16 ◾ Steven R. Escamilla
◾ Sta changes required
◾ Monitoring and feedback
e degree to which each of these factors is present aects the likelihood of successful change. If
one change factor is lacking, strength in other factors must make up for it.
A successful ME not only has a strong grasp of tools, but also is able to coach the naviga-
tion of the multiple factors that will impact whether an organization, process, or individual will
change. In addition to using the appropriate tool to dene, develop, and measure an organiza-
tional change, the ME will simultaneously monitor the organizational wherewithal to implement
change, and will adjust the approach to design and implementation to appropriately account for
organizational challenges. is ability is far more important than the tools themselves, and reects
the capabilities of a change agent to facilitate the change.
Active Ingredient of Improvement
Dr. Gustafson’s research team also studied various quality improvement approaches to deter-
mine the QI approach that yields the most signicant and sustainable improvement.
2
Conducting
improvements across many addiction treatment centers in many dierent states, Gustafson et al.
studied whether learning sessions, coaching, interest circle calls, or a combination of all three had the
greatest and most sustainable impact.
e results of the Gustafson study are intriguing. In this study, no signicant benet was
associated with interest circle calls, where change sta received telephonic advice from peers and
a coach. Coaching alone, however, was less expensive and more eective than learning sessions
where change sta learned from experts in a face-to-face, multiday conference setting. A combina-
tion of learning sessions, interest circles, and coaching added cost without improving outcomes.
e study showed that coaching dominated the other methods in terms of results, sustainability, and
cost. Coaching consisted of personalized site visits, in addition to telephonic and e-mail commu-
nication with change sta and leadership.
Intuitively, the Gustafson study’s results make sense. As with every organization, each of the
addiction treatment centers involved in the study had a dierent combination of leadership, vision,
culture, and personalities—not to mention dierent processes and systems. Merely knowing
potential solutions does not ensure that a solution can be implemented. Implementation requires
the modication of a solution to t a given organization’s processes and systems. And, most impor-
tantly, implementation requires a skillful adaptation to the leadership styles, the cultural unique-
ness, and the personality dierences present in an organization, in light of an organization’s vision.
Successful Coach and Tools
It is sometimes said, “Tools add value to a process.” While that is true in general terms, the process
is rarely the product—the process itself is not what the customer views as value.
While tools are critical, they are only one, arguably small, aspect of what leads to signicant
change. Tools can be a means of managing all other aspects of change, and a means for a manage-
ment engineer to serve as a coach. Together with tools, adaptable coaching of a skilled manage-
ment engineer will enable success in virtually any situation. It is this role of coach that is more
critical than the tool itself.
Management engineers must always keep a clear perspective on their role. As new performance
improvement or Lean departments are developed, this perspective is especially important:
It’s Not about the Tools ◾ 17
Tools are never the end goal; they are an enabler! e improvement coaching ability of
the management engineer, and the application of appropriate tools, ultimately is the
most important factor impacting the signicance and sustainability of change.
Some organizations may fall into the trap of determining, for example, that implementing
Lean or implementing Six Sigma is the goal. To be clear, Lean or Six Sigma should never be an end
goal, even from a management engineer’s or performance improvement department’s perspective.
e end goal should always focus on the customer, elimination of waste, and perfect care.
Ultimately, management engineers must serve as improvement coach and manage all factors
aecting signicant, sustainable change. Tools are an enabler for doing so, but should be kept in
perspective. e bottom line on tools can be expressed in the words of the band .38 Special:
Just hold on loosely
But don’t let go
If you cling too tightly
You’re gonna lose control.
Endnotes
1. D. H. Gustafson, F. Sainfort, and E.M. Adams, “Developing and Testing a Model to Predict Outcomes
of Organizational Change,” Health Serv Res 38 (2003):751–776.
2. A. Quanbeck, D. H. Gustafson, J. H. Ford II, A. Pulvermacher, M. T. French, K. Y. McConnell, and
D. McCarty, “Disseminating Quality Improvement: Study Protocol for a Large Cluster-Randomized
Trial,” Implementation Science 2011 6 (2011):44.
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