Perspectives on Organizational Culture in Healthcare

Over the past 30 years, the term organizational culture has gained prominence and have stimulated plenty of interest. Theories have been developed, definitions abound and debates have spurred. Today we still talk about how (and if) one can change organizational culture.  

And “whether managers think that the culture is too soft or too complicated to bother about or whether there is no unique corporate culture does not reduce the significance of culture” (Alvesson, 2002).

“Culture isn’t everything” says a title that caught my eye. The article mentions that even though it's difficult, culture is something that can be enforced. One of two perspectives on organizational culture developed by Smircich (1983) - "culture as a variable"- implies that culture is something the organization "HAS". In essence, it implies that organizational culture needs to be viewed as a tool for enhancing organizational effectiveness. Hence, the existence of "strong culture organizations" that are highly effective (Google, Southwest Airlines, Nordstrom, Westjet).

Coalitions in Healthcare: The Super Power of Pathways

"…then a nurse was telling me how they encountered a problem and how they fixed it…and I said 'No! Don’t do that way!'"* 

These are the words of Paul Levy, former CEO of Beth Israel Deaconess Medical Centre in Boston. His leadership style during the restructuring of BIDMC is studied in organizational behavior courses in postgraduate schools to illustrate decision-making and change management skills. But why would he be against local, grass-root level implementation of changes?

On Revolutions, Rebels and Reshaping Healthcare

In a world of constant change, transforming healthcare is a topic that receives considerable attention. We talk about how we can improve, what solutions to adopt and how to implement change. Then we find ourselves trying to sustain the changes and we go back again to the drawing board: a continuous PDSA cycle within an infinity Enso circle.  This is the fight: against the status quo, to protect our ethical principles as healthcare providers. Our passion guides us like a flag into a war. But is a revolution necessary? Who are the rebels and what do they do?

On Measuring Performance and the Bell Curve

I have recently had an interesting conversation with one of our surgeons about clinical performance and how to improve on it. The talk inevitably led to a discussion on the validity of the bell curve, and how surgical performance can be improved once you are in the top performing zone. As you probably know, the bell curve has been used for years as a model on how people perform. As the image below shows, this model is easy to understand and stipulates that human performance fits a normal distribution, with most performers being average and occupying in the middle, while poor performers and high performance as outliers. 

However, in 2012, a research study involving over 600K participants