# Transformation: A Strategy for Reform of Organizations and Systems

# Contents

[Definition of Transformation 3](#__RefHeading___Toc93822507)

[**Transformation Theorists** **6**](#transformation-theorists)

[***Lewin's Model*** **7**](#lewins-model)

[***Kuhn's Paradigm Shift*** **7**](#kuhns-paradigm-shift)

[Key Elements in the Transformation Process
8](#__RefHeading___Toc93822511)

[***Vision*** **8**](#vision)

[***Leadership*** **9**](#leadership)

[***Alignment*** **11**](#alignment)

[***Culture*** **12**](#culture)

[***Continual Process*** **13**](#continual-process)

[Challenges and Lessons Learned 13](#challenges-and-lessons-learned)

[***Frequent Barriers*** **14**](#frequent-barriers)

[***Guidelines Based on Experience***
**15**](#__RefHeading___Toc93822519)

[**Outcomes of Transformation** **16**](#outcomes-of-transformation)

[References 18](#__RefHeading___Toc93822522)

#   {#section .unnumbered}

# Transformation: A Strategy for Reform of Organizations and Systems

Transformation, a complex, revolutionary, and continuous process,
demands fundamental changes in the organizational structures and systems
through which products are developed and services are delivered. In this
process, laws often must be modified; norms and values, reassessed; and
systems of service delivery and finance, changed. In addition, those
involved in carrying out the changes as well as those who will benefit
from it must be reeducated to acquire and apply new knowledge needed for
the transformation. Guided by visionary leadership, transformative
change can gather momentum until it reaches "a tipping point" where it
will spread like an epidemic throughout the many intertwined systems and
dramatically alter how organizations and systems operate (Gladwell,
2000).

Fundamental system change is occurring throughout the public and private
sectors. Industries and businesses, with clear financial incentives to
improve profits and stay abreast of new consumer demand, led the
transformation charge by rethinking outmoded ways of generating products
and serving customers. Their efforts focus on increasing market share by
such methods as improving efficiency in processes, employing the latest
computer technologies, and listening to what customers really are asking
for. Federal and State Governments have begun similar efforts to
transform their operations and the quality of services delivered. Major
system changes in health service delivery are underway, and mental
health service system transformation is a top national priority. Through
these type of efforts, all Americans benefit and enjoy more rapid access
to information, lower costs for many products and services, and an
enhanced focus on needs of the customer.

This overview outlines fundamental concepts of systemic and
organizational change and transformation's key elements. It highlights
some relevant examples of transformation efforts and addresses frequent
challenges, including lessons learned. The purpose is to provide a
common conceptual understanding to individuals who are planning or are
involved in transformative change initiatives.

[]{#__RefHeading___Toc93822507 .anchor}**Definition of Transformation**

Although a dictionary definition of transformation -- an act, process,
or instance of transforming or being transformed -- may appear
straightforward, modern theorists have spent decades conceptualizing and
describing the complex and unpredictable processes involved in
transformation. They have examined transformation as it relates to
changing the composition, outward form, or character of living things
and inert objects as well as the systems that organize life in our
communities and Nation. Research suggests that successful, large-scale
transformation requires integration and change in structure, process,
and pattern (Institute for Healthcare Improvement, 2004). It involves
forward-thinking, not, as one expert observed, looking backward at
reform (Barger, 2004). Transformation is meant to identify, leverage,
and even create new underlying principles for the way things are done.
It also seeks to identify and leverage new sources of power (Cebrowski,
2002<http://www.oft.osd.mil/library/library_files/trends_164_transformation_trends_28_october_issue.pdf>).

In recent years, varying types and degrees of systemic change have
become commonplace in the public and private sectors. As one expert
notes, "the scope of change being undertaken by companies can be placed
on a continuum, with incremental change at one extreme and radical
(neutron bomb), clean-slate transformation at the other" (At Jasper
Associates \[AJA\], n.d.,
[www.aja4hr.com/services/organisational_capability_assessment.shtml](http://www.aja4hr.com/services/organisational_capability_assessment.shtml)).
Another writer contrasts change with transformation. "Change itself is
not enough. Change is merely a variation of a situation, repetitive and
cyclical in nature, while transformation is an alteration of its
essence. Transformation assumes the need for a fundamental shift to
another level of thought and action, a change in consciousness" (Neal &
Conhaim, n.d.,
[www.heartlandinstitute.com/\_pdf/Moving%20Beyond%20Change.doc](http://www.heartlandinstitute.com/_pdf/Moving Beyond Change.doc)).

