The Woes of Implementation Practice: Getting Caught by the “Program of the Month”
Senior leaders from a large American hospital told me that they wanted their hospital to become more “patient-centric” and asked me to help them. I was hired to conduct an ethnographic study of the hospital with a team of six employees and the goal of improving patient experiences. Sixteen months later, the research was completed, effective models of hospital work practices documented, recommendations made, and 16 tools developed to improve hospital culture. Yet none of our work was implemented. I returned to my field notes to discover clues that might explain why. This article explains the process I followed, the stories that revealed unwanted messages, the transcripts that enabled sensemaking, and the program-of-the-month cycle that prevented implementation from occurring.
American Hospital Association. 2012. 'Linking quality to payment,' www.aha.org:content:13:13-linkqualpayment.pdf.
Argyris, C., R. Putnam, and D.M. Smith. 1985. Action Science: Concepts, Methods, and Skills for Research and Intervention. San Francisco, CA: Jossey-Bass.
Armenakis, A.A. and S.G. Harris 2009. 'Reflections: Our journey in organizational change research and practice,' Journal of Change Management 9(2): 127–142, June. https://doi.org/10.1080/14697010902879079
Barnett, H.G. 1953. Innovation: The Basis of Cultural Change. New York, NY: McGraw-Hill.
Beer, M. and R.A. Eisenstat. 1996. 'Developing an organization capable of implementing strategy and learning,' Human Relations 49(5): 597-619. https://doi.org/10.1177/001872679604900504
Berry, J.W. 1980. 'Acculturation as Variety of Adaptation,' In A.M. Padilla, ed., Acculturation: Theory, Models, and Some Findings. Boulder, CO: Westview Press, 9-25.
Best, J. 2006. Flavor of the Month: Why Smart People Fall for Fads. Berkeley, CA: University of California Press.
Boas. F. 1920. 'The methods of ethnology,' American Anthropologist 22(4): 311-321, October-December. https://doi.org/10.1525/aa.1920.22.4.02a00020
Boje, D.M. (1991), 'The storytelling organization: A study of performance in an office supply firm,' Administrative Science Quarterly 36(1): 106-26. https://doi.org/10.2307/2393432
Bolton, R., T. Greaves, and F. Zapata, eds. 2010. 50 a-os de antropología aplicada en el Perú: Vicos y otros experiencias. Lima, Peru: Instituto de Estudios Peruanos
Briody, E.K. and K.C. Erickson. 2017. 'Success despite the silos: System-wide innovation and collaboration,' In M. McCabe, ed., Collaborative Ethnography in Business Environments. London, UK: Taylor & Francis, 26-59.
Briody, E.K., T.M. Pester, and R.T. Trotter, II. 2012. 'A story's impact on organizational-culture change,' Journal of Organizational Change Management, 25(1): 67-87. https://doi.org/10.1108/09534811211199600
Briody, E.K., R.T. Trotter, II, and T.L. Meerwarth. 2010. Transforming Culture: Creating and Sustaining a Better Manufacturing Organization. New York, NY: Palgrave Macmillan. https://doi.org/10.1057/9780230106178
Cameron, K.S. and R.E. Quinn. 2011. Diagnosing and Changing Organizational Culture based on the Competing Values Framework. 3rd ed. San Francisco, CA: Jossey-Bass.
Cefkin, M., ed. 2010. Ethnography and the Corporate Encounter: Reflections on Research in and of Corporations. New York, NY: Berghahn Books.
Cilliers, F. and H. Greyvenstein. 2012. 'The impact of silo mentality on team identity: an organisational case study,' SA Journal of Industrial Psychology/SA Tydskrif vir Bedryfsielkunde 38(2): 1-9, Art. #993.
Closser, S. and E.P. Finley. 2016. 'A new reflexivity: Why anthropology matters in contemporary health research and practice, and how to make it matter more,' American Anthropologist 118(2): 385-390, June. https://doi.org/10.1111/aman.12532
Connell, N.A.D., Klein, J.H. and Meyer, E. (2003), "'Are you sitting comfortably? Then I'll begin (to transfer some knowledge'?) Narrative Approaches to the Transfer and Interpretation of Organisational Knowledge," Proceedings of the Knowledge Management Aston Conference 2003, Aston Business School, Birmingham, UK, 152-163, July.
Cummings, T.G. and C.G. Worley. 2015. Organization Development & Change. 10th ed., Stamford, CT: Cengage Learning.
Curtis, J.R. and S.E. Shannon. 2006. 'Transcending the silos: Toward an interdisciplinary approach to end-of-life care in the ICU,' Intensive Care Medicine 32: 15-17, DOI 10:1007/x00134-005-2865-0.
