LO in Hospitals LO22720

Bill Braun (medprac@hlthsys.com)
Thu, 23 Sep 1999 08:06:47 -0400

Replying to LO22702 --

>In searching for an appropriate topic for a class paper, I decided on the
>development of an LO in the healthcare environment, specifically
>hospitals. I see how it can be done in the business aspects, since
>hospitals are organized as business. What I am wondering about is the
>clinical role of a hospital. Is it possible to take a hierarchical, skills
>intensive, knowledge focused environment and apply LO principles? If so
>does this lead to a schizophrenic organization? Most health care workers
>(direct patient care) are already schizophrenic. They deal with their
>emotions, patient's emotions, doctor's emotions, and fellow employee's
>emotions in some highly intense situations. This is the reason for burn
>out in most medical environments. Would making a hospital an LO add to or
>relieve this problem?
>Does anyone know of any specific references for this?

Hi Bruce,

I'm on the faculty at Baldwin Wallace College. In January, we begin the
third group (third class of entering students, first class graduates in
December) of people in our Healthcare Executive MBA program. We have a
good mix of MDs, RNs Techs, PTs, admin types, Rx reps and the like.

So far we haven't noticed any schizophrenic behavior though I'm sure where
an EMBA program is concerned there would be a significant self selection
factor in people who present themselves for such a program. There was one
student who dropped out temporarily for familial reasons who had exhibited
some noticeable behavior for a while but it appeared (none of us are
clinically competent to know) to be induced by extreme stress.

As the first group nears the end of the program, I can offer several
observations. As a class, this group exhibits some characteristics of a
learning organization. While most of the work is done in teams, there is
also an elements of teamwork amongst teams.

Discussions in class have shown a steady (albeit slow) increase is self
monitoring of mental models. You can hear people using advocacy and
appreciative inquiry in their communications. There is a significantly
heightened awareness of personal mastery. This may well be the most
significant. The physicians especially have demonstrated leadership skills
that no longer rely on traditional hierarchical power and authority.

People is traditionally subservient roles (relatively speaking, up and
down the traditional pecking order based on years of study, docs on top,
etc.) show more assertive leadership.

A fair amount of discussion revolves around the application of LO
disciplines in clinical teams as well as across clinical continuum of care

John Gunkler some time ago offered some interesting insights from his
experience in healthcare. He noted that physicians, accustomed to being
highly directive, out of their training an experience at "saving lives",
have a strong tendency to export this style to any human interaction,
whether the dynamics of the situation warrant it or not.

We've seen considerable changes in behavior from the docs especially. It's
quite possible that pragmatism has them modifying their behavior
selectively to get through the program with a passing grade. But, and this
is highly interpretive, it seems to me that when we listen carefully, the
docs (especially) seem to be following a very different philosophical
thread inside their heads as the words come out of their mouths.

We think real change has taken place. We have no observations in their
places of work, so we also cannot assess to what degree the behavior in
class is an "act". It may be wishful thinking, but we are optimistic that
the behavior shift is real and will last.

Bill Braun

The Health Systems Group
- Physician Leadership Training
- Simulation Modeling for Healthcare


Bill Braun <medprac@hlthsys.com>

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