Managing organizational transformations: Lessons from the Veterans Health Administration

California Management Review

Volumn , Issue 1, 2000, Pages 66-82

  Young, Gary J ^a  

^a NONE

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EID: 0034561687     PISSN: 00081256     EISSN: None     Source Type: Journal    
DOI: 10.2307/41166066     Document Type: Article

References (37)

1. See, for example, J.P. Kotter, "Leading Change: Why Transformation Efforts Fail," Harvard Business Review, 73/2 (March/April, 1995): 59-67; G. Hall, J. Rosenthal, and J. Wade, "How to Make Reengineering Really Work," Harvard Business Review, 71/6 (November/December 1993): 119-130. Some evidence suggests that change efforts in public-sector organizations are less likely to succeed than change efforts in private-sector organizations (e.g., P. J. Robertson and S. J. Seneviratne, "Outcomes of Planned Organizational Change in the Public Sector: A Meta-Analytic Comparison to the Private Sector," Public Administration Review, 55/16 (1995): 547-558).
2. See, for example, J.P. Kotter, "Leading Change: Why Transformation Efforts Fail," Harvard Business Review, 73/2 (March/April, 1995): 59-67; G. Hall, J. Rosenthal, and J. Wade, "How to Make Reengineering Really Work," Harvard Business Review, 71/6 (November/December 1993): 119-130. Some evidence suggests that change efforts in public-sector organizations are less likely to succeed than change efforts in private-sector organizations (e.g., P. J. Robertson and S. J. Seneviratne, "Outcomes of Planned Organizational Change in the Public Sector: A Meta-Analytic Comparison to the Private Sector," Public Administration Review, 55/16 (1995): 547-558).
3. See, for example, J.P. Kotter, "Leading Change: Why Transformation Efforts Fail," Harvard Business Review, 73/2 (March/April, 1995): 59-67; G. Hall, J. Rosenthal, and J. Wade, "How to Make Reengineering Really Work," Harvard Business Review, 71/6 (November/December 1993): 119-130. Some evidence suggests that change efforts in public-sector organizations are less likely to succeed than change efforts in private-sector organizations (e.g., P. J. Robertson and S. J. Seneviratne, "Outcomes of Planned Organizational Change in the Public Sector: A Meta-Analytic Comparison to the Private Sector," Public Administration Review, 55/16 (1995): 547-558).
4. The collection and analysis of data were guided by a model of the change process that was originally proposed by Kurt Lewin. In this model, transforming organizations are conceptualized as moving through three stages or states of equilibrium -frozen, unfrozen, and refrozen. The model does not consider strategies or tactics that move organizations from one stage to another. K. Lewin, "Group Decision and Social Change," in G. E. Swanson, T. N. Newcomb, and E.L. Hartley, eds., Readings in Social Psychology, rev. ed. (New York, NY: Holt, 1952).
5. The surveys were conducted by selecting a random sample of employees from each VHA operating unit. During each wave of the survey, completed questionnaires were obtained from over 10,000 members of the agency's workforce for a response rate that was consistently above 60 percent.
6. Information contained in this section was drawn from both published sources as well as internal VHA documents. For published sources, see generally K. W. Kizer, "The 'New VA': A National Laboratory for Health Care Quality Management," American Journal of Medical Quality, 14/1 (1999): 3-19; E. S. Fisher and H.G. Welch, "The Future of the Department of Veterans Affairs Health Care System," Journal of the American Medical Association, 273/8 (1995): 651-667; K.W. Kizer, "Re-engineering the Veterans Healthcare System," in P. Ramsaroop and J. Ball, eds., Advances in Federal Sector Health Care (New York, NY: Springer, 2000).
7. Information contained in this section was drawn from both published sources as well as internal VHA documents. For published sources, see generally K. W. Kizer, "The 'New VA': A National Laboratory for Health Care Quality Management," American Journal of Medical Quality, 14/1 (1999): 3-19; E. S. Fisher and H.G. Welch, "The Future of the Department of Veterans Affairs Health Care System," Journal of the American Medical Association, 273/8 (1995): 651-667; K.W. Kizer, "Re-engineering the Veterans Healthcare System," in P. Ramsaroop and J. Ball, eds., Advances in Federal Sector Health Care (New York, NY: Springer, 2000).
