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Recognizing and Preventing the Turf Battles that Can Disrupt Innovation and Change
They are considered two of the most pervasive jokes told in business: 1) "I'm from the System office and I'm here to help." 2) "We're glad to see you." It may be an old joke, but the trouble and disruption caused by a dysfunctional relationship between a health system and its regional hospitals is no laughing matter to healthcare executives.
Unfortunately, too many leaders approach the system-region relationship like a big brother telling a little brother what to do, and with predictable, painful results; both sides feel they are right and the other wrong, many are forced to choose sides, each side feels they have to impose their view on the other, and communication breaks down altogether.
This corporate version of sibling rivalry can slow or halt change and innovation initiatives, not to mention the damage it can cause to a company's morale and productivity. So, how can you recognize and prevent these turf battles?
Problems to be solved vs. Polarities to be Managed
One of the primary reasons health system/regional hospital relationships often resemble sibling rivalries more than strategic partnerships is because many leaders approach them as problems to be solved where there are winners or losers. For example, one might say "we must either impose the systems' best practices onto the Regional operations or let the Regions or hospitals do what is best for their local market". Viewed in this "either/or" manner, people begin picking sides, each side digs in, communications degrade and progress towards the important change initiative slows and gets off track.
Unlike a problem, which has a clear and definitive path to a solution, system vs. region issues are actually polarities--meaning pairs of interdependent opposites where one cannot exist without the other. Breakdowns occur when leaders focus on one side of the polarity and neglect the other side. For example, if people only concentrated on inhaling to breathe, they would soon die from a build-up of carbon dioxide in their bodies. If they only exhaled, they would also soon die from a lack of oxygen. It is the relationship between inhaling and exhaling that keeps the body breathing and healthy.
The balance between health system authority and regional control has the same dynamic. Too much control by the home office and the company experiences more of the negatives of home office control without gaining any of the benefits of regional autonomy; and vice-versa.
Expand Your View to Manage Polarities
As part of our work with senior healthcare leaders, we help them expand their own view rather than try to get others to expand theirs. Open and honest conversations are essential. We teach our clients that people are more likely to hear your viewpoint if they feel heard themselves.
One of the tools we employ is the polarity quadrant developed by Dr. Barry Johnson in his book, Polarity Management. This map aids leaders in identifying each of the elements, both positive and negative, contained on both sides of a polarity and the relationship among them.
In the above example, the upper two quadrants contain the positive elements of each pole, in this case strong health system control versus delegation of authority to the regions or individual hospitals. The lower two quadrants contain the negatives of each pole.
The arrows show how the conversation between the System office and the regional hospitals will evolve over time. It is important to understand that people who desire change are looking to move in the direction that is the opposite of the negatives they experience in their own pole.
With this model, leaders can diagnose the critical elements, predict problems if one side "wins" and prescribe actions for people on both poles. Since all "sides" of an issue can be viewed and understood, it is easier to create both/and conversations that enroll everyone in decision-making. For example, what practices and policies do we need to pool our resources and promote best practices across the regions and enable the regions to concentrate on their mission and goals?
If your relationship between your system office and regional hospitals seems harder than it needs to be, maybe you are trying to solve a problem that does not exist. Use a quadrant map to expand your thinking and see the whole picture -- the positive and negative elements of each pole. Then reframe the issues into both/and statements to guide actions that enroll everyone and encompass the positives of both sides. Soon you will turn these breakdowns into breakthroughs and breathe new life into your innovation and change initiatives.
For more ideas on how to increase the pace, success, and sustainability of change in your organization, please call 513-821-9580 or email me at michael@obriengroup.us.
Dr. Michael O'Brien
Founder & CEO
O'Brien Group
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