Building capacity for a transformation initiative: system redesign at Denver Health.
BACKGROUND
This article examines the development of transformation initiatives-deliberate attempts to achieve systemic changes and rapid performance improvements. Accounts of transformation initiatives often reveal little about past organizational and contextual conditions that contributed to success. Instead, these accounts concentrate on change barriers.


OBJECTIVE
We seek to restore balance to this field by examining how antecedent system capacities contributed to a successful transformation initiative.


METHODS
This article presents a case study of the first 2 years of a system redesign initiative at an integrated safety-net health system and provides a historical analysis of developments during the decade preceding the redesign.


RESULTS
Beginning in the mid-1990 s, Denver Health benefited from strong municipal support for its development and expansion. Gradually, it developed its financial and human resources, organizational structure, change strategy, change-management capabilities, information technology, and physical plant. These antecedent capacities all contributed to the implementation of the 2004 system redesign and helped Denver Health overcome several constraints.


CONCLUSIONS
Transformation initiatives may build on existing features and resources, even as they overcome or depart from others. The Denver Health case study helps researchers identify positive antecedents to transformation initiatives, assess the success of such initiatives in terms of implementation progress and outcomes, and recognize complementary contributions of incremental and episodic changes. The study alerts practitioners to the importance of assuring that change efforts rest on solid organizational foundations.
Harrison
Michael I
MI
Center for Delivery Organization & Markets, Agency for Healthcare Research and Quality, Rockville, Maryland, USA. Michael.Harrison@ahrq.hhs.gov
Kimani
James
J
D003120:Colorado; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006804:Ergonomics; D006754:Hospital Restructuring / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000458:organization & administration*; D006801:Humans; D007324:Institutional Management Teams; D007857:Leadership; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D009936:Organizational Innovation; D010934:Planning Techniques; D011635:Public Health Administration; D013597:Systems Analysis; D018511:Systems Integration; D013598:Systems Theory; D013997:Time Factors; D017749:Total Quality Management / Q000379:methods*; D019037:Urban Health Services / Q000145:classification / Q000458:organization & administration*