P. Kotter’s book, The Heart of Change because it touches all aspects of change, including the need to get employees emotionally invested to create the energy needed to change. With the new “normal” of our economy, one thing I fear will not change is that as markets dictate consolidation, the percentage of Merger and Acquisition failures will remain constant. You see, acquisition happens. One company is bought by another. Seldom does a merger happen. Oh, assets get combined, leadership is chosen and redundancies eliminated; and the real heart of change that makes M&A’s worth the price paid is the MERGER of cultures. Most leaders pay more attention to the organization chart, press releases, and employment contracts than the real need to enroll employees in the changes. The fact is, about 70% of mergers and acquisitions fail. Almost 100% of the failures can be traced to not asking everyone to pay equal attention to the M as well as the A. Communication is the leadership’s responsibility in times of change; it becomes their legacy.
Sara adds: I was with IBM when it acquired Lotus. I coached a number of people on the Lotus development team and was struck by how victimized they felt. The acquisition had occurred, but for them, there was no merger. In the shadow of those memories, I turned to Adam Kahane, author of Solving Tough Problems . Kahane is known for his work in helping create unity in places like South Africa. He states, “There are two ways to unstick a stuck problem. The first is for one side to act unilaterally – to try imposing a solution by force or violence.” That’s how I read the press release in mergers like IBM acquiring Lotus or Oracle acquiring Sun Microsystems. Kahane goes on to add, “The second way to unstick a problem is for the actors to start to talk and listen in order to find a way forward together.” My opinion? Acquisitions are financial agreements to acquire assets; mergers require people to work with other people intentionally and creatively.