Three Key Lessons for How to Make Large-Scale Change to a Health Care System

Implementing large-scale change at any organization can be challenging, and health care organizations are certainly no exception to this. Changes have the potential to face resistance from both patients and providers, and even knowing where to begin can be difficult. Following are three key lessons from Southcentral Foundation’s whole system transformation; these steps were a tremendous help to SCF in making major changes to improve the system and provide quality health care for all customer-owners.

Listen to the Voice of the Customer

Upon taking over from Indian Health Services in 1998, SCF spent a year collecting feedback from Alaska Native and American Indian people to find out what they wanted from the health care system. Some of the methods employed were focus groups, one-on-one interviews, meetings with tribal leadership from across the region, and surveys, both within and outside the clinics. The feedback from customer-owners formed the basis of a list of requirements for the new health care system. SCF used these requirements to shape and direct the development of the Nuka System of Care.

Develop Management and Leadership from Within the Community Being Served

In addition to guidance from customer-owners, SCF also recognized the need for Alaska Native management and leadership for the Nuka System of Care. By bringing in people from the community to take on managerial roles, SCF was able to develop highly capable Alaska Native leadership with a deep and personal understanding of the community they were serving. This also allowed providers who had previously been serving in management to return to predominantly clinical work.

Customer Service is Key

Upon establishing the Nuka System of Care, SCF moved from a provider-centric to a customer-centric model, developing systems to ensure that the customer would always come first. All SCF employees received customer service training, and effective customer service was made a priority for all SCF managers. SCF also made extensive efforts to ensure that customer-owners were involved in their care, working together, in relationship with providers to achieve overall wellness. The fact that customer-owners could see the changes made to the system based on their feedback was a major help in building a trusting relationship with them, one that has continued to this day.


Large-scale change to a system can be a daunting prospect, but as SCF’s experience shows, if an organization follows an inclusive strategy that involves the community being served throughout the process, positive results can be achieved. For more information about making large-scale change at a health care system, contact the SCF Learning Institute today!