Dankowski, J.A., J. Gluesing, and K. Riopelle. 2011. 'The revolution in diffusion theory caused by new media,' In A. Vishwanath and G.A. Barnett, eds. The Diffusion of Innovations: A Communication Science Perspective. New York, NY: Peter Lang Publishing, 123-144.
Darrouzet, C., H. Wild, and S. Wilkinson. 2010. 'Participatory ethnography at work: Practicing in the puzzle palaces of a large, complex healthcare organization,' In M. Cefkin, ed. Ethnography and the Corporate Encounter: Reflections on Research in and of Corporations. New York, NY: Berghahn Books, 61-94.
Deming, W.E. 1982. Out of the Crisis: Quality, Productivity and Competitive Position. Cambridge, MA: MIT Press.
Diamond, M., S. Allcorn, and H. Stein. 2004. 'The surface of organizational boundaries: A view from psychoanalytic object relations theory,' Human Relations 57(1): 31-53. https://doi.org/10.1177/0018726704042713
Ferraro, G.P. and E.K. Briody. 2017. The Cultural Dimension of Global Business. 8th ed., London, UK: Taylor & Francis.
Fiske, S.J., L.A. Bennett, P. Ensworth, T. Redding, and K. Brondo. 2010. 'The changing face of anthropology: anthropology masters reflect on education, careers, and professional organizations,' AAA/CoPAPIA 2009 Anthropology MA Career Survey. Arlington, VA: American Anthropological Association.
Gaglio, B., S.M. Phillips, S. Heurtin-Roberts, M.A. Sanchez, and R.E. Glasgow. 2014. 'How pragmatic is it? Lessons learned using PRECIS and RE-AIM for determining pragmatic characteristics of research,' BioMed Central 9.1, https://doi.org/10.1186/s13012-014-0096-x
Geller, E.S. 2014. 'Are you a safety bully? Recognizing management methods that can do more harm than good,' Professional Safety 39-44, January.
Ginsberg, D. 2016. 'AAA members outside the academy,' 2016 Membership Survey, Report #2. Arlington, VA: American Anthropological Association, 1-15, July.
Gunn, W., T. Otto, and R.C. Smith, eds. 2013. Design Anthropology: Theory and Practice. London, UK: Bloomsbury Academic.
Herold, D.M., D.B. Fedor, and S.D. Caldwell. 2007. 'Beyond change management: A multilevel investigation of contextual and personal influences on employees' commitment to change,' Journal of Applied Psychology 92(4): 942-951. https://doi.org/10.1037/0021-9010.92.4.942
Israel, B.A., E.A. Parker, Z. Rowe, A. Salvatore, M. Minkler, J. López, A. Butz, A. Mosley, L. Coates, G. Lambert, P.A. Potito, B. Brenner, M. Rivera, H. Romero, B. Thompson, G. Coronado, and S. Halstead. 2005. 'Community-based participatory research: Lessons learned from the Centers for Children's Environmental Health and Disease Prevention Research,' Environmental Health Perspectives 113(10): 1463-1371, October. https://doi.org/10.1289/ehp.7675
Jordan, A.T. 1996. 'Critical incident story creation and culture formation in a self-directed work team,' Journal of Organizational Change Management 9(5): 27-35. https://doi.org/10.1108/09534819610128779
Kennedy, D.M., R. Didehban, and J.P. Fasolino. 2014. 'Creating and sustaining a culture of accountability for patient experience,' Patient Experience Journal 1(2): 46-52, Fall.
Kotter, J.P. 1996. Leading Change. Boston, MA: Harvard Business School Press.
Kroeber, A.L. 1919. 'On the principle of order in civilization as exemplified by changes of fashion,' American Anthropologist 21(3): 235-263, July. https://doi.org/10.1525/aa.1919.21.3.02a00010
Lencioni, P. 2006. Silos, Politics and Turf Wars. San Francisco, CA: Jossey-Bass.
Lewin, K. 1947. 'Frontiers in group dynamics: Concept, method, and reality in social science, social equilibria and social change,' Human Relations 1(5): 5-41. https://doi.org/10.1177/001872674700100103
Maiter, S., L. Simich, and N. Jacobson. 2008. 'Reciprocity: An ethic for community-based participatory action research,' Action Research 6(3): 305–325. https://doi.org/10.1177/1476750307083720
Margalit, R., S. Thompson, C. Visovsky, J. Geske, D. Collier, T. Birk, P. Paulman. 2009. 'From professional silos to interprofessional education: Campuswide focus on quality of care,' Quality Management in Health Care 18(3): 165-173, July-September. https://doi.org/10.1097/QMH.0b013e3181aea20d
May, C. 2013. 'Towards a general theory of implementation,' Implementation Science 8(18): 1-14. https://doi.org/10.1186/1748-5908-8-18
McCabe, M., ed. 2017. Collaborative Ethnography in Business Environments. London, UK: Taylor & Francis.
