Before and After. The Impact of Implementing RO Theory

Speaker A Let's talk a little bit about to get the change management strategy. Remember, it was such a radical change. We brought together in two large conferences, people from all over the medical department, and we discussed the issues and the fine s broke out in workout groups, had them go back and understand the new concepts and the New ideas and then take those back home. Because we knew that we had to change the culture if we're going to affect this kind of change across the entire system. And so that was part of our cultural change, probably as important as it.

Speaker B Was to but we educated everybody to what the empirical theory was, the methodology. So people understood the methodology. We then laid out very systematically a process for us as a team where we identified internal and external stakeholders and educated all those stakeholders and introduced them to the methodology in a plain, simple way, but also had them lay out what their respective concerns were when it got and so that as the process went, everyone was involved and there was no need to, at the end, do a big sell. Everybody had been involved all along. They participated in their ideas, had been part of it. We did have a major challenge, a lot of work went into what we were going to do with the internal stakeholders because we were forcing them to change the way they had worked for 2030 years. They had worked in stovepipes, they had worked in their very small, kind of almost clickish way and now say that they were going to be part of a bigger team in a different way was quite a big challenge for them, big surprise. So we brought them together in these big meetings, said to them, no doubt we will form these new teams. That is not to be discussed, that is not going to be negotiated. So with that premise we're giving you, we expect you to come back to us with what the smartest way is to form these new teams using this methodology as a basis to in the best way rationalize it to everybody. What are the team looks like, what is the work that's going to be done by each person in the team? What are going to be the products and how is that going to then be communicated and received by the various clients of your work? And in fact in those two large meetings we vary with a lot, a lot of effort. We're able to achieve that and bring it back to implement the process.

Speaker A And I think that we were able to achieve those kinds of reductions and get acceptance and implement that program. And it took us three years from start to finish in this particular process. But it's interesting as I look back now on the army, it is the only part of the army that has continued to have that model since the early ninety s. The rest of the army has gone through a series of changes. That model estate and it's still the model today. There's been some minor changes in some of the places, but basically that command is still functioning that way. The headquarters is still about the same size. The kinds of things we put in are still there and they have coped with this new Gulf War and a number of different things.

Speaker B Well, that's really because we put in place, from what we had before, the kind of organization, as I said, that had all 38 hospitals, sort of all of them actually answering directly to the commander in San Antonio. They were not organized in any kind of regional way or clusters. We had some research command and we had various activities, but not in a way that you'd say, well, it really makes a lot of sense. We know where we're going in the new organization. We came out and had one commander who also advised chief staff of the army. We set up regions. Those regional commanders then respectively answered to the medical command commander, the senior commander. We also put in place a new organization. We said one of the functions that everyone has looked at the army medical Department to is preventive medicine, public health and health promotion. In fact, in a military preventive medicine, health promotion may be one of its most important functions. So we set up a separate command. That command has really been really important in this Gulf War because they have gathered all sorts of information very early on, much earlier than any other conflict that we've been on. What's been the medical and health impact of this particular operation for us?

Speaker A And remember, we also, because we knew that the system would consume all healthcare dollars, we separately funded health promotion and wellness away from the traditional delivery because we knew that in times of scarce resources they would be cut, be the first to go. And that still stands and I think it's a testimony to that structure that it's still in place today and performing well. And the dilemma with health preventative medicine is that you don't see the immediate outcome because you're preventing something. And so it's the notion that it's very difficult to deal with, but so that's still there. And it's interesting to see that 15.

Speaker B Years, it's really robust. I mean, they're producing all sorts of information.