The Woes of Implementation Practice: Getting Caught by the “Program of the Month”

Abstract

Senior leaders from a large American hospital told me that they wanted their hospital to become more “patient-centric” and asked me to help them.  I was hired to conduct an ethnographic study of the hospital with a team of six employees and the goal of improving patient experiences.  Sixteen months later, the research was completed, effective models of hospital work practices documented, recommendations made, and 16 tools developed to improve hospital culture.  Yet none of our work was implemented.  I returned to my field notes to discover clues that might explain why.  This article explains the process I followed, the stories that revealed unwanted messages, the transcripts that enabled sensemaking, and the program-of-the-month cycle that prevented implementation from occurring.