Online publication of OD Network
Volume 4 • Number 1 • Winter 2008
Healthcare Rx: Start with
Results Today
By Patrice Murphy and Celia Kirwan
I
n these days, it seems all roads lead to healthcare.
In response to the immense pressure facing health
organizations, many OD methods developed in other
industries are being used to help unlock the insight and
creativity of workers in hospitals, clinics and health
administration.
For around two decades our experience has followed a
similar path, starting with a wide range of organization
development work in sectors as varied as
manufacturing, engineering, pharmaceuticals, financial
services, retail, government and non-profit. For the past
five years, we have been colleagues in a consulting
practice devoted to the achievement of results now, no
matter what the sector and no matter what the
challenge. We have been increasingly drawn to
healthcare, where the stakes for individuals,
organizations and societies are so very high.
Most management thinking assumes a causal flow in
which lengthy preparation to strengthen an organization
is necessary in order to improve on outcomes that
matter. First, we are told, we must wait for shifts like
training, process redesign, systems investment,
corporate restructuring or cultural transformation to take
hold in the health sector. Only then can we reasonably
expect to see results – months or even years down the
track. It’s cold comfort, particularly if you are a
participant in our ailing healthcare system who needs a
better outcome today - a sick patient needing urgent
care, a frustrated nurse or doctor navigating the
bureaucracy, or a harried administrator struggling to
cover spiraling costs.
It doesn’t have to be this way. Patience is no virtue when
results are needed fast. There is plenty of evidence from
other industries, and from healthcare itself, that big
improvements in critical outcomes can be achieved
quickly. They can be achieved using the wisdom, skills
and know-how of people already in the organization. The
Patience: n. A minor form of despair disguised as a virtue.
– Ambrose Bierce, The Devil’s Dictionary 1906
“Be realistic: Demand the impossible”
– Che Guevara
experience of unlocking those improvements can
actually increase the organization’s capacity to achieve
even greater results in the future. And a rapid results
approach can be scaled to touch almost any kind of
challenge, whether small or large.
What exactly do we mean by rapid results? We mean
results achieved in 100 days or less. For example:
halving Emergency Department walkouts within 3
months; increasing operating room efficiency by starting
90% of initial OR cases on time; and increasing revenue
by hitting 95% procedure coding accuracy in patient
registration. It can also mean reducing worker injuries in
two mental health wards by more than half in just 30
days, or achieving an 80% jump in the use of an
HIV/AIDS voluntary counseling and testing service in
100 days.
Results like these have been accomplished by unlocking
the insight and creativity of employees at every level and
across disciplines, in both union and non-union
environments. They have been accomplished with the
assistance of internal and external consultants equipped
with the typical OD tool-kit. Any OD practitioner can
bring a rapid results perspective into his or her work –
and we hope, with this article, to encourage more
practitioners to do so.
In this article we outline how the rapid results approach
can look and feel. We illustrate the process with case
examples from a major hospital system, a mental health
facility and local health clinics in a developing country.
And we offer some guidance on how to get started in
using a rapid results approach in your own work.
How do rapid results projects work?
The basic building block of the approach is the rapid
results project. Each project is typically commissioned by
a sponsor and driven forward by a cross-functional team
of 6-10 people who touch key aspects of the issue.
Projects aim to achieve ambitious goals and thereby
accomplish two things: (1) delivering dramatic results—
not just enabling activities —in critical focus areas and
(2) stimulating action, experimentation and learning.
