Are we paving cowpaths

I am pleased to have the opportunity to comment on "Downsizing, Reengineering, and Restructuring: Long-Term Implications for Healthcare Organizations." I would also like to share some of my thoughts as a healthcare executive who has had to select the best tools to help restructure my organization, the University of Michigan Medical Center. I agree with the premise of the article that the concepts of downsizing, reengineering, and restructuring are poorly understood, are often used interchangeably, and may fail to achieve the desired change results. As Joseph Juran (1994) pointed out in an interview in Quality Progress, "Our society is mesmerized by buzzwords, such as reengineering or excellence. Often these words are new labels for old, well known concepts." The terms put forward by consultants, writers, or the press sound tempting and full of promise. For belabored executives fighting to survive, these "instant puddings," as W. Edwards Deming used to call them, sound wonderful (1992, 126). Encouraged by the promise, poorly developed plans for organizational improvement are implemented, generating poor to mixed results. As the authors indicate, with the magnitude of change in healthcare organizations today, executives cannot afford to implement ineffective change programs. The organizational transformation agenda typically includes downsizing, overhead reduction, employee empowerment, process redesign, and portfolio rationalization. As important as these initiatives are, their accomplishments can neither restore a company to industry leadership nor ensure that it intercepts the future (Prahalad and Hamel 1994). Organizations that wish to ensure their continued success use strategies that allow them to become smaller, better, and different. They challenge the core business strategy and its applicability for both the present and the future. We know that any medicine, no matter how promising, may have side effects. Just as the physician must weigh the potential risks and benefits of a medicine, it is the responsibility of leadership to analyze the potential side effects of organizational change and to prescribe those interventions with the least amount of risk. Merely following the latest fad-without a full assessment of the impact on operations, customer satisfaction, organizational culture, and level of trust-is a recipe for disaster. In my view, any organizational change process begins with an assessment of consistency with the mission, vision, and values of the organization. Questions to be explored at the executive level include: Does the change process enhance the organization's ability to achieve existing key goals and objectives? Is the pain of the change process worth the projected outcomes? Does the process allow quick and effective responses to the changing marketplace? Does the change process maintain productivity and enhance creativity and innovation? Are cost savings real? Will this process enhance our ability to compete? Will the changes enhance customer satisfaction? Will the changes allow development of new lines of business and areas of revenue expansion? Leatt et al. note that North American industries in the 1980s and 1990s were affected by the emerging global marketplace, which began to change customer expectations, placing organizations at greater risk. For example, customers today have access to an instant worldwide market. The Internet brings information about new products and services directly into the home on a real-time basis. Competition for customers is fierce, and any variation in price, value, service, or new technology may shift customer loyalty very quickly. Organizations must produce products or services better, faster, and cheaper than the competition. Because it is necessary to produce value for customers, organizations that decide to attack their cost structure must also focus on how they will exceed customer expectations, or their cost-cutting efforts may be in vain. …