JULY / AUGUST 2005

HARVARD MACY

Embracing change—again and again and again—at the Harvard Macy Institute

In the early 1960s, a thin unassuming book entitled The Structure of Scientific Revolutions launched a small revolution of its own, inspiring its readers to reconsider the subject of change. The author, Thomas Kuhn, argued that science does not evolve gradually toward truth, but instead undergoes periodic revolutions which he called “paradigm shifts.” A paradigm shift, he explained, occurred when “normal science” was confronted with an anomaly, leading to a crisis of questioning and rethinking. This, he wrote, was how scientific revolutions—and the innovations that resulted—got started. It was a new definition of change.

In June, at the Harvard Macy Institute’s Program for Leaders in the Health Professions, leaders in academic medicine gathered for five days of interactive discussions and activities focused on developing their ability to create and sustain organizational change. The program is an opportunity to gather new perspectives on leading change from others who have faced or are facing the same challenges, and to develop strategies for translating goals and objectives into action plans.

An underlying assumption of the program and its participants is that everyone who attends is already on board with the idea of change. They all agree: we must embrace change. However, the program also emphasizes that today’s new idea is tomorrow’s status quo.

A new paradigm
Clayton Christensen, who co-directs the leadership course, is part of a cohort of professors from the Harvard Business School who bring their insights and experiences to the program. For many of the Harvard Macy scholars, the use of classic management cases and other thinking from the business world poses a challenge that cuts straight to the heart of their assumptions about the “values” related to the medical profession. On the program’s final day, responding to a question that was rooted in just that kind of ambivalence, Christensen invoked Kuhn’s theory of scientific revolutions, including the familiar term coined by the author.

Elizabeth G. Armstrong: “Looking at health care from a business perspective allows us to figure out how to serve more patients, how to serve them better, and ultimately, how to make continuous evaluation and improvement part of the health care culture —change as a constant.”

“It doesn’t matter if business and medicine are different. This [program] gives me a good opportunity to look at problems from a different point of view—inside a new paradigm,” said Christensen. He went on to explain how one’s unflinching belief in one paradigm—that is, today’s accepted wisdom, what used to be a new, disruptive idea—can prevent one from seeing the new paradigms that come along to replace it. In the business world, this is how companies lose their competitive edge. For the medical professionals at the Harvard Macy Institute, it gets at the question of why it is so difficult to bring about improvements in health care and patient services.

“One of the major questions this course asks is why is it so hard for health care organizations to change, even when we discover easier and more cost-efficient ways to accomplish our goals,” said Elizabeth G. Armstrong, PhD, the director of the Harvard Macy Institute. “The contributions from Professor Christensen and others who are examining issues with a business model approach offer the Harvard Macy scholars a new paradigm that enables them to overcome their assumptions about the differences between business and medicine, and identify the similarities between the fields that can help us improve health care delivery and better educate medical students.”

Patients and profits
An oft repeated slogan, usually attributed to the president of a hospital affiliated with Harvard Medical School, goes like this: “If there is no profit, there is no mission.” The initial reaction to the statement might be negative, but a second look reveals that the president of this hospital is not saying that profit is the mission of his hospital, but rather that the two ideas cannot be so easily separated.

Four decades after its publication, Kuhn’s study of scientific innovation still holds lessons for leaders of change.

“It’s important to think about how profitable organizations thrive. In essence, high-performing organizations, whether they manufacture automobiles or treat patients, succeed for the same reasons. They create efficiency, manage costs, make informed decisions, work to identify and solve problems, and invest in their people,” said Armstrong. “Looking at health care from a business perspective allows us to figure out how to serve more patients, how to serve them better, and ultimately, how to make continuous evaluation and improvement part of the health care culture—change as a constant.”

Christensen agreed, emphasizing that leadership is about the ability to serve customers and solve problems—two major factors that lead, in the best case scenario, to an organization’s profitability. “When a health care organization allows problems to persist, and works around them, then those health care organizations become money-centered, he said. “Health care organizations that solve the consumers’ problems never have money problems.”

Copyright 2006 Harvard Medical International