8. Information contained in this section was drawn from both published sources as well as internal VHA documents. For published sources, see generally K. W. Kizer, "The 'New VA': A National Laboratory for Health Care Quality Management," American Journal of Medical Quality, 14/1 (1999): 3-19; E. S. Fisher and H.G. Welch, "The Future of the Department of Veterans Affairs Health Care System," Journal of the American Medical Association, 273/8 (1995): 651-667; K.W. Kizer, "Re-engineering the Veterans Healthcare System," in P. Ramsaroop and J. Ball, eds., Advances in Federal Sector Health Care (New York, NY: Springer, 2000).
9. The Department of Veterans Affairs was formed in 1988. The Department subsumed the former Veterans Administration, which was established in 1930 to consolidate most veterans' programs within a single agency. Through its two other components, the Department of Veterans Affairs administers on behalf of veterans a program for disability benefits and a national system of cemeteries.
10. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
11. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
12. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
13. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
14. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
15. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
16. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
17. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
18. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
19. Information contained in this section was drawn from a number of sources. See Paralyzed Veterans of America, The VA Responsibility on Tomorrow's National Health Care System: Strategy 2000, Washington, D.C., 1992; Mission Commission, Report of the Commission on the Future Structure of Veterans Health Care, Washington, D.C., 1991; E. S. Fisher and H.G. Welch, op. cit.; J.K. Iglehart, "Reform of the Veterans Health Care System," New England Journal of Medicine, 335/18 (1996): 1407-1411; K. W. Kizer, "Health Care, Not Hospitals: Transforming the Veterans Health Administration," in G.W. Dauphinais and C. Price, eds., Straight from the CEO (New York, NY: Simon & Schuster, 1998); S. Findlay, "Military Medicine: The Image and the Reality of Veterans' Hospitals," U.S. News & World Report (June 1992); Department of Veterans Affairs (Management Decision and Research Center), "Analysis and Recommendations for Reorganization of Veterans Health Administration," October 1993; Task Force on the Reorganization of VHA Central Office, "Veterans Health Administration Central Office Reorganization," September 1994; Northwestern University (Kellogg Graduate School of Management), "Analysis of the Organizational Structure and Management Functioning of VA's Health Delivery System, 1991; Kizer (2000), op. cit.
20. U.S. General Accounting Office, Veteran's Affairs: Progress and Challenges in Transforming Health Care, GAO/T-HEHS-99-109 9, April 1999.
21. The VHA is among the first health care organizations to conduct a comprehensive self-examination of medical errors and adverse events. The agency has also initiated several research and operational activities to reduce the frequency of medical errors and adverse event. These initiatives are serving as models for other health care organizations. See R. Pear, "Report Details Medical Errors in VA Hospitals," Sunday New York Times, December 18, 1999.
22. For a recently published book that discusses the concept, see R.M. Miles, Leading Corporate Transformation (San Francisco, CA: Jossey-Bass, 1997).
23. Veterans Health Administration, Vision for Change: A Plan to Restructure the Veterans Health Administration, Washington, D.C., February 1995.
24. Veterans Health Administration, Prescription for Change: The Strategic Principles and Objectives for Transforming the Veterans Healthcare System, Washington, D.C., January 1996; Veterans Health Administration, Journey for Change, Washington, D.C., April 1997.
25. Veterans Health Administration, Prescription for Change: The Strategic Principles and Objectives for Transforming the Veterans Healthcare System, Washington, D.C., January 1996; Veterans Health Administration, Journey for Change, Washington, D.C., April 1997.
26. See T.J. Larkin and S. Larkin, "Reaching and Changing Frontline Employees," Harvard Business Review, 74/3 (May/June 1996): 95-104; S. Wetlaufer, "Driving Change: An Interview with Ford Motor Company's Jacques Nasser," Harvard Business Review, 77/2 (March/April 1999): 76-88.