Rapid results projects have several clear attributes:
• Results oriented – work is focused on achieving
tangible, measurable, bottom-line results
(instead of activities, preparations or
recommendations)
• Rapid cycle – project duration is 100 days or
less (often 30, 60 or 90 days)
• Exciting and experimental – fosters innovation
and learning
• Stimulating – participants gain new insights on
implementation challenges and risks
• Empowered – teams set their own goal, and are
expected to actively pursue it with considerable
latitude
• Cross-functional – teams draw together people
who have front-line knowledge of the challenge
at hand
• Visible – projects are actively supported and
valued by an explicit sponsor commission
Rapid results projects follow the rhythm shown in Figure
1, regardless of their duration. The first phase is a short
period in which change leaders, project sponsors and
facilitators work together to define areas for focused
effort. This could conceivably spring from earlier strategy
development work using methods such as open space,
Work-Out, or future search, or based on urgent and
compelling priorities facing the organization. Sponsors
define a challenge for each team, providing guidance as
to where a result is needed, and helpful intuition
regarding the territory for discovery.
The sponsors, team leader and team members are
brought together at a formal launch event, usually lasting
one day, at which they carve out their own goal and
shape a work plan for achieving the result. The key here
is that the team sets its own goal at a level that is
challenging enough to stimulate innovation and
experimentation. In fact, the goal should create a slight
feeling of anxiety as to how it will be accomplished. If the
team is relaxed and confident that the goal is readily
achievable using the current system, then it is not
enough of a stretch to provoke out-of-the-box thinking.
By encouraging the team to push itself out of its comfort
zone, ownership of the challenge and commitment to
change is also located with the team.
After the launch meeting, the team is responsible for
implementation, a phase that lasts 30-100 days. During
implementation, there are two formal review points
where the team reports on progress and results. Half-
way through the project, the team meets for a mid-point
review to check for traction against its goals, and to
reflect on what the team is learning. At project
completion, teams have a review to report final results,
team learning, and ideas to sustain results over time.
Once the project is complete, sponsors and change
leaders consider the scale-up opportunities, taking into
account the teams’ insights. This can include turning
fresh attention to a related challenge or a new issue
thrown up by the team, extending the experiment to
other locations or customer segments, or snowballing
the best practice insights to other work groups for
adoption or further development and discovery.
Frequently, rapid-cycle projects also reveal cross-cutting
or supporting activities (such as training or system
enhancements) that are needed across locations, which
are commissioned as part of the overall portfolio of
system changes. In this way, organizations and
communities can build large transformations on a
foundation of rapid result projects.
Rapid results in action — Major hospital challenges
Like many major hospitals across the US, the facility that
we will call Highton Hospital forms part of a system of six
hospitals and a centralized administration facility (let’s
call it the Kingfield Hospital System). Kingfield was under
enormous financial pressure, and had been challenged
by the leadership to radically improve its financial
condition, operating performance and patient
satisfaction.
At each Kingfield facility, empowerment committees
were created consisting of local union and management
leaders. Each committee agreed to work collaboratively
to find ways to improve the financial condition, operating
performance, and patient satisfaction in that facility,
working together in ways that would help to quickly
turnaround the entire system and lay the foundation for
strong labor-management cooperation going forward.
Each selected two or three rapid results projects for its
facility. Each rapid-result project had co-sponsors—one
from union and one from management—as well as team
co-leaders, to
ensure joint
ownership and
accountability for Shape 2 weeks
results.
To shape one of
Launch 1 day
Highton Hospital’s
first rapid results
projects, the
sponsors
Implement 30-100 days
responded to the
need for increased
revenue and lower
costs by focusing
Scale-Up 30+ days
on one area of
major opportunity—
reducing the
number of walk-outs
from the Emergency Figure 1: Phases of a Rapid Results Cycle
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Department (ED). As with many hospitals, Highton
derives a large share of its revenues from ED patients.
However, low acuity patients, for example, sprained
ankles, small cuts and scrapes often are made to wait
long hours because high acuity patients, for example,
heart attacks and auto accidents, are treated first.
Sometimes low acuity patients become so frustrated
they walk out of the ED, taking potential hospital
revenues with them.
