The hospital where I work has recently recognized the serious negative impact our disengaged and non-participatory community of providers is having on the ability of our medical center to innovate and achieve excellence. Evolving from an apathetic to an activist staff is not easy.
My decade of advocacy for the kinds of change I believe necessary has been neither popular nor fruitful. The biggest hurdle has been epistemic closure: the mind set, tools and processes that created, maintained, and now thrive and dominate governance within our passive provider community are terribly ill-suited for the task of creating a collaborative and participatory community.
Every system is perfectly designed to produce the results it produces, and we are no exception. Minor tactical changes (changing the names and boundaries by reorganizing the medical staff) cannot create a collaborative culture within our hierarchical and centrally managed medical center. A major paradigm shift will be needed. Operational innovation (new ways of doing what we do), product innovation (new services) and strategic innovation (new business models) will all be necessary. Alone, these three lower levels of innovation will not be sufficient: we need change at a much more fundamental level. Our current management culture has too much management and too little freedom, too much hierarchy and too little community, too much conformity and too little creativity, too much prescription and too little purpose. To succeed in becoming a collaborative community and center of excellence, we will need the truly deep change that comes with management culture innovation.
I see four components as necessary for this change:
- Access to information. People cannot act on information they do not have, or do not know exists. Information and skills available to ANY individual within the organization must be easily available to EVERY individual within the organization.
- Patterns of communication. Instead of unidirectional one:one and one:many communication often limited to prescribed conduits from one department or committee to another (and often requiring approval by higher levels in the hierarchy), communication patterns must be multidirectional, include robust many:many pathways, and follow a matrix pattern, rather than a series of stacked pyramids.
- Community public space. This flows from (and is dependent on) information and communication. When information and communication live openly at the community level, the barriers to participation and engagement that are created by compartmentalization shrink. The huge body of knowledge and widely varied perspectives and experience within our community become available for creativity. When projects and processes no longer hide in the obscurity of individual departments or committees, but live in the open, the entire community can follow and contribute.
- Culture of collaboration. Rather than cooperation and coordination managed by a hierarchical and fairly centralized command and control structure, the community within the medical center needs to be seen as a self-regulating collaborative community with as much local autonomy as possible. This requires at least four things: (1) Enthusiastic and very public endorsement and modeling by the most powerful in the organization, the C-level and the various presidents and vice-presidents. (2) Managers must see themselves as connectors and facilitators, not as directors or controllers. (3) Diversity of opinion needs to be sought and valued. (4) Variability and experimentation must be encouraged as essential for innovation and improvement, rather than dealt with as a problem to be eliminated.
If - and ONLY if - the necessary information and communication infrastructures are created and supported, processes are moved from the obscurity of walled gardens to an available public space, and those at the top create a safe culture of collaboration, one can expect that providers and other members of the community will start to see themselves as actors rather than victims.
Some outstanding additional resources about communication and collaboration and management are here:
- The Future of Management by Gary Hamel.
- Designing Care: Aligning the Nature and Management of Health Care by Richard Bohmer.
- Digital Strategies for Powerful Corporate Communications by Paul Argenti.
- Cultivating Communities of Practice by Etienne Wenger
- The Culture of Collaboration by Evan Rosen
- The Innovator’s Dilemma and The Innovator’s Prescription by Clayton Christensen
- Open Leadership by Charlene Li