The reality is that most change efforts fail. McKinsey & Company carried out a fascinating research project on change to "crack the code" on creating and managing change in large organizations. One of the questions they asked--and answered--is why most organizations fail in their efforts to manage change. They found that 80 percent of these failures could be traced to 13 common errors. They are: (1) No winning strategy; (2) failure to make a compelling and urgent case for change; (3) failure to distinguish between decision-driven and behavior-dependent change; (4) over-reliance on structure and systems to change behavior; (5) lack of skills and resources; (6) failure to experiment; (7) leaders' inability or unwillingness to confront how they and their roles must change; (8) failure to mobilize and engage pivotal groups; (9) failure to understand and shape the informal organization; (10) inability to integrate and align all the initiatives; (11) no performance focus; (12) excessively open-ended process; and (13) failure to make the whole process transparent and meaningful to individuals.

Humans↗

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Just row.

To learn anything outside of our usual experience is to try on a new way of being. Doing something new--dealing with change--calls for a commitment to be where you are, to be present in the experiment, even while you are uncertain about the outcome. Being present and committed to the moment is as essential in management or self-management as it is in rowing a boat. How, for instance, can you tell the difference between intuition and fear? In the midst of a crisis, a change, a white water passage, a "learning opportunity," what if you get this gut feeling that something is wrong? If the feeling goes away when you drop into the present, into your body, and "just row," it's not an intuition, it's fear. The opportunity is to know the difference between opinion and intuition, between judgments and experience. Because judgments and opinions carry extraordinarily high price tags.

Fear↗

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In the mush.

Approaching change, we cannot really know who we will be when we come out the other side. We can envision, plan, and sed goals, and these exercises will make a difference in how the process turns out, but we can never know exactly. When we have come through a profound change, we will have difficulty remembering how we could ever have been anything else. In the midst of profound change, we cannot see with certainty how it will turn out. We are "in the mush." Every change creates a need for learning. This change-induced learning has four phases: (1) Unconscious incompetence, (2) conscious incompetence, (3) conscious competence, and (4) unconscious competence. Health care--not just the industry, but the whole way in which we manage our health, our birth and death, our wellness and comfort--is at or approaching not just one strategic inflection point, but several at once. Physician executives need to guess correctly about this strategic inflection point, and position themselves and their organizations to take advantage of it.

Delivery of Health Care↗

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The water is wide.

Trying to predict what cardiology will look like in 10, 25, or 50 years is an almost absurd act of imagination. Perhaps even more than most branches of medicine, it has been changing so fast that it is hard to recognize from year to year. When we contemplate the changes that cardiology and the rest of health care are facing, we know that none of these changes will ever be "just technical." They will all be deeply human, and each one will be very difficult for some people. As people and organizations, we all come to that point where we have to change. Where we are is not working, we can't go on like this, we have to do something different. After boldly setting off to go someplace new, after some basic work is done to escape the original presenting problem--we reach the Great River. This is a point at which small, incremental changes won't do and we truly need to see ourselves differently. There is no bridge, no easy way across. This is where we must gather our resources and courage, remind ourselves of why we came this far. Yet many of us don't, and settle for something comfortable rather than cross that wide, turbulent river.

Cardiology↗

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In an era of change ... we're changing!

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American Hospital Association↗

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The way it is, is not the way it will be.

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Allergy and Immunology↗

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You gotta have heart: the future of cardiology.

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Biotechnology↗

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Living in the question.

We live in a fast moving-world. Business has accelerated to breathtaking speeds in the 1990s--and in the last few years the afterburner has really kicked in. The speed of change is overwhelming. Especially in health care, who has time to "live in the question?" We need to decide things quickly, get the decision out of the way, and move on, right? Maybe. Biology shows us that you can't plan ahead very far. New things come along that you don't even have a category for, and therefore you don't even see them. Things are going to happen that you literally have no notion are even possible. The key to succeeding in this environment? Don't plan ahead. Stay curious. Make small bets. Build organizational hothouses. Feed the seedlings that grow. The challenge is to remain curious, to live in the question, both personally and organizationally.

Creativity↗