Transforming the dominant logic of hospitals.

Substantial and sustained change is inevitable for U.S. hospitals, driven by the Medicare and Medicaid cost inflation curve and embodied in regulatory initiatives and reforms. This study explores the conception that evidence-based management is necessary but not sufficient for 21st century success in health care organizations. Success will require challenging and changing the organization's dominant logic, substituting a more transformational style of problem analysis and decision making. In order for evidence-based management decisions to transform organizations, the organizational culture must be ready to adopt transformation changes. The outcomes of this shift in management style are dramatic changes in worker engagement and retention and a reinforcing cycle of performance improvement efforts. We use a series of examples to illustrate changes in the dominant logic and to identify how the combination of evidence-based management and a new dominant logic results in a fundamental and highly productive shift in how problems are framed and solved. We conclude with recommendations for changing the dominant logic--such as visioning, sensemaking, process questioning, getting the right people together, rewarding innovation, and overcoming risk aversion--all necessary for transforming the dominant logic, allowing evidence-based management techniques to flourish.