Paving the Road to Hell: Why Change Programs Ultimately Fail. (Positively Influencing Physicians)‪.‬

IN "CULTURE AND Communications: A Critical Part of Reengineering," (1) Lisa Hirsh views cultural alignment as necessary for successful reengineering. Culture is "a pattern of beliefs, values, and expectations shared by members of an organization that powerfully shapes the behaviors of Individuals and groups within the organization." This is a theoretical ideal that would lead one to assume change is possible once realignment has been accomplished. In reality, most organizations are composed of disparate groups whose "beliefs, values, and expectations" are often in opposition. Executives of health care organizations are beholden to stockholders (2) and have goals that are anathema to physicians (limiting services and payments versus maximizing services and payments). Employees, having learned there is no reward for corporate loyalty, are suspicious of physicians and health care executives, believing the latter's positions offer a level of security unavailable to ancillary staff. (3) Nowhere is this misalignment more apparent than in health care reengineering programs.