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Eight Critical Sequential Stages to ARRA

December 10, 2009
by Joe Bormel
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Leaders who successfully transform businesses do eight things right . . . and they do them in the right order

So begins John P. Kotter's classic article, Leading Change, Why Transformation Efforts Fail.

Their efforts have gone under many banners: total quality management, reengineering, right-sizing, restructuring, cultural change, and turnaround. But in almost every case the basic goal has been the same: to make fundamental changes in how business is conducted in order to help cope with a new, more challenging market environment. A few of these corporate change efforts have been very successful. A few have been utter failures. Most fall somewhere in between, with a distinct tilt toward the lower end of the scale. The lessons that can be drawn are interesting and will probably be relevant to even more organizations in the increasingly competitive business environment of the coming decade.

For your convenience, I've pasted the Stages, Actions Needed and Pitfalls at the end of this. The concern I had when re-reading Kotter in light of the ARRA/HITECH provisions with their MU and C components, is that the government has probably already done almost everything it can to establish the urgency. Given the fundamental stakeholder issues in our political system, it seems unreasonable, unwise, or both, to ask for anything more. It also seems to me that stages two through four, Coalitions, Visioning and Communication are all stages where we have strong industry leadership and exemplars. It is each of the subsequent stages where I see ARRA and the work to achieve the 2011, 2013 and 2015 capability/performance milestones getting derailed. For example, short term wins for us and those we lead. Note: The stimulus dollars are a win, but a short-term win. Similarly, many of us, including the ONC's Dr. Blumenthal, have identified the unintented consequences that certifaction is having, negatively impacting usability. For my deeper thoughts on that topic, i.e. defering usability enhancements potentially being necessary, go to my post on Non-Goals (of ARRA).

Does anyone else see this disconnect between our shared strategy for HCIT-enabled improvement of the healthcare system and its processes, and our current stakeholder model, beyond the good work of the political system to drive the dialogue and support the funding that gets us started through these stages?


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