| Newsflash | ||
|---|---|---|
|
||
| Polls |
|---|
| 20% + off all books |
|---|
|
 |
| Help Wanted: Managers to Lead Organizational Culture Change |
| Feature Articles - Cultural | |
| Written by James E. Burgin, MDiv, MAC | |
| Tuesday, 04 March 2008 | |
|
Editor’s Note: This article inaugurates what will be a regular column
for managers. The next issue will carry the first Management Corner
column,“The Monk’s Offer.” Right at the top of the risk factors confronted by the behavioral healthcare field is organizational culture rigidity. Even talented managers find that changing the historic culture of their organizations, so that they can thrive in the current environment for services, is a daunting challenge. The culture of an easier time for services dies hard. Too, day-to-day operating, narrowly focused on this year’s problems, created by last year’s solutions, sucks energy out of efforts to evolve a culture able to pursue next year’s opportunities. Even counselors in small private practices confront the challenge of culture change. Gone is the time when they could give almost exclusive attention to providing therapy, and regard running their practice as a business, as an intrusion on professionalism. Changes in reimbursement practices and referral streams require a mindset that says, “I run my business so that I get to practice my profession.” Though most practitioners know this, many continue to find it challenging. Culture rigidity is not a challenge confined to the behavioral health field. Andy Grove, former CEO of Intel Corporation was interviewed last year (2007) by Charlie Rose, who asked why Intel missed the opportunity to develop connectivity (servers and search engines such as Google, Yahoo and Cisco). He said, “Because I was so damn busy making micro-processors and wasn’t hungry!” The culture changed and Intel did not. The recent history of the American automobile industry also tells a story that we find familiar. It was so successful for so long that it was able to deny the quality problems without paying a severe price. When the industry began changing dramatically, American manufacturers did not follow suit. When competitive forces changed, American manufacturers did not. When what people were willing to pay for changed, American manufacturers did not adapt to this market demand. The problem was past success and a model of expertise that was outmoded. This is the problem of managers in the behavioral health field, too. For decades we were successful because we had relationships with the public, legislators and insurance companies that supported our service. For decades we were successful because we were expert in models of service and management that did not suffer much intrusion from third parties having powerful influence on our professional efforts to heal, sustain and guide. Some years ago, change in all of that began to come so fast that many of us began to suffer from anticipatory nostalgia. Control had passed from our organizations to our customers (read third-party payors). Once the anticipatory nostalgia ramped up into the full-blown manifestation of the disease, we constructed a narrative of our history that bifurcated “the good old days” from the more challenging present. That bifurcation, at times, seems to have us stuck in nostalgia and anxiety; unable to energize initiatives for the new culture that is required. A creative future, and the culture change that will make it possible, is now the urgent calling of behavioral healthcare. When the call is answered, the entire workforce will integrate a business mindset with the professional mindset; managers will become skillful leaders of culture change; and counselors will become proficient in evidence-based practices. These changes will open a door to a preferred and possible future. Leadership is the hinge on which the door swings. Even expert managers who are operating in our familiar management paradigm will not prevail. Henry Kissinger discriminated the functions for us when he stated, “It is . . . the responsibility of the expert to operate the familiar and that of the leader to transcend it” (Kissinger, 1982). Transcending the familiar may be the best description of what it means to lead culture change. But transcending yesterday’s reality is an uphill pull. Gravity intrudes. Compounding the challenge is the fact that most managers in behavioral healthcare graduated from the ranks of frontline providers with insufficient preparation for organizational leadership. Their transition from expert provider to leader/manager has not been well supported by training, coaching and mentoring. We, like many industries, have believed that if a professional is good on the front line, can think and communicate in an organized way, and has enough human relations skills to not be a pain in the assets, then he or she will be a good manager, capable of leading a team. That belief, along with the lack of workforce development initiatives for leader/managers, bears a high price tag. A 2007 report, commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA), An Action Plan for Behavioral Health Workforce Development, states: ". . . the need for leadership and the demands on leadership have increased exponentially. The current health care environment has become much more complex due to major changes in financing that have created enormous pressures for efficiency in behavioral health programs and systems. Simultaneously, there have been many new demands to improve services by providing evidence-based practices, reducing cultural disparities, increasing patient safety, and demonstrating outcomes . . . Yet, this changing health care landscape, which has heightened the need for strong leadership, has at the same time created increased instability in many organizations, undermining their ability to retain and develop the next generation of leaders" (SAMHSA, 2007). As healthcare professionals choose to move into management, they find that integrating their skills with new skills is a large order. It can be done, but it is not easy, it is not quick, and it is not cheap. Clinicians often make fine managers. They intuitively keep the anchor fastened to the deep place, even during storm, and when they are provided opportunities for development, when their organizations are willing to invest in them, they