A strong impetus to change is needed to engage both leadership and staff in a transformation process. Impetus appears outside the organization to emphasize external pressures for change that often are strongest. But in some cases, impetus for change comes from within the organization, and often was stimulated by multiple factors.
Regardless of its source or nature, the impetus to change has to be sustained within the organization to motivate and engage staff in ongoing change efforts.
The Pursuing Perfection (P2) grant was a major driving force behind Site X’s improvement efforts. While most systems had well-defined improvement programs in place by the time that P2 began, the program brought renewed focus. For systems with serious financial challenges, P2 funding contributed importantly to their improvement efforts. For all P2 systems, however, the prestige and visibility engendered by P2 seemed more important than the financial gain. As one senior manager in Site F said,
“Pursuing Perfection gives legitimacy to the [clinical improvement] efforts… by building a coalition of people… and hopefully having a lasting impact. It provides a focus and gives a framework for changing culture in different parts of the organization… P2 challenges us to think about the next level. We are better thinkers than before…”
In Site I, the impetus was the recognition by system leaders that organizational performance had plateaued and that the Baldrige Award criteria provided a framework for linking clinical improvement efforts with the organization's business strategy. The Baldrige application process, with its deadlines and feedback opportunities, also created a powerful urgency to change.
In Site J, medical errors created urgency. The institution was stunned when one of its own physicians suffered a medication error while undergoing treatment. This sentinel event spurred the leadership to action.