Suchman Regenstrief Conference 2207 Slides

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Information about Suchman Regenstrief Conference 2207 Slides

Published on October 6, 2007

Author: ShawnHoke

Source: slideshare.net

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Suchman

Organizations as Machines, Organizations as Conversations: Two Core Metaphors and their Consequences Anthony L. Suchman, MD, MA Relationship Centered Health Care Rochester, NY

Anthony L. Suchman, MD, MA

Relationship Centered Health Care

Rochester, NY

My hope is that as a result of this talk, you will: recognize that an organization is ongoing emergent pattern-making (patterns of meaning and patterns of relating) pay more attention to process: how patterns form, what constraints are present and what effect they have be more aware of your own participation in the process (how you form it and it forms you) and recognize that organizational change begins with your own mindful changes in how you participate recognize the parallels between administrative, research, clinical and educational processes, and be more excited and hopeful about relationship-centered methods for both organizational change and organizational research

recognize that an organization is ongoing emergent pattern-making (patterns of meaning and patterns of relating)

pay more attention to process: how patterns form, what constraints are present and what effect they have

be more aware of your own participation in the process (how you form it and it forms you) and recognize that organizational change begins with your own mindful changes in how you participate

recognize the parallels between administrative, research, clinical and educational processes, and

be more excited and hopeful about relationship-centered methods for both organizational change and organizational research

Core metaphors Organization as machine (Taylor) Organization as conversation (Broekstra, Stacey)

Organization as machine (Taylor)

Organization as conversation (Broekstra, Stacey)

Curious properties of patterns Patterns are perpetually under construction here in the “living present” The construction of patterns is a self-organizing process

Patterns are perpetually under construction here in the “living present”

The construction of patterns is a self-organizing process

Helpful concepts from complexity Non-linear dynamics: reciprocal influence Amplification of small difference (Butterfly Effect) Inverse power law (Sand Pile Effect) Self-organization: requires both freedom and constraint The emergence of new patterns is favored by diversity and responsiveness Similarity across scale

Non-linear dynamics: reciprocal influence

Amplification of small difference (Butterfly Effect)

Inverse power law (Sand Pile Effect)

Self-organization: requires both freedom and constraint

The emergence of new patterns is favored by diversity and responsiveness

Similarity across scale

How does change happen? Grand design (blueprint) – emergent design Details come from leader – details come from everyone

Grand design (blueprint) – emergent design

Details come from leader – details come from everyone

Case History IUSM is a 102 year old medical school… 2 nd largest in US (>1100 students) Only AHC in Indiana 9 campuses; 5 major hospitals 70 postgraduate programs Leading-edge competency-based curriculum Concerning GQ questionnaire results

IUSM is a 102 year old medical school…

2 nd largest in US (>1100 students)

Only AHC in Indiana

9 campuses; 5 major hospitals

70 postgraduate programs

Leading-edge competency-based curriculum

Concerning GQ questionnaire results

Undergraduate Competencies Effective communication Basic clinical skills Using science to guide diagnosis, management, therapeutics and prevention Lifelong learning Self-awareness, self-care and personal growth The social and community contexts of health care Moral reasoning and ethical judgment Problem solving Professionalism and role recognition

Effective communication

Basic clinical skills

Using science to guide diagnosis, management, therapeutics and prevention

Lifelong learning

Self-awareness, self-care and personal growth

The social and community contexts of health care

Moral reasoning and ethical judgment

Problem solving

Professionalism and role recognition

Problem List Informal curriculum (organizational culture, social environment) doesn’t match or support formal curriculum Frustrated idealists; reaching point of burnout The challenge Transform the informal curriculum such that it consistently embodies the values and principles of Relationship-Centered Care.

Informal curriculum (organizational culture, social environment) doesn’t match or support formal curriculum

Frustrated idealists; reaching point of burnout

Transform the informal curriculum such that it consistently embodies the values and principles of Relationship-Centered Care.

The RCCI 3 year project to initiate culture change/ informal curriculum change 1 PI, 2 co-PI’s, 1 project manager 2 external consultants; monthly visits for 3 years

3 year project to initiate culture change/ informal curriculum change

1 PI, 2 co-PI’s, 1 project manager

2 external consultants; monthly visits for 3 years

RCCI Strategy Recognize emergent nature of change Let go of control Initial project followed by spontaneous rippling and dissemination Begin with an Appreciative Inquiry – Discovery Team interviews and first Open Forum

Recognize emergent nature of change

Let go of control

Initial project followed by spontaneous rippling and dissemination

Begin with an Appreciative Inquiry – Discovery Team interviews and first Open Forum

Paired interview questions: Fostering humanism in medicine – creating more room for both patients and clinicians to be fully present to each other – may be the most important work in medicine today. To learn about humanistic environments, we need look no farther than SHIM. Whether you’ve been involved for a day or for decades, you may have experienced a moment when SHIM fostered some degree of congruence, community or renewal. Think of such moment; tell me the story of that time. What was it that made that moment successful? What did you do or bring to that moment that contributed to its success? What did others do? What was it about the context or situation that made a difference? What lessons do you take from this experience?

