Two canoes: a case study in organizational change failure and the implications for future population health initiatives

Organizational change is undeniably difficult, and change efforts often fail to overcome the status quo processes and routines. By threatening these structures, change becomes an existential danger to organizations, who often respond with significant resistance. Organizations will look to their experiences with past change efforts to inform future changes, limiting the ability of change actors who seek to implement change beyond this narrow scope.

The “Heart Failure Lite” model was a change effort that exceeded the scope of previous changes at an organization with deeply embedded routines and processes. This model threatened the traditional revenue streams that had benefited the organization for years. The resistance exhibited by the organization when presented with the change was consistent with the underlying theory.

Although change failure is common, proactive efforts on the part of change actors can help break down the organizational barriers. Conceptual models like PARiHS can be utilized to identify the evidence supporting the change, the contextual environment in which the change will be introduced, and the facilitation efforts needed to guide the project to a successful conclusion. The “Heart Failure Lite” team failed to survey the organizational landscape and tailor the project accordingly. Therefore, the change effort failed.

Shifting clinical practices toward a population health model presents a unique opportunity for healthcare organizations. A concerted effort from all stakeholders to find common ground will allow change agents to overcome the traditional barriers, and will help organizations to truly transform the delivery of healthcare services.