| The purpose of the research was to study system-wide organizational transformation and the long-term competitive advantage gained from implementing quality improvement methods. The drivers of the change, the change process, and outcomes of the transformation were evaluated.; This study focused on the role of key organizational components (Leadership, Strategy, Structure, Organizational Culture, Human Resources, and Process) on the change process. The alignment of the components with the objectives of the change was described and analyzed. The organizational transformation was studied in the context of Kurt Lewin's organizational change model, Katz & Kahn's Open Systems Theory, and the principles of Quality Improvement as described by the founders of the movement: W. Edwards Deming, Kaoru Ishikawa, and Joseph Juran.; Data were obtained and analyzed from semi-structured interviews with staff, middle and senior managers and board members; archival documents, as well as non-participant observation. The documents reviewed were from five years before to five years after initiation of the change process. Census and per visit data obtained from Medicare Cost Reports were reviewed and compared. The JCAHO accreditation process was examined as a driver of the change, vehicle of the change, and outcome of the change process. Barriers and resistors to the change were identified and interventions implemented. Drivers and facilitators were strengthened to move the change forward. These strategies were critical to the success of the change process.; Desired outcomes from the transformation were compared with actual outcomes. Outcomes achieved include increased market share (census and number of visits), increased revenues, expansion and centralization of community-based services, standardization through sharing of best practices and improved patient-focused care, transparent communications, formalized performance improvement processes including best practices, and increased use of telemetry.; This study examined the change process at a home health care organization: what drove the change, how they approached the change process, how the change worked, and what were the strengths and weaknesses of the approach taken. Results demonstrate that to maintain competitive advantage, it is the confluence and synergy of these components that will produce and sustain the change once the requisite systems and methods are institutionalized. |