Paired interview questions:

Fostering humanism in medicine – creating more room for both patients and clinicians to be fully present to each other – may be the most important work in medicine today. To learn about humanistic environments, we need look no farther than SHIM. Whether you’ve been involved for a day or for decades, you may have experienced a moment when SHIM fostered some degree of congruence, community or renewal. Think of such moment; tell me the story of that time.

What was it that made that moment successful?

What did you do or bring to that moment that contributed to its success?

What did others do?

What was it about the context or situation that made a difference?

What lessons do you take from this experience?

STUDENTS RAD FM ADM COMMITTES 6 mo 12 mo 18 mo DISCOVERY TEAM RESIDENTS EDUCATION ADMIN DEANS RETREATS TALKS

Lessons learned New patterns of thinking and relating are spreading Individuals and committees are making more mindful choices Emergent approach to organizational change is working; “master plan would likely have failed Storytelling has been engaging and community-building Ongoing use of success stories is leading to more favorable self-image, higher self-expectations and greater confidence and hope Change happens and spreads one person at a time

New patterns of thinking and relating are spreading

Individuals and committees are making more mindful choices

Emergent approach to organizational change is working; “master plan would likely have failed

Storytelling has been engaging and community-building

Ongoing use of success stories is leading to more favorable self-image, higher self-expectations and greater confidence and hope

Change happens and spreads one person at a time

How do we go about the work of organizational change? Focus on the plan – focus on the process Change agent as director – change agent as reflector and disturber Change agent acting from outside – change agent participating from within

Focus on the plan – focus on the process

Change agent as director – change agent as reflector and disturber

Change agent acting from outside – change agent participating from within

What are the underlying attitudes and expectations of change work? Seeking control – seeking relation Expecting predictability – expecting surprise

Seeking control – seeking relation

Expecting predictability – expecting surprise

Parallels with… Relationship-centered Care Health services research

Relationship-centered Care

Health services research

Research questions inspired by CRPR What are the existing patterns of meaning? Of relating? How are they maintained/re-enacted in each moment? What are the constraints that help them stay in place? What new patterns are forming? Or what new patterns are intended? What are the initial disturbances? How do they spread? What constraints support that? How is the change agent participating? What are the sources of diversity? What favors and inhibits their availability to the organizational conversation? What are the crucial relationships? What factors favor and inhibit responsiveness in the organizational conversation?

What are the existing patterns of meaning? Of relating?

How are they maintained/re-enacted in each moment?

What are the constraints that help them stay in place?

What new patterns are forming? Or what new patterns are intended?

What are the initial disturbances? How do they spread?

What constraints support that?

How is the change agent participating?

What are the sources of diversity? What favors and inhibits their availability to the organizational conversation?

What are the crucial relationships?

What factors favor and inhibit responsiveness in the organizational conversation?

STUDENT RCCI LEADERSHIP BOOK of STORIES CENTER VISITS STUDENT ENGAGEMENT TEAM HONOR CODE MEETING STUDENT LINE

ADMISSION COMMITTEE INTERVIEWER OSCE SIMULATED APPLICANTS NEW SELECTION PROCESS PROFESSIONAL STANDARDS TLAC FACULTY COMMITTEE LINE ACADEMIC STANDARDS CURRICULUM COMMITTEE

SENIOR LEADERSHIP LINE 3D RELATIONAL AWARENESS CHAIR EVALUATIONS EAD’S

DISCOVERY TEAM LINE OPEN FORUM OPEN FORUM OPEN FORUM DT RETREATS RCCI NEWSLETTER CTL CTL CTL CTL

HOUSESTAFF FORUM RADIOLOGY RESIDENTS RESIDENTS LINE Discovery Tm HOUSESTAFF FORUM Resident Engagement Team COGME Resident Coordinators

Believing in the capacity of all people to learn and grow: giving them freedom and support to pursue their professional growth and career development.

The importance of connectedness: student-teacher, patient-clinician, cross-disciplinary healthcare team; research collaborators, basic scientist-clinician, across departments and institutions

The importance of passion: for patient care, learning, teaching, trying new things, creating new knowledge.

The wonderment of medicine: the discovery and continuing appreciation of the profound nature of our work.

Subsequent steps… Tell more people about the stories and themes Conduct additional interviews DT becomes cadre of internal change agents meets monthly to share ideas, learn organizational change methods, give and get peer coaching and support practice and disseminate relationship-centered meeting practices (e.g.: check-in, noticing success, appreciative debriefing)

Tell more people about the stories and themes

Conduct additional interviews

DT becomes cadre of internal change agents

meets monthly to share ideas, learn organizational change methods, give and get peer coaching and support

practice and disseminate relationship-centered meeting practices (e.g.: check-in, noticing success, appreciative debriefing)

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