To get started, the co-sponsors selected and met with
the team co-leaders to refine the challenge, discuss the
composition of the team, and prepare for the project
launch. The co-sponsors clarified their challenge to the
team in writing, outlining the importance of the issue of
ED walkouts and the potential effects of any
improvement on hospital revenue and patient
satisfaction. At the launch session, rather than sharing
their view of the solution, the co-sponsors talked with the
whole team about the importance of the project and the
support the team would have to go after for a significant
improvement within 100 days. Then it was the
responsibility of the team to define its own rapid results
goal. After sharing ideas and data, the team was clear:
they would halve the number of low acuity patient walk-
outs within three months. The team then developed a
detailed plan of the work they thought would be required,
assigned leads and deadlines for each step, figured out
a way to track progress, decided on a weekly meeting
schedule, and agreed on how they would keep their
colleagues informed and involved.
Figure 2 shows how the sponsors and team together
worked their way from a big strategic issue (increase
revenue and cut costs) to a team challenge (reduce the
number of ED walk-outs) to a rapid results goal that
could be accomplished in 100 days or less. In fact, the
team used the idea of a funnel to help them brainstorm
and debate how they would focus their goal, choosing
among various ways of tackling the team challenge.
Strategic Issue:
Increase revenues and cut costs
Initial Challenge:
Improve service levels in the
Emergency Department (ED)
Team Challenge:
Reduce the number
of ED walk-outs
Rapid-Results Reduce low-acuity patient walk-outs
Goal: in the ED by 50% in 3 months
Figure 2: From Strategic Issue to Rapid Results Goal
To achieve its goal, the team experimented with several
changes to the way patients received services in the ED.
First, they created a separate Fast Track area for low
acuity patients. They also improved signage so these
patients could move more quickly from station to station
within the ED. Finally, they worked with the day,
evening, and night shifts to make sure patients were
moved as quickly as possible into exam rooms once
they had been interviewed by the triage nurse. As the
team worked together, members learned about the
critical role that each function such as registration,
nursing, and radiology plays in keeping patients
satisfied and willing to wait in the ED.
Three months later the team celebrated an outstanding
success—they had more than halved ED walkouts,
which had dropped from over 7% on average to 3%. In
the six months following the launch of the team, this
project alone was responsible for over $400,000 in
estimated additional revenues for Highton Hospital.
Meanwhile, at Kingfield’s central administrative facility, a
rapid results team was challenged to improve
reimbursement rates for implantable devices (IDBs) such
as pacemakers, joint replacements and corneas. IDBs
are an important item because they are reimbursed at
higher rates. For a variety of reasons, Kingfield was
collecting only 58% of IDB reimbursements for its largest
hospital. Again, the joint labor-management rapid result
team set itself a significant goal: Increase IDB
reimbursement to 90% within three months.
Specific interventions the team used included updating
the medical record procedure codes to identify and
capture all claims with IDBs, setting internal billing
deadlines (e.g., billing for reimbursement within 15 days
of initial bill drop), and creating a much more aggressive
set of follow-up procedures to ensure timely receipt of
reimbursements on all IDBs.
As a result of the team’s efforts, reimbursements for
IDBs at the targeted hospital increased from 58% to
80%. Although short of the goal, everyone associated
with the rapid-results team recognized the significant
impact of the changes the team had pioneered, and the
collaborative manner in which the changes had been
implemented. The 22% improvement translated into
additional hospital revenue of $1.9 MM in just three
months. The same improvements were then applied for
IDBs reimbursement at other facilities, enabling new IDB
revenues to increase many times over in the following
months.
In a third example at Highton Hospital, a rapid result
team focused on the operating room (OR) and the
challenge to improve patient throughput – the efficiency
with which patients were being checked in, evaluated,
and treated. The team was made up of people who were
responsible for scheduling, performing, transporting
patients to, and cleaning up after operations. They
decided to focus on late starts, one of the key causes of
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slow patient throughput. Their rapid results goal: To start
at least 75% of all operations on time within three
months. If accomplished, this would be a huge increase
over the previous on-time rate of less than 25%.
