Resistance to Change
The human impulses related to change are probably as old as our knuckle dragging ancestors. Presented only as English literature, there is an interesting 2,000 year old story in the New Testament Book of Mathew. The setting for this story is the village of Gadarenes. Theologians only agree that the town was on the eastern coast of the Sea of Galilee. Because the villagers were herding pigs, it is thought the villagers were Greek, or possibly Roman. As Jesus entered the town, he was threatened by two mentally disturbed men. The response of Jesus was to heal the two men of their mental illness. It seems like good news; maybe not. Jesus was promptly asked to get out of town. Yes, the status quo had been altered. The villagers had accommodated themselves to their mentally ill villagers. People hate change; resist information that will lead to change; even when that change might lead to a new and more favorable set of conditions. In two thousand years, nothing has changed.
Our firm had a short misadventure representing a nationally recognized group purchasing organization (GPO) in a small geographic territory. What a waste of time, money and effort.
Yes, we went from hospital to hospital proclaiming the good news. We were evangelists for cost savings. We did not ask our audience to accept our message by faith. We were armed with eighth grade math. The numbers used are only an example:
• GPO # 1 – 32,000 items times an Average Cost of X = Total Supply Spend = $ 37,342,334
• GPO # 2 – 32,000 items times an Average Cost of Y = Total Supply Spend = $ 32,123,654
• St. Smithers by the Swamp Medical Center Savings . . . . . . . . . . . . . . . . . . . . $ 5,218,680
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Yes, we represented GPO # 2. The message was largely unwelcome. The most interesting, if frightening example was a female supply chain executive who reviewed the “facts and figures” and came out of her office screaming at the top of her lungs, “We are not interested in changing GPO’s, I don’t care what the savings are, get out of our hospital.” She was “bug-eyed”, her face was red as a tomato and we estimated her blood pressure at 200 over 120 (stroke range).
Most stories were less interesting. One CEO said they were not going to change GPO’s because his hospital system makes decisions based on “facts and figures” and that was the basis of his discriminating determination. We found this to be an odd response. One step in the process the CEO scrupulously avoided was the review of the “facts and figures.” Go figure. As it turns out, this CEO was ingratiating himself to his staff by supporting their recalcitrance.
One of the executives related to GPO # 2 provided me with a window into one understandable reason to resist switching GPO’s. There is a one time cost in time and effort, however small, to switch from one GPO to another.
There are other reasons not to change:
• The supply chain executive is generally not given any incentive to recommend a change that would lead to thousands or millions of dollars of hospital savings. It just sounds like a lot of extra work. Further, it may be well understood internally that the CEO is “drinking the “Kool-Aid” from the resident GPO.
• The hospital “supply chain” operations are, perhaps, the least intensely managed department of the American hospital. This is rooted in a deep tradition of not wanting to be tagged with the responsibility.
• GPO’s are extraordinarily solicitous of their existing customer base to lock in undeserved loyalty. Strategies and tactics include meetings (away from the hospital grind) with outside speakers, golf, tennis, tickets to professional sports events, lavish luncheons and dinners and on and on. In 1970, folk rocker Stephen Stills captured this phenomenon best with his song, “Love the One You’re With.”
• Notwithstanding my eight grade math example, GPO’s morph in ways that make them somewhat difficult to compare. Difficult but not impossible. More work with no reward for the effort. Each GPO is laden with bells and whistles that are intended to differentiate themselves from alternate GPO’s or obfuscate meaningful comparisons.
It would be disingenuous not to acknowledge that our firm may not be very good evangelists for change. We speak truth to power. There are many hospitals that do seek meaningful solutions to existing challenges. There is little time to suffer hospital leaders willing to squander scarce hospital resources for all the wrong reasons. Yes, some things never change.
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