In 2004, a large Midwest hospital was losing money, patients, employees, and physicians. A business consultant was hired to engage key employees in a process to improve the quality and efficiency of patient care. The improvement was negligible after the first year, so a 3-man consultancy was added in 2005 to engage all employees in an educational process with the same mission. The author was the hospital director of this experimental change project titled Transformation and worked with both the business and education consultants. The opposing models were serendipitously discovered to be parallel and resulted in positive change. The business model was the application of two Six Sigma models, DMAIC (define, measure, analysis, improvement, control) and Ten Step Kaizen. The education model was proprietary but discovered to be a learning process toward self-direction (Taylor, 1986). Interviews were conducted in this grounded theory study to understand the perceived relationship between the 2005 experiment and current realities. Significant improvements were immediate and sustained over time. The hospital is currently making money and attracting patients, employees, and physicians and the emerged theory posits that merging the models creates transformational change, but sustainability requires empowered leaders to manage the process.
The world values change more than any time in recent history. I investigated a hospital-wide change project that played a role in moving the organization from barely surviving to thriving. The process was discovered to be a merging of parallel models—an education change model that empowers employees to be self-directed with a business change model that empowers employees to eliminate waste and defects (see Figure 1). The purpose of this study was to understand the phenomena of the unlikely merging of the two models and the sustainability of the resulting change. A new model and theory emerged for transformational change.
The Ten Step Kaizen and Six Sigma DMAIC models compared to the Taylor (1986) learning process toward self direction: Merging a business model with an education model to create a new model for transformative change. Note. Copyright 2006 by Susan Isenberg
The Importance of the Problem
All over the world adults face change in their work, school, community, country, and home lives. When asked, adults have the answers to most questions related to what they do every day and they want to participate in solving their own problems instead of being told what to do and how to do it by someone who does not know what they do. Adults seek to learn what they need to know in order to create their own change. Delors’1996 report to the United Nation’s Education, Scientific, and Cultural Organization (UNESCO) of the International Commission on Education for the Twenty-first Century described four pillars of learning as follows:
Learning to Know, that is acquiring the instruments of understanding; Learning to Do, so as to be able to act creatively on one’s environment; Learning to Live Together, so as to participate and cooperate with other people in all human activities; and Learning to Be, and essential progression which proceeds from the previous three (p. 86).
This research on merging business and education models for sustaining transformational change is important to the practice of adult, continuing, extension, and community education because learning to change has been recognized as important to the field of adult education and was proposed as an additional pillar of education. The UNESCO Institute for Education (UIE) proposed adding the pillar “Learning to Change” (2003, p. 9). According to the current UIE strategy, “the world should be an open learning world . . . where individuals, communities, and societies construct their [own] learning pathways in order to transform themselves and their environment” (p. 10). A guiding principle of UIE’s work is “Three in One . . . [which] applies to the simultaneous search for quality, efficiency/effectiveness and sustainability in programme [sic] outcomes” (p. 10). Because a current focus in the international study of lifelong learning is change and its sustainability, this grounded theory study investigated a program for change (improved quality, efficiency/effectiveness and sustainability), which was discovered to be merged with parallel business and education models.