can learn to navigate and steer the ship. Managers can learn to render unto Caesar what is Caesar’s without losing therapeutic soul. In our deep history we were too much of a crusade to be a business. Some feel we are becoming too much of a business to be a crusade. We are called upon to go into the crusade business — to wed clinical quality with business efficiency. But culture change takes a long time, even under skillful leadership. It is not quick. It is not easy. It is not simple. The underpinnings of organizational culture are far more influential than policies, practices and day-to-day management initiatives. Culture is to an organization what personality is to an individual, and often, personality does not yield to reality without a struggle. There may be such a thing as organizational neurosis or post-traumatic stress disorder (PTSD) in the face of explosive change. Leaders must understand what organizational culture is, how resistant it is to change, and how to lead change processes. The most direct insight into an organization’s culture comes when you answer the question, “What is it like to work here?” Ralph Kilmann has written a lucid description of a corporate culture that every manager could envy. "Members actively support one another’s efforts to identify all problems and implement workable solutions. There is a shared feeling of confidence: the members believe, without a doubt, that they can effectively manage whatever new problems and opportunities will come their way. There is widespread enthusiasm, a spirit of doing whatever it takes to achieve organizational success. The members are receptive to change and innovation (Killman et al. 1990). It is hardly arguable that this is a desirable destination. How do managers approximate it? There are diverse paths, but some commonalities emerge. They arise in the look backward, the look forward, and the look inward. The backward look Culture change is not accomplished by laying new procedures and skills on top of the old values, norms, assumptions and feeling-tone. The new procedures and skills are the results, not the wings, of culture change. Culture change is retarded when organizations attempt to flee the past without re-imagining it. We create history as a way of imagining a past that points toward a creative future — how to live and serve tomorrow. Past success is never as grand as we imagine it, but we cannot arrive whole at tomorrow by severing yesterday. Groups aspiring to thrive in the current environment will reflect on the old values, norms and assumptions. They will get curious about how they came to be, what they mean, and how they can be evolved. Teams will commit candor about what is real and what is not; what must be changed and what cannot be changed without selling soul. Effective managers facilitate this robust dialogue. Values. We have valued those supports and confrontations that aid the human pilgrimage from emotional constriction to freedom, from disability to ability, from addiction to recovery. Whatever aids that pilgrimage has been of paramount value to us. Robust dialogue with teams says, “This value cannot be sacrificed, but what new shapes does it need in the light of the advance of research, practice, and a national culture striving to contain healthcare costs?” Behavioral norms. We have had a behavioral norm that promoted almost exclusive loyalty to one’s own department (business or clinical), service program (outpatient or residential), or disability domain (MH/MR/SA). Managers felt more loyalty to the team they led than to the management team they were part of. Robust dialogue with groups of managers asks, “What is this norm costing us in the current environment? And, how can we change it without sacrificing the value of specialized knowledge?” Assumptions. We assumed that the public wanted addicted people treated and were willing to pay for it; that expanding insurance coverage was a good thing and would continue; and that legislatures could be persuaded to allocate more money next year. Those assumptions are no longer grounded in reality. Robust dialogue with teams asks, “What new assumptions does the new reality call for? And what new behaviors will spring from those assumptions?” Robust dialogue indeed — in the seed of our past is the energy, once transplanted, for a second flowering. The forward look Effective managers know and feel the uncertainties and contingencies that shape the future, but they titrate the anxiety level in their communications so that staff are energized, not paralyzed, by the survival implications in the need for corporate transformation. They say to those they lead, “Trust me . . . we’re going somewhere worth going.” Even when they really only see past the next few turns in the road they tell followers, “This is who we are! This is where we’re going! We’re going to have to be willing to change everything except our most core values! This is why we want to go to the new place! It’s worth the journey!” Leaders trust their own vision, claim their own voice, and persuade. There are five wildly important things we can do to lead culture change: 1. We can confront our own fear that if we invite robust dialogue with providers, change will take forever and we will lose control of the process. We can resolve our fear that we cannot blend direction and empowerment. We cannot resolve these fears alone. Managers can benefit from peer coaches — fellow managers who can help us relax the fear and come to know that you gain influence for change by giving people voice and choice. 