Engagement and the underpants gnomes

They say, life imitates art.

In a classic 1998 South Park episode the Underpants Gnomes present their business plan to make money with stolen underwear: 

  1. Steal underwear
  2. ?
  3. Profit

A hospital in our area approached provider engagement this way. The hospital was saddled with a governance system and Staff Bylaws based on a pre-1950s reality that didn’t work and led to inefficiency, poor and unpopular decisions, and growing apathy. This had necessitated an administratively created shadow governance to accomplish administrative goals, but this added complexity and confusion and exacerbated the problem of disengagement. 

The Bylaws Committee proposed fixing the dual issues of impaired decision making by an inefficient and irrational governance system and the problem of apathy with a two part approach:

  1. Create a single and streamlined governance system, tailored to the current medical universe, and with a focus on issues of high salience to the medical staff, like quality and processes of medical care. 
  2. Lower barriers to participation, increase local autonomy, make information widely available, enhance communication, and decrease bottlenecks stemming from hierarchical control.

The hospital leadership, apparently having missed the Underwear Gnomes episode, chose instead to pursue their own three part plan to increase efficiency and engagement:

  1. Reorganize staff governance to allow more central decision making and less local autonomy, without changes in the functional or cultural barriers to information access, communication, collaboration and engagement.
  2.  ?
  3. Have increased efficiency, higher quality and more provider engagement

More than a year after the restructuring, the governing oligarchy now expresses surprise and concern that the new structure has not improved the quality or popularity of decisions or enhanced engagement.  That black box in step 2 is a killer.



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