One of the more challenging interventions that the OR
rapid results team used was clarifying and enforcing time
standards for on-time starts. This often required
coaching tardy doctors to arrive early for their first cases.
At the end of their 100-day initiative, the OR team
achieved their stretch goal—with over 75% of OR cases
starting on time. More on-time starts meant that fewer
delays were being caused later in the day which reduced
overtime costs. The team also positively affected
communication and collaboration between Ambulatory
Surgery and Admitting; both departments now
understand the revenue and cost implications as well as
the impact delayed starts have on patients.
These and many other rapid results projects in the
Kingfield hospital system transformed not only hard
numbers that went straight to the bottom line, but also
many of the “soft” areas that the empowerment
committee had identified as needing attention —
improved communication, teamwork, and employee
satisfaction. Despite initial skepticism, the process of
working together to achieve hard goals in revenue
improvement, cost reduction, and improved customer
service had created simultaneous improvement in these
interpersonal areas. Without exception, all teams
reported improved communication, teamwork, and
satisfaction as they worked to achieve their team goals.
Rapid results in action – Worker safety in a mental
health facility
In a mental health setting, this time at the Connecticut
Department of Mental Health, rapid results projects
targeted worker safety through the reduction of patient-
related incidents and injuries. Two wards, one Geriatric
and one Psycho-Social, were selected. They both
assembled project teams representing all three shifts
and established aggressive goals. The Geriatric ward
team gave themselves one month to reduce patient-
related incidents and injuries to 50% of the previous
year’s monthly average.
After a relatively swift analysis, the team learned that
patient-related injuries were quite predictable. To
ensure that staff members could quickly get up to speed
on their patients, the team developed a profile for each
patient that was kept on the unit for all staff to review
and update. A patient alert report was also created to
inform staff on the next shift of changes in patient
behavior. The Psycho-Social team similarly performed a
brief analysis of the root causes of incidents. This led
them to experiment with a ‘buddy system’ to reduce the
times when individual staff members responded alone to
potentially unsafe situations. Although initially focused
on a few patients, after 13 nights without incident, the
team decided to apply the buddy system to all patients
for the remainder of the month’s implementation.
Rapid results in action – HIV/AIDS prevention in
Eritrea
A rapid results approach also has significant impact in
other social, economic and cultural settings. For
example, the method has been applied to combat the
spread of HIV/AIDS in Africa. Working with the Eritrean
Ministry of Health, in partnership with the World Bank,
rapid results teams targeted various components of a
five-year strategy to slow the rate of HIV infection. One
team increased the use of a voluntary counseling and
testing center in the capital city Asmara by 80% (the goal
was 25%). Other rapid results teams increased safe-sex
practices among commercial sex workers and expanded
school-based preventative education programs. The
success of these first rapid results projects led to a rapid
roll-out of the approach and learnings—initially in the
region around the capital, and within a year throughout
Eritrea.
The “secret sauce” of rapid results
Case studies like these illustrate the capacity for
extraordinary performance that lies hidden within most
individuals, teams and organizations. Rapid results
projects work because organizations almost always have
some “hidden reserve” that can be tapped if people are
given a temporary structure that spans the typical
boundaries and a rationale for innovation.
We are often asked to name the “secret sauce” that
makes the rapid results approach so effective in
unlocking that performance and the immense capability
for further change.
Rapid results projects work because they:
ƒ Begin with action and results, not preparations
ƒ Strengthen grass-roots implementation
capability, building capacity and confidence
ƒ Test large-scale change in low-risk ways
ƒ Drive accountability lower in the organization—
so that someone beyond management is lying
awake at night thinking about what it will take to
accomplish the result, and how to bring all the
necessary elements together
ƒ Leverage the group energy of cross-functional
teams that draw together the varied
perspectives of everyone who touches an issue
ƒ Are designed to replicate, in a calm and
systematic way, dynamics that naturally arise
during crisis—such as clear sense of purpose,
sense of urgency, collaboration across
boundaries, and freedom to experiment. We call
these the ‘zest’ factors.
