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Change Management: Learnings from Virgina Mason Institute

Ellen Godfrey

I recently attended an Executive Leadership Seminar presented by the Virginia Mason Institute, one of the leaders in the U.S. in creating cultural transformation in an organization.

Some background

Virginia Mason is a U.S. not-for-profit medical centre, with 50,000 employees. In addition to running hospitals, health centres and primary care, Virginia Mason includes a research centre and an education program.

Virginiamason100-200x120The organization has been on a nine-year journey of cultural change. They have gone from being in peril of ‘disappearing’ to now being the leader in the U.S. in terms of delivering sustainable, top quality health care – they consistently combine the best patient outcomes with excellent employee satisfaction. In addition, Virginia Mason’s financial position is sound and sustainable.

Important insights

Here are some of the nuggets that struck me following an excellent 1 ½ day presentation:

  • A sense of urgency (a crisis) is a pre-requisite for cultural change.
  • If people figure out something for themselves they will believe it. Therefore, rather than telling their employees what is to be done, it is better for managers to enable people to see what needs to be done.
  • Managers need to have ‘big eyes, big ears, small mouths’.
  • The concept of ‘fair practice’ is essential. That is, if people believe that the process by which a decision or a change was made is fair, they will be more likely to accept it even if they don’t agree with it.

Several seminar speakers cited Kotter’s eight steps for successful large scale change - my comments follow in italics:

  1. Increase Urgency - in fact, without a sense of crisis, true change is unlikely
  2. Build the guiding team - the team must be 100% committed to the cultural change
  3. Get the vision right
  4. Communicate for buy-in - this doesn’t mean communicate information, it means get engagement at the grass roots level
  5. Empower action - at the grass roots level
  6. Create short-term wins
  7. Don’t let up - perseverance is key to success
  8. Make change stick - by monitoring if measurable gains are sustained

Recognize the emotions

While there is nothing new here, it was instructive to see how Virginia Mason had put these principles into action, how difficult they found the journey, and how committed they were to not allowing dilution of these principles.

There was discussion about barriers to change - about people who refuse to go along and who have the power to prevent change. An insightful discussion was led by Jack Silversin of Amicus Inc, a U.S. consultancy on cultural change. In response to audience questions, Jack revealed an outstanding ability to see beneath the usual reasons cited for change-resistance and get to the deeper emotional needs and fears of those who resist. During the break, Jack told me that getting to these emotions and addressing these fears were a fundamental piece of any change process. Virginia Mason has developed a compact (.doc file) with their doctors which required a year of mutual discussion. This agreement outlines the responsibilities of Virginia Mason to their doctors - and of their doctors to Virginia Mason. The compact has been essential in enabling change in an environment where many traditions are held sacred.

The most difficult change environments?

Virginia Mason attributes most of their successes to the implementation of the ‘Lean’ management system, and a majority of the seminar was devoted to the specifics of this system. However, the underlying theme was how to implement change in a large hierarchical organization. Seminar speaker Dr. Gary Kaplan referenced literature indicating the hardest organizations to change were higher education, health, and government.

The reasons? If we accept the stated Virginia Mason view that profound change takes 8 – 10 years of single-minded, unwavering commitment from the CEO (Deputy Minister) level, we can easily see how challenging it is for public service institutions and employees who are faced with the shifting priorities and change of focus that arise from the frequent shuffle of senior managers and other high level personnel.


Ellen Godfrey holds an MA in Conflict Analysis and Management and is a senior consultant at Delta Partners. She is currently on the board of the Vancouver Island Health Authority where lean design initiatives are profoundly improving health outcomes. Ellen brings 30 years of experience in leadership in the public and private sectors – having won a Canada medal for innovation in working with a worldwide, Fortune 100 clientele – to her views of change management.


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Posted by Ellen Godfrey
Posted on July 23, 2010

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Categories: change management, lessons learned, organizational development