Review by Beth O'Brien and Margaret McCarthy
Organizational Transformation in Healthcare: A Work in Progress
Heather A. Andrews, et al.
Jossey Bass, San Francisco, 1994, 264 pps.
This book is a compilation of six healthcare executives' work diaries in which they share their experiences as leaders in the midst of a major organizational transformation at the University of Alberta Hospital. Their recorded experiences, learning, and insights may be useful to individuals or leadership teams preparing for organizational change.
The 12-chapter book is divided into three parts: an introduction that focuses on the Canadian healthcare system, organizational transformation, and organizational alignment; an extensive discussion of the principles of total quality management (TQM); and a conclusion highlighting future challenges and how to prepare for them.
Chapter 5 is especially insightful in its clear description of how the hospital implemented a shared governance model in its nursing division. Any reader involved in dramatic changes in a healthcare organization will benefit by reflecting on the issues that emerged.
The authors emphasize the need to use a construct of balance to organize work and delineate the lessons learned. They underscore the need for clear and accurate communication of budgets and strategy alignment.
They also give a cogent explanation of the need for organizational transformation. The University of Alberta Hospital would, as page 13 suggests, suffer from a pattern of "long waiting lists, divisiveness and competition within and between organizations, rebellious taxpayers, challenging governments, disenchanted employees, skeptical unions and harassed managers," if care and services were to be delivered in the future in the same manner as in the past.
The book does suffer from a few omissions. Several times, the authors alluded to a need to reduce costs without clearly articulating a vision or goal regarding the transformation of the hospital. Also, they failed to state a quantifiable goal for performance improvement. The reader would benefit from more concrete details of the changes in Canadian healthcare that resulted in the process for formulating a specific vision for the hospital and developing and evaluating a tactical plan of action.
Unfortunately, the book's strong message may get lost in its many chapters, which consist of basic material unlikely to hold the attention of the experienced healthcare professional. The authors would do well to update their work by using chapters 5, 11, and 12 (on empowerment, decentralization, and preparation for the future) as an ongoing construct to emphasize the book's important points.
In summary, we believe the key to the book's worth lies in this statement from page 258: "Is total quality management sufficient to enable us to confront the challenge? The principles of TQM provide a powerful approach to promote the systemic, cultural and societal changes advocated by many. However, the key to fundamental transformation is the commitment to personal transformation of each individual occupying a role in the organization, the healthcare system and indeed society as a whole." The book shows the importance of helping each member of the organization's staff adopt the TQM philosophy in their work.
Reviewed by Beth O'Brien, Executive Vice President and Chief Operating Officer; and Margaret McCarthy, Senior Vice President, Performance/System Improvement, Franciscan Health System, Aston, PA
Mr. Roberts is chief executive officer of the Oregon region of PeaceHealth, Eugene, OR.