LO in Healthcare LO16723

David C. Rupley, Jr. (spirit1@azstarnet.com)
Mon, 26 Jan 1998 23:18:49 -0700

Replying to LO16648 --

Paul Foley wrote:

Are they, because of their knowledge based work, fertile ground? Or,
because of actual or perceived hierarchies, difficult to get the flow

I wonder if anyone has examples of LO delivering clear benefits for such
organisations? It'd be nice to give them some motivational stories.

It perhaps also raises the question of whether all this stuff is easier to
introduce in highly knowledge based organisations. My own suspicion, and
to a degree my experience, is that the effect can be more dramatic and
quicker in more traditional manufacturing environments where people have
always been paid to use their hands rather than their heads.

Sorry for the slow response. I didn't notice this thread until today.

My perspective is from the viewpoint of a physician embedded in a rural
medical clinic with a poorly recognized interdependence on a rural

This Catholic hospital's owners (sisters) identified becoming a LO as one
of the corporate goals. They were met with mixed responses - anyone
surprised? The CEO played along. Two VP's were extremely interested
despite open discouragement by the CEO. I became involved prior to
knowing of the corporate goal.

We had three physicians, administrators from both the clinic and the
hospital, and a few additional individuals who voluntarily met every other
week for almost two years to discuss - and attempt dialogue at times.
Within these individuals there was some significant learning. The system
had some changes, particularly in dealing with some negotiations which
suffered from poor communication in the normal channels. The
relationships established outside those channels - in this group - kept
the negotiations from exploding.

My belief is that the CEO was very attached to his power AND was very much
suspicious of the latest fad. There was no movement to embrace the shared
vision which I felt was desperately needed at the hospital and the clinic.
Both organizations rolled out visions from the top which were not well
accepted at the bottom - surprise!

My bias from the MD view is best framed by Argyris in Teaching Smart
People to Learn and Overcoming Organizational Defensiveness. Add in a
healthy - pardon the pun - dose of do not ever, ever, ever, ... make a
mistake. And if you do, do not ever, ever, ever, ... let anyone catch you
at it. This is medical education. That is a great foundation for an open
and honest communication needed for CQI and LO.

It is a mixed picture with some strides and much resistance. Oddly, the
profit incentives in the US may align with change more than maintaining
the status quo.

Hope this adds to the picture.

David Rupley, Jr.
no longer practicing medicine

Spirited Growth
7400 N Oralce Rd, Suite 100A
Tucson, AZ 85704


"David C. Rupley, Jr." <spirit1@azstarnet.com>

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