Leadership and learning in health care

MGMA Connexion, Aug 2005 by Schrum, Bill

reader take-away

* Learn why medical management still has a ways to go to embrace the concept of "learning organization"

* Learn the author's prescription for managers to embrace the concept of continuous learning

* Get a checklist to assess an organization's cultural norms

* Learn a simple, systemic approach to leadership development

* Gain nine points for reengineering a learning culture

Buzzwords are fascinating, aren't they? Ideas that when put into the realm of reality become trendy, overused and scorned when interpreted and misinterpreted. One of those unlucky terms is "learning organization," a term appropriate in any successful organization and a concept too valuable to ridicule.

Peter Senge, author of The Fifth Discipline, describes a learning organization as continually expanding its ability to create its future.1 It is developing the interrelated systems of learning and knowledge that bridge our current reality with a vision for tomorrow. Buzzword or not, that's pretty powerful stuff.

Are medical groups learning organizations?

Given that sweeping definition, we might believe that medical groups are learning organizations. Medicine and management work together to diagnose, treat, cure and learn. They do so, of course, with the underlying premise that this knowledge facilitates the vision for tomorrow's cures, care and cash flow. We regularly hear of innovative practices, imaginative technologies, new medicines, new machines and new treatments, yet diseases continue, costs go up and health care providers and managers go down or out financially or physically.

Is it heretical to suggest that medical management still has a ways to go? Medical practice management functions have grown almost as fast as medical theories themselves. Organizations strive to stay abreast of changing regulations, competition factors, staff expectations and a host of management development, improvement and other "educational" programs. With the pressures of patient care and increased need to create revenue, managers and physicians alike rarely have the inclination to consider vision as anything other than something to refer to ophthalmology.

Underneath it all lies the challenge: Create genuine learning organizations that can work through a maze of concepts and buzzwords, and blend them with local and individual circumstances to create the tools for long-term success.

Creation

Managers need to become leaders, creating environments that evoke and direct employees' motivation. They must allow people to gain knowledge and abilities to shape their futures. This construction project must first master the basic elements of the organizational structure before building anything. An understanding and appreciation of the tangible and intangible elements needs deeper consideration than the latest month-end financial statement.

Managers must facilitate departmental and individual processes of learning and development based on commonsense thinking and long-term design. This responsibility gives the manager the opportunity to mature as a leader and create positive change within his/her organization.

Likewise, it offers the opportunity for failure. If the manager as change agent does not understand the cultural foundations of the organization, does not think through the effects of change within the organization's collaborative systems and their associated financial implications, and cannot move from theory to practice, senior leaders may disdain the effort and classify it as just another program gone awry.

Based on a simple observation that we must know where we are to go anywhere else, this project - building a learning organization - should also assess the entity's current state of existence. Answering a list of questions (top box, page 39) can give leaders a good sense of the present situation.

Construction

Successful long-term change, like learning, comes from within. It is not dictated from the top or brought in from the outside.

Successful practice managers understand that people are conditioned to be educated rather than to learn. We have all received grades and approval based on our ability to ingest information and regurgitate correct responses. We have been taught to perform for approval - that is, meeting others' expectations. Organizational learning begins with addressing people's need to relearn how to learn.

The concept of continuous learning is a low priority to most people in our financially driven, reactive medical environment. Leaders, personally and organizationally, must take time to continually clarify and deepen personal vision, focusing energies, developing patience and seeing objectively. Developing this learning comes on many levels and in many arenas. It needs involvement from everyone, at every level. But by the scope of most jobs, practices and life habits, people generally want education in short bursts; usually via videos or journals. And we all know how that works.

As a risk-taking kind of practice manager, you might ask your physicians if they became doctors by watching a video. Not likely. Managers don't become leaders that way, either. They become leaders by: