A 450,000 member health maintenance organization (HMO) is failing. Competition is intense. Membership is declining. The HMO is losing money.  Patient complaints circulate through the community as urban legend; impossibly long waits to schedule an appointment, see a specialist, and the sour disposition of its 6,000 staff. A strategic overhaul is needed in culture, systems and work practices. This transformation will need the support of 750 physician multi-specialty group and leadership of its board. The board creates a strategic “roadmap” and a participative process to implement it across the organization. Four years of steady work follow – implementation of electronic medical records, new structures and reporting relationships, the realignment of specialty and primary care, major shifts of authority and more.  Today, their HMO is ranked as the nations’ best for same day appointments, health outcomes and patient satisfaction….READ MORE



The literature on planned change emphasizes the tendencies of individuals, groups, organizations and societies to resist change. This inclination is usually cited when change efforts fail. However, resistance to change is not an inherited human characteristic. In fact human beings have a predilection both to seek change and to reject it.

The tendency of human beings to resist change is more accurately described as resistance to being changed, and resistance to the agents of change. Involvement and control of the change process is a remedy for this affliction. However, even with involvement, some resistance to change will likely exist. Reducing this resistance and building support can be aided by understanding the other factors involved….. READ MORE


Large group interactive events have emerged in response to the need for organizations and communities to adapt more rapidly to changes in their environment. What sets this approach apart from other change strategies are the large numbers of people implementing strategic change in “real-time”. The more comprehensive models involve 1500 or more people from all parts of the system working in small groups to:

  •     Assess the organization, or community’s present situation,
  •     Agree on future directions,
  •     Create commitments and action plans to implement their agreed strategy.

The idea of such large numbers of people working together productively is a relatively new phenomenon. Fifteen years ago working with 60 people seemed the upper limit of what was possible. Today 3-day events with 1500 people are common. How can such large meetings be productive and where are they used? …READ MORE