Chapter 3
Phantom Successes
Our experience in helping departments and teams improve
their processes led us to question whether all of the effort
made in improving processes in healthcare was to anyones
benet. Anecdotal comments and experiences from colleagues
only supported our concerns. We could easily come up
with a list of why certain projects failed to meet their objec-
tives or why some projects failed before they ever got to the
implementation phase. What we did notice was the difculty
colleagues had in creating lasting improvements. One joke
common in consulting and management engineering is, “If we
made lasting improvements [or “If they ever implemented our
recommendations”], then we would all be out of jobs.” We fre-
quently found ourselves called back to improve processes in a
department a year after we thought the issue had been solved
by the prior process improvement project.
To understand more about the success rate of process
improvement projects, we reached out to professionals in the
process improvement community with a short survey. Our
objective was to identify whether project success and sustain-
ability were the norm or whether improvements in healthcare
24Preparing for Continuous Quality Improvement for Healthcare
did not meet the levels of success often found in manufactur-
ing. In addition, we wanted their opinions on the primary
reasons for project shortcomings and failures. Our hypothesis
was that we were not the only organization for which process
improvement did not always end up improving the process.
We wanted to obtain a healthcare industry read on project
failure and whether it was as dismal as some have estimated,
including a Wall Street Journal study noting the “brutal fact”
that the low success rate of initiatives such as new technology,
downsizing, restructuring, or changing corporate culture con-
tributes to an overall change initiative failure rate of 70%.
Although our ndings are directional and in no means
scientic in scope or size, they do conrm what others have
surmised: Process improvement projects are not always suc-
cessful. Using our connections with healthcare societies, we
sent out a survey to over 400 professionals involved with pro-
cess improvements in healthcare. We surveyed stakeholders,
champions, process owners, project leaders, facilitators, team
members, and support analysts who had taken part in a pro-
cess improvement project in a healthcare facility in the previ-
ous two years. In total, we based our conclusions on responses
from 110 people whose focus was in the healthcare eld and
who had been directly involved in process improvements.
Although less bleak than a 70% failure rate, these responses
still showed that half of the process improvement projects
failed to meet some or all of their stated goals: Half (49%)
were deemed successful, about a third were somewhat suc-
cessful, and one in six (16%) was deemed unsuccessful
Even the projects that were successful did not always have
sustained gains. Health process improvement profession-
als cited that half of the somewhat and completely success-
ful projects could not maintain their gains for more than one
Chakravorty, Satya S., Where Process-Improvement Projects Go Wrong, Wall
Street Journal, January 25, 2010.
Phantom Successes25
year. Similar to our own experiences, many of the projects
that began with what appeared to be promising changes
could not maintain the gains projected for the new process.
Environments change, people forget, monitoring is not fol-
lowed through, new equipment breaks, and a number of other
things happen, and the gains made and expected from a pro-
cess improvement project begin to evaporate. For us, what was
most surprising was the percentage of evaporation. Within a
year, only half (51%) of the projects that were deemed a suc-
cess kept their improvements (Figure3.2).
Project Success Rate
Half of all process
improvement projects are
Still, half don't meet their
anticipated goals and
almost 1 in 6 (16%) are
Figure 3.1 Process improvement project success rate.
Six Months One Year More than 2 years
Percent of Projects Where the Gains Lasted …
Figure 3.2 Process improvement project gain backsliding.

Get Preparing for Continuous Quality Improvement for Healthcare now with O’Reilly online learning.

O’Reilly members experience live online training, plus books, videos, and digital content from 200+ publishers.