Although several terms associated with major organizational or systemic
change are used interchangeably with transformation, these do not convey
the full vision the transformation process. Some of these terms -- total
quality management or total quality improvement, reengineering, right
sizing, and restructuring -- refer to methods for affecting change;
however, they imply less-sweeping change than the term transformation.
Even reform -- often used to describe major change --does not connote
the more revolutionary characteristics of transformation (Mazade, 2004).

Selected examples of closely related terms and their definitions follow.

-   *Reinvention.* Reinvention implies "something tantamount to changing
    the very 'DNA' of public organizations so that they habitually
    innovate" In this process they are continually improving their
    performance without having to be pushed from the outside.
    Reinvention means building an entrepreneurial organization with a
    built-in drive to improve or "what some would call a self-renewing
    system."(Osbourne & Plastrik, 1997).

-   *Redesign.* "Enterprise redesign" also is depicted as revolutionary
    rather than evolutionary. Related to organizational development,
    redesign usually requires devising a new strategic vision and
    competitive strategy, with the concomitant development of entirely
    new business processes (AJA, 2004,
    <http://www.aja4hr.com/services/organisational_capability_assessment.shtml>).

Stephen Haines (2004) describes how transformative change is
fundamentally different than other change processes:

-   It results in a major structural and fundamental impact on the
    entire organization;

-   It is complex and chaotic in nature or will constitute a radical
    departure from the current state, and is so complex that desired
    outcomes and approaches to achieve them may be unclear;

-   The scale of desired change is large and will result in a
    significantly different enterprise;

-   It requires years to complete, with multiple phases and stages of
    major changes;

-   The rules of the game change, including the norms, guideposts,
    values, and guides to behavior.

Thus, while organizations and systems may have initiated change in the
past, those that undertake transformation face a significantly more
complex and challenging journey. However, the potential rewards of the
transformation efforts can exceed dramatically those achieved by more
limited changes. (See box, this page.)

## Transformation Theorists

The current concepts of organizational and systems transformation derive
from many theoretical frameworks, including work in organizational
psychology. Two leading theorists, Kurt Lewin and Thomas Kuhn, provide
helpful conceptual frameworks for those embarking on transformation
efforts.

### *Lewin's Model* 

Social scientist Kurt Lewin, combining the theories of sociology and
psychology, developed a three-stage model for large-scale system change.
The stages are: (1) "unfreezing," or opening up and examining the
patterns of norms, values, and beliefs that hold a system together and
discussing concerns about change; (2) "moving," or planning and
implementing the change process, while continuing the ongoing and
transparent communication within the system; and (3) "freezing," or
consolidating and integrating the changes to establish a new
\"quasi-stationary\" equilibrium of the system and prevent reversion to
the old ways of doing things. According to Lewin, social system change
is not a steady, ongoing process, but rather occurs in spurts consisting
of alternating periods of movement and standing still. Lewin suggests:
(1) social systems, in contrast to physical systems, cannot be changed
directly, but have to be prepared for change and movement; and (2) a
social change process has to be followed by consolidation and
integration, providing a new state of balance and a new sense of
\"normality\" and predictability (AJA n.d.-A,
<http://www.aja4hr.com/services/change_management.shtml>).

### *Kuhn's Paradigm Shift* 

Thomas Kuhn captured the essence of revolutionary system change when he
came up with the term "paradigm shift" in his 1962 landmark work,
*Structure of Scientific Revolutions.* Originally a description of the
scientific process and later expanded to encompass many domains, the
term paradigm shift describes the process and result of a change that
implies a total revolution in theory or worldview (Wikipedia n.d.,
<http://en.wikipedia.org/wiki/Paradigm_shift>). Questioning the
traditional view of scientific progress as a gradual, cumulative
acquisition of knowledge, Kuhn held that when the scientific world
amasses sufficient evidence that contradicts its current theories and
methods, science is thrown into a crisis. As a result of this
"intellectual revolution,"a new paradigm is formed (Wikipedia,
<http://en.wikipedia.org/wiki/Paradigm_shift>). Paradigm shift is the
colloquial term frequently used to describe this often radical change of
worldview (Wikipedia, <http://en.wikipedia.org/wiki/Paradigm_shift>).
This shift alters the fundamental concepts underlying research and
inspires new standards of evidence, new research techniques, and new
pathways of theory and experiment (Brown, Crawford, & Hicks, 2003,
<http://www.mcgraw-hill.co.uk/openup/chapters/033521164X.pdf>).

[]{#__RefHeading___Toc93822511 .anchor}**Key Elements in the
Transformation Process**

Experts have defined five elements, highlighted below, as essential for
orchestrating large-scale, transformative change.