27. See T.J. Larkin and S. Larkin, "Reaching and Changing Frontline Employees," Harvard Business Review, 74/3 (May/June 1996): 95-104; S. Wetlaufer, "Driving Change: An Interview with Ford Motor Company's Jacques Nasser," Harvard Business Review, 77/2 (March/April 1999): 76-88.
28. U.S. General Accounting Office, Major Management Challenges and Program Risks: Department of Veterans Affairs, GAO/OCG-99-15, January 1999.
29. See, generally, L. E. Greiner, "Patterns of Organizational Change," Harvard Business Review, 45/3 (May/June 1967): 119-128; M. Beer, R.A. Eisenstadt and B. Spector, The Critical Path to Corporate Renewal (Boston, MA: Harvard Business School Press, 1990); D.A. Nadler, R.B. Shaw, and A.E. Walton, eds., Discontinuous Change (San Francisco, CA: Jossey-Bass, 1995); R.K. Reger, L.T. Gustafson, S. M. Demarie, and J. Mullane, "Refraining the Organization: Why Implementing Total Quality Is Easier Said Than Done," Academy of Management Journal, 19/3 (1994): 565-584.
30. See, generally, L. E. Greiner, "Patterns of Organizational Change," Harvard Business Review, 45/3 (May/June 1967): 119-128; M. Beer, R.A. Eisenstadt and B. Spector, The Critical Path to Corporate Renewal (Boston, MA: Harvard Business School Press, 1990); D.A. Nadler, R.B. Shaw, and A.E. Walton, eds., Discontinuous Change (San Francisco, CA: Jossey-Bass, 1995); R.K. Reger, L.T. Gustafson, S. M. Demarie, and J. Mullane, "Refraining the Organization: Why Implementing Total Quality Is Easier Said Than Done," Academy of Management Journal, 19/3 (1994): 565-584.
31. See, generally, L. E. Greiner, "Patterns of Organizational Change," Harvard Business Review, 45/3 (May/June 1967): 119-128; M. Beer, R.A. Eisenstadt and B. Spector, The Critical Path to Corporate Renewal (Boston, MA: Harvard Business School Press, 1990); D.A. Nadler, R.B. Shaw, and A.E. Walton, eds., Discontinuous Change (San Francisco, CA: Jossey-Bass, 1995); R.K. Reger, L.T. Gustafson, S. M. Demarie, and J. Mullane, "Refraining the Organization: Why Implementing Total Quality Is Easier Said Than Done," Academy of Management Journal, 19/3 (1994): 565-584.
32. See, generally, L. E. Greiner, "Patterns of Organizational Change," Harvard Business Review, 45/3 (May/June 1967): 119-128; M. Beer, R.A. Eisenstadt and B. Spector, The Critical Path to Corporate Renewal (Boston, MA: Harvard Business School Press, 1990); D.A. Nadler, R.B. Shaw, and A.E. Walton, eds., Discontinuous Change (San Francisco, CA: Jossey-Bass, 1995); R.K. Reger, L.T. Gustafson, S. M. Demarie, and J. Mullane, "Refraining the Organization: Why Implementing Total Quality Is Easier Said Than Done," Academy of Management Journal, 19/3 (1994): 565-584.
33. The management literature recommends a number of factors that organizations should consider in addressing this issue, such as the magnitude and pace of technological and market changes in the external environment. See, generally, P. Leatt, S. Shortell, and J. Kimberly, "Organization Design," in S. Shortell and A. Kaluzny, eds., Health Care Management: Organizational Design and Behavior (Albany, NY: Delmar, 2000).
34. U.S. Senate, Minority Staff of the Committee on Veterans' Affairs, op. cit.; U.S. General Accounting Office, Major Management Challenges and Program Risks; Department of Veterans Affairs, Office of the Inspector General, Quality Management in the Department of Veterans Affairs Veterans Health Administration; Office of Healthcare Inspections, Report 8HI-A28-072, Washington, D.C., February 1998.
35. U.S. Senate, Minority Staff of the Committee on Veterans' Affairs, op. cit.; U.S. General Accounting Office, Major Management Challenges and Program Risks; Department of Veterans Affairs, Office of the Inspector General, Quality Management in the Department of Veterans Affairs Veterans Health Administration; Office of Healthcare Inspections, Report 8HI-A28-072, Washington, D.C., February 1998.
36. U.S. Senate, Minority Staff of the Committee on Veterans' Affairs, op. cit.; U.S. General Accounting Office, Major Management Challenges and Program Risks; Department of Veterans Affairs, Office of the Inspector General, Quality Management in the Department of Veterans Affairs Veterans Health Administration; Office of Healthcare Inspections, Report 8HI-A28-072, Washington, D.C., February 1998.
37. U.S. Senate, Minority Staff of the Committee on Veterans' Affairs, "Staff Report on Quality Management in the Veterans Health Administration," Department of Veterans Affairs, December 1997.