Success
in strategic organizational initiatives depends on changing the way people work
together.
You cannot look anywhere in health care today
without confronting the need for major organizational change. It might be
transforming roles and processes to improve patient safety and customer
service. It might be creating new models of integration to improve quality
while reducing cost — medical homes, accountable care organizations or bundled
payments. Or it might be engaging communities in new ways to reduce health
disparities, improve access or promote healthier lifestyles.
The track record of health care leaders in
directing change is not good. Many change initiatives stall, while others leave
a wake of discord and resentment. Even Lean projects — the current favorite
among improvement methodologies — have a 30 to 50 percent failure rate. The
problem is too widespread to be a matter of individual leadership performance;
there is something more systemic at work here.
Using
an Outdated Model
We believe that a big piece of the problem is
the widespread use of an outdated mental model to guide change. This model,
based on Frederick Taylor's 100-year-old theory of scientific management,
invites us to look at an organization as a machine. It puts leaders in the role
of engineers, responsible for designing and operating the machine to produce
flawless execution. And it puts staff in the role of machine parts, performing
their assigned tasks to the engineer's specifications, precisely and without
variation.
The machine model has at least three major
problems as a framework for leading change. First, it results in top-down
decision-making that fails to harness the wisdom of front-line workers, who
have the most intimate understanding of both patients and work processes. Second,
it fails to engage the hearts of workers, who are less committed to work that
is designed for them than to work they have helped design.
Third, it creates unrealistic expectations of
control. Unforeseen events and unintended consequences imply culpability:
Either the leader's plan wasn't good enough or the workers did not execute it
properly. The resulting anxiety, defensiveness and self-justification divert
considerable attention and activity away from the work at hand. It also makes
people reluctant to talk about error and waste, which impedes process
improvement.
Relationship-Centered
Administration
Fortunately, a host of exciting and effective
new approaches to organizational change are emerging from complexity science,
positive psychology and relationship-centered care. We have integrated a number
of these approaches into a model we call relationship-centered administration.
It is an evidence-based alternative to the machine model and is far more
effective.
Complexity theory provides a dynamic
perspective on organizations, showing that an organization is composed of
patterns of meaning (mission, purpose, knowledge about how to do the work) and
patterns of relating (organizational culture) that are being created anew in
each moment. These patterns usually perpetuate themselves over time but,
sometimes, small disruptions or disturbances can spread rapidly to become
transformative new patterns. This perspective refocuses change efforts from
grand, elaborately detailed, top-down initiatives to smaller grassroots
interventions with the potential to amplify and cascade. It also encourages
reflection: noticing the patterns we are creating in each moment (often
unwittingly) and enabling us to act with greater mindfulness and intention.
Several approaches from positive psychology
offer useful perspectives on leading change: Appreciative inquiry is a
well-established method that turns problem solving upside-down. Instead of
looking for causes of problems, appreciative inquiry looks for the causes of
successes. It presumes and calls forth competence rather than deficiencies. And
because it involves sharing and comparing stories, it also helps build
community. Positive deviance features an internally facilitated search for
innovative solutions and best practices within the organization and constant
rapid-cycle experimentation.
Relationship-centered care is a clinical
philosophy that promotes partnership, shared decision-making and respect at
every level of health care: among patients, family members and clinicians;
among members of the health care team; and between health care organizations
and their communities. Relationship-centered administration brings the same
qualities of partnership and respect from clinical work into organizational
behavior, treating clinical staff members the same way we want them to treat
their patients.
Underlying and supporting these levels of
partnership is one's relationship with self. Relationship-centered
administration holds that self-awareness, self-acceptance, and awareness and
acceptance of others are the foundation of effective leadership. These core
capacities enable leaders to participate mindfully in the pattern-making of
each moment, to call forth the best capacities of others and to form
trustworthy relationships.
The
New Model in Action
To bring these abstract principles to life,
let's look at a real-life case study, Clarian West Medical Center in Avon, Ind.
Former CEO Al Gatmaitan and his executive team determined that
relationship-centered care would be one of the three pillars of the hospital,
informing the creation and maintenance of a healing workplace culture that promotes
caring; the well-being of patients and staff; and respectful relationships
among patients, family, staff and the broader community.
Had they been working from a machine model,
Gatmaitan and his team might have set up mandatory training in relationship
skills for everyone in the hospital — in effect, programming the behavior of
all the machine parts. Such approaches transmit an unspoken message of
disrespect: that senior leaders believe staff members lack these skills and
need remedial education. Instead, working from a model of relationship-centered
administration, the leaders pursued a more emergent, mindful and affirmative
approach.
They designed new hiring practices to attract
and identify people with a strong relational orientation. They invited applicants
to tell stories about their best moments in health care, and then listened
carefully to assess their interpersonal awareness and capacity for
self-reflection. The stories yielded data to assess each applicant's fit with
the culture of relationship-centered care, and it attuned applicants to the
values and specific behaviors that would be expected of them.
The senior leaders also developed a regular
discipline of reflecting together on their behavior to better understand their
contribution to the organizational culture. They thought through the relational
implications of major business decisions; and they redesigned common
organizational processes, such as budgeting and strategic planning, to foster
greater participation and engagement (partnership) in the organization. They
also coached and mentored their directors and managers to help them develop
similar relational management practices.
Without a grand plan, but with a clearly
articulated vision and a reflective approach to their day-to-day activities,
the leaders succeeded in spreading the culture of relationship-centered care
throughout the organization, resulting in not only high patient and staff
satisfaction, but also high scores on quality measures and a strong financial
performance.
This case study offers a glimpse of
relationship-centered administration in action, showing an emergent,
affirmative and participative change process that began with personal
reflection and mindful behavior on the part of senior leaders. It's readily
apparent how different it is from the traditional machine model and how it
opens new avenues for bringing about change.
Anthony L. Suchman, M.D., David J. Sluyter and
Penelope R. Williamson
Business & Investment Opportunities
YourVietnamExpert is a division of Saigon Business Corporation Pte Ltd, Incorporated in Singapore since 1994. As Your Business Companion, we propose a range of services in Consulting, Investment and Management, focusing three main economic sectors: International PR; Healthcare & Wellness;and Tourism & Hospitality. We also propose Higher Education, as a bridge between educational structures and industries, by supporting international programs. Sign up with twitter to get news updates with @SaigonBusinessC. Thanks.
No comments:
Post a Comment