### *Vision*

A clear and compelling vision is a key ingredient for successful
transformation. Developing a vision requires defining a "perfect world"
and clear principles to guide the transformation effort (Society for
Technical Communiction \[STC\] 2004). It should constitute a shared
image for a desired future state -- not a strategic plan, but the
inspiration that will motivate people to create such a plan and
willingly make the special effort to achieve it (Sugarman, 2000,
<http://www.solonline.org/repository/download/SugarmanReport.pdf?item_id=357321>).

As Kotter (1996,
[http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/viewFileNavBean.jhtml](http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/viewFileNavBean.jhtml  ))
explains, a successful vision encompasses a sense of urgency to overcome
stakeholder complacency. A well-defined vision clarifies the general
direction for change, motivates people to take action in the right
direction, and helps coordinate people\'s actions. To assess the
effectiveness of a vision, planners may want to ask: Is it imaginable,
desirable, feasible, focused, flexible, and communicable?

### *Leadership* 

Transformation efforts require exceptional leadership abilities. Leaders
must have both the capability to formulate a compelling vision and the
skills to organize and manage the change processes. These skills may
reside in more than one person. In addition to developing and
communicating the vision, the leadership's responsibilities involve
developing a coherent transformation plan, maintaining a focus on key
transformation goals, and managing external changes to complement
internal ones (Kotter, 1996,
[http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/viewFileNavBean.jhtml](http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/viewFileNavBean.jhtml )).

A transformative leader can "guide, direct, and influence others to
bring about a fundamental change not only of the external world but also
of internal processes" (Jahan, 2003,
<http://www.capwip.org/resources/womparlconf2000/downloads/jahan1.pdf>).

In transformation, Cebrowski (2004) notes that leadership plays a
fundamental role by creating a vision of the future as well as inspiring
people regarding their place in that future. He states, "If the senior
leaders do not own transformation, there is no sense in pursuing it."
These executives do not necessarily have to declare that they own
transformation, but they should convey that transformation is part of
the entire organizational strategy in which each employee is involved.
Leadership must establish an incentive structure that will maximize good
management, encourage exploratory jumps, and harness resources to
empower "big jumps." (See box, previous page.).

Bernard Bass (1990) describes "transformation leadership," whereby a
leader transforms, or changes, followers by increasing their awareness
of the need to perform tasks well, making them aware of their needs for
personal growth and accomplishment, and motivating them to work for the
good of the organization instead of just their own personal gain. At
least three stages of change management demand transformational
leadership: motivating changes in behavior and overcoming resistance;
managing the transition to ensure control; and shaping the political
dynamics so that power centers develop that support change (Nadler,
1983).

### *Alignment*

A system's structures and processes must be aligned with the idealized
vision in order for relevant persons, organizations, and systems to
participate in the transformation process. (STC, 2004,
<http://www.stc.org/transformation/article6.asp>).

According to *Crossing the Quality Chasm: A New Health System for the
21^st^ Century* (National Academy Press, 2001,
<http://www.nap.edu/execsumm/0309072808.html>), four strategies are
required for large-scale alignment: finance reform; retraining of human
resources; developing performance measures and information technology;
and identification and implementation of evidence-based practices.
Similarly, Durant (2004) recommends that administrative, responsibility,
and accounting structures be aligned and that central administrative
units do not undermine the change strategy. Kotter, (1996,
<http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/viewFileNavBean.jhtml>)
underscores the power of systemic structures working in concert with
empowered employees, stating that:

Discouraged and disempowered employees never make enterprises winners in
a globalizing economic environment. But with the right structure,
training, systems, and supervisors to build on a well-communicated
vision, increasing numbers of firms are finding that they can tap an
enormous source of power to improve organizational performance. They can
mobilize hundreds or thousands of people to help provide leadership to
produce needed changes.

### *Culture*

As defined by Kotter (1996), "Culture refers to norms of behavior and
shared values among a group of people." In large organizations, a
variety of social forces affect everyone; these forces comprise the
corporate culture. He states that corporate culture has a significant
influence on human behavior, noting culture is difficult to change and
essentially invisible. Kotter believes that organizational culture is
powerful because: (1) individuals are selected and indoctrinated so
well; (2) the culture exerts itself through the actions of hundreds or
thousands of people; (3) the effects happen without conscious intent and
thus are difficult to challenge or even discuss. Despite the challenges,
visionary leaders do spearhead cultural change within their systems.
Cebrowski (2002,
<http://www.oft.osd.mil/library/library_files/trends_164_transformation_trends_28_october_issue.pdf>)
recommends that leaders of transformation efforts realize success hinges
on creating a culture of innovation that encourages and rewards those
who embrace innovative risks.

