Leadership For Health Care In the Age of Learning

The Project on Technology, Work and Character received a grant from the Robert Wood Johnson Foundation to fund travel and research to study the leadership and the culture of exemplary health care organizations. This study was based on the belief that leadership to create and develop such organizations is an essential element in improving health care and one that is missing from current debates. The purpose of the study was not only to describe best practice but to propose ways of improving and sustaining it.

We were looking at these organizations from the point of view of learnings from the most advanced companies in telecommunications, energy, banking, engineering, among others. In Michael Maccoby’s Harvard Business Review article (Nov-Dec, 1997) on automobile production, he showed the failure of just taking the best technical solutions, including lean production and total quality management, without integrating them in a social system with strong values. In Dr. Maccoby’s consulting work, he has seen that the best companies are moving to a post-bureaucratic organization which is defined by continual innovation, organizational learning, shared understanding of purpose and values, empowerment of front-line employees, and the capability to create teamwork across functional boundaries. Some of these companies have advanced by recognizing that their success depends not only on developing the internal social system, but also on partnering with suppliers, customers, unions and community organizations to create a business ecosystem based upon collaborative planning and mutual learning. Leaders in managed care companies have told us in initial interviews that the health care industry is in an early competitive phase and in need of learning from advanced models.

The study described the values practiced in health care systems as they are evolving, in relation to the values that motivate the professionals and other stakeholders in these organizations. To what extent are the values of physicians and nurses being engaged or are there serious disconnects? For example, it is evident that the expert and caring values of traditional physicians clash with those of health care administrators and entrepreneurs who are motivated by the challenges of the business game and the financial score. How can health care organizations encourage the development and creativity of physicians? How well do people with different values communicate with each other, and to what extent do they have the ability to develop common vision and purpose?

In studying these organizations, we to explored the following questions:

  1. Have these organizations developed a social system model that guides them?
  2. Have they developed a culture or social system which engages the creative values of all health care professionals?
  3. How is the organization led? What are the values of the stakeholders? Are these values aligned with the organization? If nurses belong to a union has this union been made a partner?
  4. Do these organizations go beyond installing information systems to create learning and innovation systems for all stakeholders, including providers, managers and patients?

By culture or social system, we mean the alignment of the hard elements of the organizational culture, the strategy, systems (quality, information, human resources), and structures, with the soft elements, the shared values, the style of relationships, and the skills developed and practiced throughout the system.

The research was conducted through The Project on Technology, Work and Character, a not-for-profit research center, which originated at the Kennedy School at Harvard in 1970 and is now independent and based in Washington, D.C. Using anthropological and socio-psychoanalytic methods, the Project has studied leadership, values, and organizational change and pioneered model projects to improve work.

Advisory Committee

Dr. Geraldine (Polly) Bednash, PhD, RN
Executive Director
American Association of Colleges of Nursing

Roger J. Bulger, MD
President
Association of Academic Health Centers

Paul Griner, MD
Vice President and Director,
Center for the Assessment and Management of Change in Academic Medicine,
Association of American Medical Colleges

Federico Ortiz Quesada, MD
Director, International Relations, Mexican Ministry of Health

Stan Pappelbaum, MD
Executive VP & COO
Scripps

Richard Riegelman, MD, M.P.H., PhD
Dean, School of Public Health and Health Services
George Washington University Medical Center

Henry Simmons, M.D., M.P.H.
President
National Coalition on Health Care

These advisors helped focus the study and evaluated the findings.

Work products included a book, and workshops to share our findings and develop better systemic approaches to change with the Association of American Medical Colleges, Association of Academic Health Centers, American Association of Colleges of Nursing, and other practitioner groups.



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