McKinnon, N. 2008. 'We've never done it this way before: Prompting organizational change through stories,' Global Business and Organizational Excellence 16-25, January-February, DOI: 10.1002/joe.20191. https://doi.org/10.1002/joe.20191
Montini, T. and I.D. Graham. 2015. "'Entrenched practices and other biases:' Unpacking the historical, economic, professional, and social resistance to de-implementation," Implementation Science 10(24): 1-8. https://doi.org/10.1186/s13012-015-0211-7
Neta, G., M.A. Sanchez, D.A. Chambers, S.M. Phillips, B. Leyva, L.
Cynkin, M.M. Farrell, S. Heurtin-Roberts, and C. Vinson. 2015. 'Implementation science in cancer prevention and control: A decade of grant funding by the National Cancer Institute and future directions,' Implementation Science 10(4) :1-10. https://doi.org/10.1186/s13012-014-0200-2
Newhouse, R.P. and B. Spring. 2010. 'Interdisciplinary evidence-based practice: Moving from silos to synergy,' Nursing Outlook 58: 309-317, November-December. https://doi.org/10.1016/j.outlook.2010.09.001
Nilsen, P. 2015. 'Making sense of implementation theories, models, and frameworks,' Implementation Science 10(53): 1-13, DOI 10.1186/s13012=015-0242-0.
Nolan, R.W., ed. 2013. A Handbook of Practicing Anthropology. Malden, MA: Wiley-Blackwell. https://doi.org/10.1002/9781118486597
O'Hagan, J. and D. Persaud. 2009. 'Creating a culture of accountability in health care,' Health Care Manager 28(2): 124-133. https://doi.org/10.1097/HCM.0b013e3181a2eb2b
Orr, J.E. (1996), Talking About Machines: An Ethnography of a Modern Job. Ithaca, NY: ILR Press.
Prasad, V. and J.P.A. Ioannidis. 2014. 'Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices,' Implementation Science 9(1): 1-5. https://doi.org/10.1186/1748-5908- 9-1
Reichers, A.E., J.P. Wanous, and J.T. Austin. 1997. 'Understanding and managing cynicism about organizational change,' Academy of Management Executive 11(1): 48-59. https://doi.org/10.5465/AME.1997.9707100659
Rogers, E.M. 2003. Diffusion of Innovations. 5th ed. New York, NY: Free Press.
Rudd, E., E. Morrison, J. Picciano, and M. Nerad. 2008. 'Anthropology report. Social science PhDs 5+ years out, center for innovation and research in graduate education,' Seattle, WA: University of Washington, February 14.
Schein, E.H. 2010. Organizational Culture and Leadership. 4th ed. San Francisco, CA: Jossey-Bass.
Shin, H.W., J.C. Picken, and G.G. Dess. 2017. 'Revisiting the learning organization: How to create it,' Organizational Dynamics 46: 46-56. https://doi.org/10.1016/j.orgdyn.2016.10.009
Tax, S. 1958. 'The Fox project,' Human Organization 17(1):17-19, Spring. https://doi.org/10.17730/humo.17.1.b1gtr520r323687t
Tylor, E.B. 1871. Primitive Culture: Researches into the Development of Mythology, Philosophy, Religion, Art, and Custom. Vol. 2. Cambridge, UK: Cambridge University Press.
Urban, G. 2017. 'Corporate compliance as a problem of cultural motion,' Rutgers University Law Review 69(2): 1-37.
Urban, G. 2010. 'A method for measuring the motion of culture," American Anthropologist 112(1): 122-139. https://doi.org/10.1111/j.1548-1433.2009.01201.x
Wissler. C. 1914. 'The influence of the horse in the development of plains culture,' American Anthropologist 16(1): 1-25, January-March. https://doi.org/10.1525/aa.1914.16.1.02a00020
Wanous, J.P., A.E. Reichers, and J.T. Austin. 2004. 'Cynicism about organizational change: An attribution process perspective,' Psychological Reports 94: 1421-1434. https://doi.org/10.2466/pr0.94.3c.1421-1434
Zorich, D.M., G. Waibel, R. Erway. 2008. 'Beyond the silos of the LAMs: Collaboration among libraries, archives and museums,' Dublin, OH: OCLC Research. Published online at: http://www.oclc.org/research/publications/library/2008/2008-05.pdf
Copyright (c) 2018 Elizabeth K. Briody
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).