### *Continual Process*

According to Durant (2004) it is important to understand that
transformation is an ongoing and permanent campaign. Cebrowki (2003)
adds that change processes, "whether or not they...have a preconceived
end point, are intended to create or anticipate the future and to
simultaneously deal with the co-evolution of concepts, processes,
organizations, and technologies wherein change in any one of these
necessitates change in all."

## Challenges and Lessons Learned 

A variety of potential obstacles may immediately or eventually impede
the transformative process. Some of these obstacles result from inaction
by key parties. Such obstacles include the lack of a clear vision;
nonexistent or poor leadership; lack of critical mass; lack of parties'
incentives to move forward; and lack of participation. (Spodark, 2003,
<http://www.thejournal.com/magazine/vault/A4344.cfm>). Stakeholders may
be hesitant to move forward due to fear of the unknown; the view that
there is no need to change; and fear of a failed attempt to transform.
(Hagner, 2000,
[http://www.educause.edu/LibraryDetailPage/666&ID=NLI0011](http://www.educause.edu/LibraryDetailPage/666&ID=NLI0011 )).

### *Frequent Barriers*

Haines et al. (2004) suggest that the three primary reasons large-scale
change efforts fail are: (1) an analytic, piecemeal approach to
system-wide problems (with multiple conflicting frameworks and
mindsets); (2) a focus primarily on the economic alignment of delivery
(an artificial "either/or" mindset); and (3) a focus primarily on
cultural attunement and people issues (another artificial "either/or"
mind set). Senge et al. (1999) suggest the barriers encountered in
organizational transformation initiatives as: difficulty in translating
successes achieved in smaller units and applying them broadly within the
larger organization or system; and challenges in obtaining long-term,
sustained support for investing in organization- or system-wide capacity
building. Other problems may include: truncated learning (when learning
efforts are interrupted or only partially implemented); learned
helplessness (passive response exhibited by individuals, teams, and even
organizations when their efforts to take control are met with resistance
or even punishment); and tunnel vision (when people do not have the
perspective and appreciation of their connection to the whole complex
systems) (Watkins & Marsick, 1993,
<http://sll.stanford.edu/projects/tomprof/newtomprof/postings/215.html>).

[]{#__RefHeading___Toc93822519 .anchor}***Guidelines Based on
Experience***

In his *Leading Discontinuous Change: Ten Lessons from the Battlefront*,
David Lawrence, former CEO of the Kaiser Permanent Health Care System
(KP) identified the following "lessons learned" drawn from his
experiencing overseeing KP's transformation efforts. (See box this
page.) These practical guidelines can be helpful to those undertaking
similar, large-scale transformation initiatives.

1.  Do not expect people to embrace easily the need for change.

2.  Sometimes it is better to experiment than to plan.

3.  Pay close attention to the timing of change.

4.  When the need to remove people becomes clear, do not put off the
    inevitable.

5.  You cannot succeed without a senior team that thinks and acts as a
    team.

6.  Give coherence to the change process by clearly articulating a
    central mission and a consistent set of themes.

7.  Even though the content of change may be radical, the building
    process must be methodical.

8.  Think of change as a campaign that must be waged simultaneously on a
    variety of fronts.

9.  This race may not have any finish line, so keep looking for reasons
    to stop and celebrate along the way (Power, 2003,
    [www.mentalhealth.samhsa.gov/\_scripts.printpage.aspx](http://www.mentalhealth.samhsa.gov/_scripts.printpage.aspx))

## Outcomes of Transformation 

"Transformation is ultimately about newness, about new values, new
attitudes, and new beliefs," according to A. Kathryn Power, Director of
the Center for Mental Health Services, Substance Abuse and Mental Health
Services Administration. "It is about how these changes are expressed in
new behaviors of people and institutions (Power, 2004A,
<http://www.mentalhealth.samhsa.gov/newsroom/speeches/081904.asp>).
Power points out, "It is not accomplished through change on the margin
but instead, through profound changes at the core....These changes lead
to new behaviors and new competencies" (Power 2004B).

The challenge now confronting government agencies at all levels and many
private sector organizations lies in embracing the concept of
transformation. Their leaders must formulate and communicate a unique
vision for the future, offering the needed support and providing the
essential visionary and operational direction. Employing theoretical
models and practical implementation methods used in other successful
transformations, the United States can be prepared to meet the global
and national challenges confronting our society. Then, as Power points
out, we will be able to "look at what we can do now that we were unable
to do before" (Power, 2004B).

Outcomes will mean improved competitiveness in the global economy and
more effective systems for performing the essential functions of
government. Thus, by responding successfully to the challenge of
transformation, our Nation can look forward to a new reality when all
Americans can enjoy a meaningful life in their community.

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