As a clinician leader you are going to be working in some kind of organization. To be effective, you must learn how things get done in your institution. I have experience with a dialysis unit, a multi-specialty medical group, and a public hospital, and have come to appreciate that all three have different cultures, different styles, and different ways of thinking about the things that are important to us as practicing physicians. Styles tend to be the most malleable, but habits of mind and culture tend to be resistant to change.
One of my premises is that the successful medical organization of the future has to find ways of blending the styles, habits of mind, and cultures of physicians with those of administrators and other stakeholders. I also find that most people leading these efforts do not appreciate the width and depth of the culture gap, and many efforts fail when they fall into that ditch.
There is no one way to think about these issues, so what I have done over the years is to write a series of articles illustrating various facets of the problem. Some revolve around finance, some around governance, and some about how medicine is really practiced, which is not always the way we talk about it in public. I hope these articles help you think about your culture and those of your institutions in more depth—the success of your efforts depends upon it.
Team Building Articles
A Good Place To Work
Is your organization a just one? How do you know?
Doctors and hospitals operate with different cultures and unexamined assumptions may cause conflict.
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
The scandal at the VA shows the importance of choosing performance measures wisely and the need to consider organizational culture in applying standard management techniques.
Horizontal Violence and Nursing Staff Turnover
A recent study shows horizontal violence - conflict between nurses in a hospital - is common and a major cause of job dissatisfaction and intention to leave. What can be done about it?
How did you know?
How do experts know? The roles of formal and tacit knowledge are considered.
Knowledge management (KM) covers any intentional and systematic process or practice of acquiring, capturing, sharing, and using productive knowledge, wherever it resides, to enhance learning and performance in organizations. Which strategy for knowledge management is appropriate in dialysis clinics?
Leadership Lessons From the Military
Lessons from Leading the military in Afghanistan have implications for which medical organizations will thrive in the current turmoil.
Measurement error is recognized in the laboratory, but not in US healthcare, which is causing problems.
Measuring Stress in Your Team
Making health care organizations more successful may begin with recognizing distress in the persons providing the care. But how?
Measuring teamwork is difficult, but important if healthcare systems are to invest in their development. This article reviews the literature and provides suggestions for action now.
New Leadership Skills for Physicians
David Brooks has identified highly valued skills in the modern world. The good news is that physicians already use three of them.
Nursing Staff Turnover
If empowered teams of clinicians is the key to effective, efficient care, then staff turnover is Achilles' heel. Nationally, RN turnover exceeds the cap needed to maintain patient safety and quality of care. The problem and approaches to a solution are considered.
Organizing for Success - Lessons from Keystone
The Keystone Cooperative ICU Project obtained major improvements in safety. The "soft science" lessons need to be applied more widely.
Shared Decision Making
A consideration about decision making at the person, group and organizational levels.
Making simple ideas work turns out to be complicated and hard.
Strategic Human Capital
Healthcare organizations need to realize the economic value of experienced teams of clinicians able to provide highly reliable care and to recognize the importance of maintaining team integrity in times of surges in patient volumes.
Teams and Learning Organizations
A brief introduction to the concept of the learning organization for physicians.
The Center Effect
Some dialysis units have consistently better performance than others, even after adjusting for individual patient variables, which is termed the center effect. This has important implications for hospitals and health care organizations as they respond to public reporting of data.
Time Span Preferences