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Most importantly, the social demonstration effect created
in every rapid result project serves as a strong aid to
scale up. Remedies and improvements developed and
shown to be successful by a team of peers are more
likely to be adopted by colleagues. Teams may also
illuminate a new perspective on other issueswith which
the organization is grappling. Many major organizations
and communities have built large transformations on a
foundation of waves of rapid results projects.
Integrating rapid results into your OD work
The rapid results approach is intellectually simple, but
subtle in its execution. OD practitioners who wish to
incorporate it into their work can start with five points of
interaction:
1. Focus on a critical need or opportunity, help a
ready sponsor to articulate one or more
executable challenges that can be assigned to
rapid results teams.
2. Help the project sponsor make a clear
assignment that is urgent and compelling
3. Help a team to carve out a stretch goal that is a
near-term result (not just a set of activities) that
they commit to delivering in 100 days or less
4. Support the sponsor and team through the
periods of excitement, frustration, persistence
and innovation that teams typically experience
______________________________
5. Help the sponsor and team reflect on what they
have learned and the potential to scale their
breakthroughs across the wider organization.
If the readiness is small, start with one project to
demonstrate the potential for change. The tangible,
valuable result—plus the enthusiasm and energy that
emanates from successful teams—becomes the fuel for
scaling up into a larger effort. Stoking the fire in this way
offers better payoff than trying to negotiate up-front for a
big commitment of resources, emotional energy and
organizational time.
Underlying these simple steps is a more radical shift for
OD practitioners – toward defining our own work in terms
of results. We can approach this confidently when we
engage in results-focused dialogue with our clients and
maintain a clear connection to the value that each
intervention is intended to support.
The promise of rapid results lies in uncovering the
wisdom for change that is so often hidden in plain sight
within the organizations and communities we serve.
Unlocking that potential is to the ultimate benefit of the
individuals, groups and organizations who are not
content to sit around and patiently wait.

REFERENCES

− Schaffer, R.H. and Ashkenas (2005). Rapid Results: How 100-day projects build the capacity for large-scale change. Jossey -Bass, San
Francisco.
− Murphy, P., Kirwan, C. and Ashkenas, R. (2007). “Rapid results” in Peggy Holman. Thomas Devane, and Stephen Cady, S. (Editors) The
change handbook: the definitive resource on today’s best methods for engaging whole systems. Berrett-Koehler, San Francisco.

______________________________

About the Authors

Patrice Murphy, PhD has more than 20 years of experience consulting in the U.S, Europe and Australia to organizations
ranging from manufacturing, engineering and pharmaceuticals to financial services, information technology and healthcare.
She believes that the wisdom and knowledge for successful change lie within an organization. Patrice is a leading
practitioner of rapid results methods including WorkOut, which she helps her clients use in novel ways. She has degrees in
political science, business and labor relations, and a PhD in Management and Organizational Behavior from New York
University. When she’s not working, Patrice is usually sailing with her family on Long Island Sound.

Celia Kirwan, MA has 18 years experience partnering with clients in financial services, healthcare, pharmaceuticals, retail
and not-for-profit sectors in the UK, Western Europe and the United States. She is an expert in WorkOut, which she uses to
help her clients solve problems independently and achieve improved business results fast. Celia’s recent work has ranged
from M&A to business process reengineering, improving employee morale and employee retention. Celia has also written
about Rapid Results in The Change Handbook (2nd Edition, Berrett-Koehler, 2007). She has an MA in Geography from
Boston University and is a keen adventure traveler.

The authors are consultants with Robert H. Schaffer & Associates, a Stamford, CT based consulting firm.
They can be reached at info@rhsa.com.