OB and OD Change Efforts—Healthcare System

The non-profit healthcare organization, with the best reputation locally, has just replaced it’s CEO with a very data driven individual. A new policy has been implemented that requires all patients to be seen by their provider within 15 minutes of entering the waiting room. Metrics reporting and public reporting of an organization’s metrics has become a common element in health care in the United States. Many organizations feel that this is a common sense approach to improving quality while decreasing costs and some studies have shown better outcomes. (Rambur, Vallett, Cohen, & Tarule, 2013)

While the theory of not requiring patients to wait for a long time to see their providers is a good one, it also has some drawbacks, not the least of which are the providers themselves who are starting to leave the organization due to complaints about metrics. No one likes to be rushed and healthcare is a field that is traditionally heavily centered on patient care and good bedside manner. When you are being required to meet time standards, it is not always possible to get all the information needed from a patient and encourages providers to take shortcuts on diagnoses. Rather than gather all the information, it is easy to treat the main complaint allowing other, possibly more serious, symptoms to be sidelined in the name of metrics.

In one study by Powell et al (2012), there were several negative unintended outcomes for patients as a result of performance measurement systems. Including lack of focus on patient concerns, inappropriate clinical care, misdiagnosis, and inappropriate use of antibiotics. (Rambur, Vallett, Cohen, & Tarule, 2013)

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This new CEO is clearly of the unitarist perspective on management and organizational development (OD). This style of management focuses on economic gain, if it saves money, then it is a credible strategy for management action. (McCalman, 2015) By focusing on a metric of 15 minutes, the CEO can optimize the number of patients seen by providers in any given day. This allows for increasing numbers, assuming that the metrics can be met and that care and quality patient time don’t cause delays. By making the choice to focus on the metrics, rather than the underlying needs of patients and providers to have a symbiotic relationship, the CEO is ignoring the organizational behavior (OB) practices in the organization and that is what is leading to the exodus of practitioners from the organization.

Research has shown that organizations that value their employees and have strong OB characteristics are more profitable than those that do not. (Open Textbook Library. 2017) Organizational behavior integrates well with the pluralist view of management which is where organizations are looked at as social constructs where integration of goals and aspirations of everyone makes the organization fully successful. It is not surprising that when organizations stop valuing the needs of their employees, i.e. the OB of the organization, their employees begin to have a higher level of dissatisfaction.

There is significant evidence that employee’s psychological capital, or positive feelings about their workplace/employer, are related to their performance and having desired attitudes. (Luthans, Luthans, & Luthans, 2015) Since this CEO doesn’t appear to value his employees psychological capital or positive feelings, lets focus on that unitarist approach to management.

The unitarist approach to management really came into practice at the turn of the last century when major technological leaps were being experienced by the United States, Germany, the United Kingdom and France. There were large scale production models being developed and the core principals of industrialism were developed. The general operating model emerged as the bureaucracy that we know today. This involved structuring resources by specialty and dividing the process of production into discrete parts.

This approach worked to advance large scale capitalism throughout the world and to improve and protect the economic dominance of the establishment. (McCalman, 2015) Frederick Winslow Taylor, a mechanical engineer from the US, developed the idea of efficiency to organizing production systems that had tremendous impact through the US and Europe. It was based on economic logic and increased the productive capacity of workers through a quantifiable system of measuring and controlling. His ideas were published in The Principles of Scientific Management in 1911. Some people have accused Taylor with “bringing an inhuman and overly rational approach to organizing the affairs of organizations.” .(McCalman, 2015).

Taylor actually wanted to bring about a cultural change strategy where managers could promote individualism and personal gain that didn’t depend on the effort of co-workers. The key to this change was managers “choosing” select workers that were driven by personal gain and were inherently selfish. Observe their processes and establish the maximum productivity level of the worker and give them the technology needed to achieve that productivity level. Remove activities that didn’t assist in the productivity level and pay the worker based on the output they achieved. This allowed workers to agree with the manager that the manager knew the best plan for the worker and should be organizing their work for them.

Obviously this model was very attractive to managers and became the model for industry and civic management throughout the world as it is very straightforward in planning, implementation and conflict free maintenance. While this unitarist framework was logical and made sense in the time of mass automation and industrial growth, today workers are knowledge workers with specialized skill sets that are nearly impossible to manage using scientific/unitary management principles. Today’s employee is often in a service industry, such as the healthcare organization we’re talking about here, and how they feel about their work matters as much as their attitudes towards their employer.

This is extremely important in health care, where, as Marvin Weisbord, OD guru, once wrote an 1976 article titled “Why OD Won’t Work in Healthcare” (Yaeger & Sorensen, 2010) with the underlying assumptions of a unitarian OD management system.

Healthcare is undergoing extensive changes in structure, management styles, growth and mergers. OD, has well, has developed over time. Combining the two to achieve a better work environment seems to be the needed factor in this situation. My proposal to increase satisfaction among providers, patients and the new CEO would be to start out by bringing in an OD consultant with experience in healthcare specifically. One of the newer OD approaches, which seems to work extremely well in healthcare is dialogic OD, which starts from an opportunistic-centric approach that begins with common aspirations and shared visions making engagement on all sides much easier. (Yaeger & Sorensen, 2010)

By using dialogic OD, the healthcare teams can move away from the traditional approach, which assumes there is a problem that needs fixing, and allows conversations that can create positive energy and outcomes. I would also recommend that the OD pays special attention to leadership and culture at the organization. In addition to the CEO, who are the other key leaders and what is their skillset? Are all the leaders on board with the CEO’s metrics driven program? If not, what are their capabilities, competencies, past successes and failures, education and work experience, and emotional intelligence? Can they, as a team, be coached into a program that better meets the needs of everyone involved?

In order to transform this organization, the best minds, most productive collaborations and active engagement of everyone is going to be necessary. Perhaps a leadership development program with training on OB values, from the top down, would help everyone understand why it is important that providers feel they are valued by the company and also so the CEO can understand the value his employees bring to the organization. The other important item to understand in health care is the culture. Culture in healthcare is a multidimensional approach. There is a culture for each of the following groups - the physicians, the nurses and the administrator.

All three cultures interact everyday and have different expectations, language and models. While they all have the basis of being service based or patient/family based, they each perceive patients and employees in a different manner and often, they aren’t aware that they have these differing perceptions. This awareness of the different perceptions can be brought about by opportunities to come together and discuss the differences. Once this has been done, everyone is able to come together and collaborate on solutions and ways to implement change. This is often the fastest way to go about transformation. (Yaeger & Sorensen, 2010) By setting up large scale interventions to incorporate the entire organization into the change process, everyone can feel empowered as a contributor.

Everyone can identify problems, bring them to leadership’s attention and help in fixing them. The makes the organization, as a whole, much more successful. It can also alleviate pressure on top leadership to “own” all the problems and issues by allowing them to delegate and allow others to discover things. It is important to understand that healthcare systems are hierarchical in nature and dependent on physicians. If the physicians are leaving, then that healthcare system isn’t going to survive for long. By offering leadership training and executive coaching and cultural interventions (Yaeger & Sorensen, 2013) to integrate everyone into a new understanding of the forward moving culture, this organization has a good chance to turn itself around and continue being a leader in the community.

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