Back in 1999 I wrote an article for the Washington Chapter of HFMA newsletter. It was published, and actually won the article of the year from the association. I am posting it here, realizing that writing it today I would craft it somewhat differently, but the concepts are still valid. This is also my first ever blog post – and a bit of an experiment. It is good to be constantly learning and trying new things. 🙂
Hospitals and other healthcare organizations (HCO) provide services to organic systems. People, are organic systems. Yet the structure of nearly all HCOs is mechanical. We have a military based command and control hierarchy. The finance function is probably the most structured and controlling, encouraged by years of training, experience, and regulation (GAAP, JC, etc.).
HCOs are involved in tremendous change right now. Most of it is frightening because we seem to be threatened at every turn with financial disaster. Be it managed care, APG, APC, BBA, payer consolidation, etc., you name it and we are being barraged from every direction with change, and much of it seems to be negative. So, what do we do? We engage in change efforts. We look at; non-salary cost reductions, activity based costing, new software and decision support systems, training programs, compliance programs, salary reductions, new partnerships, and whatever else we can think of. We try to run a lean ship, and we drive change down through the organization.
Peter Senge, author of “The Fifth Discipline” recently wrote” I have never seen a successful organizational learning program rolled out from the top. Not a single one.” That is a shocking statement for someone who has spent the last 25 years working with major corporations all over the world trying to enact change! When Senge speaks of organizational learning programs, he is talking about change. Learning programs help us to deal with change by providing new paradigms, expectations, and skills. They help us be more flexible, dynamic, and effective. These are all good things.
So, why can’t we drive change from the top. How many times have you heard, or even said, “its got to be supported from the top.” Senge, and many others, propose that the reason we have a hard time driving change from the top is that organizations, like people, are really organic, not mechanical. It makes sense. Think of an organized group made of organic elements (people) moving toward a common goal. Wouldn’t the group be organic, the same as the elements it is made up of? Organic systems are less susceptible to being driven, and more impacted by being cultivated.
I love that word, cultivated. Mechanics don’t cultivate, they fix things. They make things happen. Yet, how often can we “fix” people? Isn’t that a recipe for disaster? Gardeners on the other hand cultivate.
How many of you have a garden? If you do, you know that you can’t force it to do anything (same with your children isn’t it). You nurture, you provide the best environment possible with adequate light, water, soil, and fertilizing. You provide the environment, and the plants natural tendency is to grow and to thrive. Aren’t we, people, really very similar?
During the Thursday morning session of the most recent (Healthcare Financial Managers Association) HFMA workshop in Port Ludlow, Norm Bossio asked the group about change. He asked “do people resist change?” The group loudly responded “YES!”. He then proceeded to offer one of the members of the group a raise of $500 per pay-period, with no other ramifications, which she gladly accepted. He then pointed out that this was a change, and she seemed pretty willing, so do people really resist change? His point was that we accept change when it is in our favor to our benefit! Senge puts it this way “If new behaviors are more effective than old behaviors, then the new behaviors win out.”
Change is an organic process. It always involves people, and most often is centered on people. It requires patience, time, and caring. We will not be successful in getting and sustaining deep down commitment for our change efforts if we go about it in a mechanical way. We need to learn from the gardeners how to start small, to nurture, to create the environment where the natural tendencies of individuals will come out, and they will thrive. When we offer this environment with a compelling mission, vision, and strategy then our organizations will thrive also.
I do believe that we need top support for change. While it is difficult to drive change from the top, it is all to common to squelch changing from the top. Top management need to understand the generating and limiting factors which affect change.
They then need to try to reduce the limiting factors, and encourage the generative ones. In this way they help cultivate the right environment for change efforts affected by the front line staff and supervisors. This change is deep, heartfelt, and will grow. This type of change will outlast a CEO or CFO, and will serve to truly transform an organization. It looks at change from the perspective of the interaction between the customer and the provider of service. It is driven by personal commitment to the mission and the customer and cross functional communication that this change will be enduring.
This article will, hopefully, create a little bit of angst. It disputes the sanctity of the CEO and executive office. It questions the way things have been done during all of our and our parent’s lives. It is a different way of looking at organizations. It is based upon the idea that people really do want to be happy, successful, and effective. People are organic and thus complex systems, with differing backgrounds, expectations, and capabilities. I do not intend in any way to diminish the challenging nature of this proposition. It is still not easy! I would suggest, however, that using a perspective that is consistent with the nature of the individual will be more successful overall. So I encourage each of us to look at the advantages of being gardeners, and reaping the benefits of a tremendous harvest.