HMS Academy

HMS AcademyMedical Education Day

Workshop

Organizational Change and Accountability in the Hidden

Curriculum

Why little progress in 15 years?

Adaptive Challenge “…there is no common agreed-on understanding

of the problem…(people) have conflicting opinions about its causes. They propose different solutions. They have varied opinions about whose responsibility it is to solve the problem.”

Souba C. The language of leadership. Acad Med 2010;85:1609

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What are the values of your institution?

• Have they been articulated?

• Do they reflect the academic mission?

• Are they truly agreed upon by all departments?

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Clash of Cultures

Business== Outcomes

oriented== Accountability== Continuous

quality improvement

== Priorities set centrally

Education== Process oriented== Autonomous

agents== Murky

assessment== Priorities set

locally

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The DilemmaHow do you get

control of a large number of people who view themselves as expert, autonomous beings who know more than you do?

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Language, Change, and Performance

“Leading organizational change can be understood as a process that is managed and made sense of through language.”

Souba C. The language of leadership. Acad Med 2010;85:1609

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Case Study 1

Chief of Radiology is adamantly opposed to the transparent allocation of teaching money (i.e., money goes to those who do the teaching). “It’s very hard to run a department these days. I need the flexibility of the teaching money to fill in holes.”

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Appeal to Reason (gently)Be Willing to Compromise

Paradox: we claim we don’t get enough money for teaching, but what we get we use for other purposes.

Compromise: allow chiefs to have flexibility with 10% of the funds

www.cartoonbank.com

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Case Study 2

The Chief of Neurology is adamantly opposed to the proposal for a new curriculum approach to the third year clerkships. “Learning is about being on the wards and taking care of patients. If your program takes any time away from that, it is poorly conceived.”

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Do the ExperimentThe Power of Pilots

Use their language. “We have opposing

hypotheses, Dr. S. Let’s do what you would do in your lab. Let’s do the experiment.”

www.cartoonstock.com

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Negotiating 101

• What does your “opponent” care about? Align your interests with theirs.

• Go for the “win-win” solution; be willing to compromise.

• It’s about interests; avoid making it personal.

• Keep your eye on the target; you don’t have to win every battle to win the war.

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Respect (and try to understand) Finances

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Key Points• Understand your organization’s

system and its priorities• Design your work-plan to support the

organization’s priorities• Add value; outcomes driven• Respect finances• Look for the “win-win” solution

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