LO in Hospitals LO22721

Bill Braun (medprac@hlthsys.com)
Thu, 23 Sep 1999 08:27:45 -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?

Hi Bruce,

As you explore LO in hospitals, I encourage you to look beyond emotions in
intense situations explains burnout and schizophrenia. My experience and
observations suggest that many healthcare professional feel a deep
disconnect between their training (patient advocacy) and the emerging
"business model" of healthcare, and have great difficulty reconciling this

Making an hospital an LO is a step in the right direction. But it may also
be an example of excessively and tenaciously pursuing the symptoms while
leaving the underlying problems untouched. For most hospitals, the
underlying problems are predominantly outside their doors. Only a broad,
sweeping systemic approach will provide the leverage to change much of
what healthcare professional experience inside the walls of hospitals.

The other component is that healthcare professionals need to take
healthcare back from the MBAs. As one myself I have to acknowledge that my
understanding of and commitment to patient advocacy has never developed to
the scope and depth of people whose clinical training is long and intense
(I have clinical training but it is limited by comparison). When
healthcare professionals gain the competency to lead their institutions,
and your desire to see hospitals as LOs is a key component in that, in
ways that reflect core values of caring for people rather than responding
primarily to their agency duties to owners, I think you'll see a reduction
in the burnout and schizophrenia that you refer to.

Years ago (lots!) I worked as a surgical tech in a trauma unit at Mass
General Hospital in Boston. I've seen it all and a good deal of it (3 AM
rousted out of a deep sleep, a bit disoriented, knowing I had to get to
peak performance in 60 seconds, etc.) generated incredible stress and
intense emotion (especially when seeing the constant stream of human
carnage from accidents, shootings, fights, murder attempts and suicide
attempts). It was the same for everyone else. None of us were
schizophrenic and we did it for a long time.

Not only did we fail to become clinically nuts or see the world through
glazed eyes, we had fun and loved our work. We all felt a keen sense of
commitment and fidelity to some core values of caring for people who
needed this help at that point in their lives. I wasn't much of a
philosopher - I just did my job with a sense of pride and satisfaction.
Thirty years later it is still the best job I've ever had.

As compared to clinical training, management training is haphazard,
lacking in (globally recognized) unifying core values and principles,
spans multiple and frequently conflicting schools of thought, is often
susceptible to the theory of the month and places no demands upon itself
in terms of requiring its practitioners to demonstrate minimum levels of
competency (can we imagine board certification for managers?).

Clinically trained people cannot fathom how we think and frequently
conclude that we don't. How else could healthcare be in such a mess? How
could we have such blatant disregard for basic human dignity and
relentlessly pound away at the business model of healthcare? Well of
course there's two sides to the story, no side has a lock on truth and
reality. But to the clinically trained person, it's quite perplexing.

What can we conclude from all this? I don't know. I will venture that
simple explanations of behavior (where we evaluate the symptoms only in
the subsystem where they are visible) is likely to be insufficient and no
amount of LO effort will have much impact, although LO efforts will surely
be an important tool (of many) that gets us out of the mess.

Bill Braun

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


Bill Braun <medprac@hlthsys.com>

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