Development & Use of Organization Theory
To Understand Organizational Transformation
Martin P. Charns, DBA
Director, Center for Organization,
Leadership & Management Research
Professor, Health Policy & Management,
Boston University School of Public Health
Center for Organization, Leadership and Management Research
Boston University School of Public Health
The Original Problem
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Evaluate RWJF national Pursuing Perfection Program
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Identify factors associated with more vs. less successful
implementation of practices to dramatically improve patient care
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Determine extent to which the anticipated organizational changes
are actually achieved
Identify the factors (including the Pursuing Perfection initiative) that
either contributed to the observed changes or prevented the
anticipated changes from occurring
Determine the extent to which, and the ways in which, initial
successes spread to parts of the organization that did not participate
initially
Related study in VA to change organizational culture to
support evidence-based practice
Center for Organization, Leadership and Management Research
Boston University School of Public Health
Available Theory
• No single theory available to explain the
phenomena being studied
• Implementation was being guided by a framework
of spread of innovation: “2 to 5 to all”
Center for Organization, Leadership and Management Research
Boston University School of Public Health
Theories that Guided Data Collection
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Primarily theories of diffusion of innovation, e.g. Rogers
Major focus was on the innovations (QI projects) & processes of
implementation
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Framework included characteristics of organizations:
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Consultation provided
Worker involvement
Performance measurement & benchmarking
Communication
Baldrige alignment
Size, complexity
Resource availability
Leadership support
Characteristics of medical staff (% board certified)
Incentives
IT system
Also included organization’s environment
– Competition
– Business case for quality
Center for Organization, Leadership and Management Research
Boston University School of Public Health
Organizational Transformation Model
Center for Organization, Leadership and Management Research
Boston University School of Public Health
Organizational Transformation Model
• Five drivers of change:
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Impetus to transform
Leadership
Improvement initiatives (QI projects)
Alignment
Integration
• Organization/system
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Mission, values, strategy, priorities
Culture, values
Infrastructure
Organizational functions & processes
• Interaction
• Iterative over time
• Non-linear
Center for Organization, Leadership and Management Research
Boston University School of Public Health
How Good is the Model?
• One test is that it differentiated between the 4
highest performers & 7 lowest performers
• One site that looks like lower performer on model
but has high performance measures
Center for Organization, Leadership and Management Research
Boston University School of Public Health
Validation Study
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Additional 10 sites
Phone interviews
Assess OTM elements
Relate to CMS performance
Successful at differentiating highest from middle
performers
• But have one site that does not “fit”
Center for Organization, Leadership and Management Research
Boston University School of Public Health
How Good is the Theory?
• “Pretty Good”
• Exceptions
• Time lag: Do today’s organizational arrangements
(model elements) relate to tomorrow’s
performance?
• Is model over-simplified: Are we missing some
key elements that would improve the model?
Models are inherently simplifications of reality
• Measurement error in model elements &
performance
Center for Organization, Leadership and Management Research
Boston University School of Public Health
Next Steps
• Continue to test & refine model
• Focus on sustainability & spread
• Further address measurement
Center for Organization, Leadership and Management Research
Boston University School of Public Health