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Cultural Transformation Through Improvement

By Santiago Narino | Tuesday, November 26, 2019
Cultural Transformation Through Improvement

Colombia’s improvement community has been steadily growing over the last 25 years, with various levels of success across the country. Over the last five years, however, organizations throughout the country have been investing in the training of their workforce and bringing improvement science into their daily work.

One organization benefiting from building improvement skills is the Fundación Clínica Infantil Club Noel. This 90-year old philanthropic institution has 74 beds and is in the Valle del Cauca region of Colombia that has a population of around 1.2 million people. Most of Fundación Clínica Infantil Club Noel’s patients are from the region’s most vulnerable communities.

Carlina Dominguez and Paola Ortiz participated in the second wave of Experto en Mejora Continua de la Calidad, IHI’s 10-month Improvement Specialist program for Spanish-speaking countries. For their required improvement project, these consultants decided to work with the Fundacion Clinica Infantil Club Noel to increase the percentage of patients between 0-18 years with adequate leukemia or lymphoma assessment, from 75 to 80 percent in hospital services and from 50 to 55 percent in outpatient services.

As they put what they were learning (especially about the psychology of change) into practice, Dominguez and Ortiz began to realize that people who had been previously unengaged in improvement were now ready to collaborate with others to make change. It became clear that this was a significant shift in the organization. Through their project, Dominguez and Ortiz learned four key lessons about cultural transformation:

1. Link cultural transformation to your organization’s values

The five key organizational values Clinica Infantil Club Noel had established before their cultural transformation — confidentiality, loyalty, teamwork, honesty and responsibility — opened the doors for Dominguez and Ortiz to build spaces for learning and teamwork. The organization was already mission-driven, but improvement methodology gave their work structure and the psychology of change offered relational strategies to engage people in making changes.

2. Create space for co-design

Dominguez and Ortiz were intentional about bringing what they learned about creating a sense of community from the Experto course to their improvement work. For example, while learning about the psychology of change, they developed skills to build trust with their improvement team and hospital leaders. The methodology helped them organize their team and create spaces where everyone’s voice could be heard. In the initial phases of co-design, they identified the keys to achieving a closer group dynamic:

  • Identify the values, assets, and intrinsic motivation of every team member.
  • Find everyone’s zone of genius in which they are using their unique, natural abilities so each individual feels valued, appreciated, and inspired to bring their strengths to the improvement work.­
  • Disseminate the knowledge and create a learning community where everyone was engaging with the methodology, learning, and building together.

3. Continuously work on your goals as a team

Based on the understanding that power is relational, the team at Club Noel revisited their goals intentionally as they engaged more leaders and different stakeholders. Differing priorities in the organization came to the surface through these conversations. This opened the dialogue for everyone in the hospital to engage.

4. Discuss differences of opinion openly

Instead of fearing resistance, the team worked together to dialogue with those who were experiencing the project differently. This was particularly challenging when engaging doctors who are not full-time hospital employees. The team developed a strategy that involved a pediatric oncologist (who was also one of the project leaders) meeting with these doctors. She would go to their office hours and talk to them individually about the project to ensure their involvement and their commitment.


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By implementing these four lessons and mobilizing a range of stakeholders, the team has seen important improvements. For example, they persuaded the board of directors to add more beds to the hospital and invest in necessary equipment. They’ve also seen a notable increase in doctors now adhering to the key protocols.


This graph shows the proportion of patients referred to a pediatric oncologist because they may have leukemia or lymphoma. The team’s goal is 50 percent.

By using what they’ve learned about improvement science and the psychology of change, Dominguez and Ortiz have led a transformation in how Fundación Clínica Infantil Club Noel as an organization thinks about strategic initiatives and how to implement improvements.

Santiago Narino is a project manager for IHI’s Latin America Team. He would like to acknowledge the team at Fundación Clínica Infantil Club Noel: Jaime Dominguez Navia, President of Club Noel and project sponsor; Carlina Dominguez and Paola Ortiz, project leaders and Improvement Advisors; Catalina Dominguez and Lilian Patricia Alfonso, Project Managers; Luz Myriam Claros, MD, Medical Scientific Director; Diana Codognotto Giraldo, Director of Quality; Lida Milena Araujo, MD, pediatric oncologist; Gloria Espina, Finance Director; Julieth Cardona, Commercial Director; Vivian Piedrahita, Chief Nursing Director; and Diana Castro, Chief Nursing Director.

You may also be interested in:

IHI’s Experto en Mejora Continua de la Calidad program, a 10-month is enrolling now. The first virtual learning session starts in January 2020.

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