2. We can cast a vision of the preferred and possible future. A vision is not an idea. It is not even a good idea. It is a compelling image of a preferred and possible future. It magnetizes attention. It elicits and directs passionate energy. Change leaders talk about the vision — all the time. 3. We can infect people with a new paradigm by constant unremitting repetitive communication: a paradigm through which people can understand the moment and look with hope toward the future; a paradigm that offers a new way of viewing our reality that will create a more energized professional community. A paradigm that bifurcates the “good old days” from our many concerns about the present drains energy. When this happens, organizations get stuck in nostalgia and irritable expressions of loss. Bifurcation always does that. It is a static and unhelpful way of understanding reality. Stuck there, organizations cannot energize for new creation. Managers seeing this will offer a new, more process-oriented paradigm that will act as a catalyst to get an organization unstuck and moving ahead — a sense-making paradigm, an organization transforming paradigm. Bifurcation (the good old days vs. the problematic present) is, in some sense, an accurate paradigm. As Ella Fitzgerald used to sing, “Things Ain’t What They Used to Be.” Effective leaders will facilitate grief processes, but successful processing of grief leads to new insights and attachments. Consider the paradigm of journeying. It respects the past; it brings meaning to the present struggles; and it points toward the preferred and possible future. Journeying is a paradigm that sparks profound breakthroughs in self-understanding. Journeying is a paradigm that dramatically reconstructs people’s vision of what is possible. Effective leaders/managers often frame the journeying paradigm in the form of a story with three parts: 1) This is who we were; 2) This is what happened; and 3) This is where we are going, and it is worth the sweat! This neutralizes the paradigm of bifurcation. It unbolts the door that seals off needed culture change. Leaders/ managers who do this will achieve extraordinary influence. There is a reservoir of dammed up energy, idealism and hope waiting for the voice of leadership to bring forward a new way of seeing and new possibilities for positive feeling, commitment and action. Teams that are stuck in the perplexity that culture change breeds, will respond to and follow, the leader/manager who makes sense of the challenge using process metaphors. They will follow the calm, sure voice that says, “This way. . . Here’s why. . . This will be the result of our best efforts.” Every manager will frame the story differently. Most will go something like this: “We are at a moment in our history in which we are changing from being program driven to being market driven. To thrive we will wed efficient business practices to effective professional service. Historically, human service organizations have been paid for activities and programs. Businesses have been paid for results. We will now be paid for our ability to wed both, and that’s OK because efficient business practices will enable us to better serve. Here’s how___________________. And we’re going to be OK, because ___________________________.” This kind of statement by a manager (brief, luminous, repeated often and with personalized passion) cuts through the thousand things that blur the vision. It conveys meaning, and meaning reduces anxiety and sustains effort. Leaders manage meaning. The voice of leadership says, “The times are challenging, but here’s what it is about. Here is where we are going, and it’s going to be good.” 4. We can build a bridge between the professionalism of practitioners and the strategies and structures of the new culture. We can build a bridge between professional values and the new ways. People who get into behavioral healthcare are idealists. They require the bridge — a felt connection between who they are and where their organizations are going. Where that felt connection has been severed, managers leading culture change will build it back. Managers do that by showing the connection. They talk about it all the time. “This is who we are. This is what we have always treasured. This is the new shape we can give it. This is where we are going.” 5. We can invest in development of the management workforce (present occupants and those soon rising) on an unprecedented scale. Present and future managers are our most underserved target population for development. The addiction field is being re-shaped by trends that call for skillful pilots at the helm. Getting them in place will require that we re-vision, re-energize, and fund training and mentoring for staff who show management potential. Succession planning is not optional. What is it, exactly, that must be developed? What will support the management talent required by the new culture? What new ways of thinking, being and feeling will provide the foundations? There are four: 1. A cross-functional mindset. In the new culture managers will have a feel for how their former professional specialty or programmatic component effectively works with other departments within the organization – peer managers who compete for the organization’s limited resources, top executives, the consuming public, political forces and third-party payors. 2. A mindset that welcomes, embraces and leads organizational change, and uses it to create opportunity. Managers will think strategically and tactically about the risks, benefits and unintended repercussions of a change. They will accept the reality that the culture of the organization will change — that the only question is whether they will lead the change or be its casualty. 3. A business mindset. Managers will become accustomed to translating professional activities and programs into business terms, monitoring progress and executing mid-course corrections. They will develop a natural bent toward outcome thinking – forecasting what will be the financial outcome of a strategic or programmatic decision? 4. A new mindset about the training function. Managers will be able to effectively turn a clinical team toward the business and clinical practices of the new culture using new conceptions of training. The action plan for behavioral health workforce development mentioned above states that our field is trying to meet high levels of demand with inadequately prepared and trained staff. It says that both university-based and professionally-based training is not preparing people for the realities of practice in the real world. It indicts much typical training, saying that it does not change practice patterns. The typical training workshop shows people the skills and values supporting clinical and business practices, but six weeks after most of those training workshops, nothing much has changed. However, organizations facilitating culture change can re-vision the training function. In order to produce lasting and continuous results they can:
Development of these four changed mindsets will grow a management corps that can facilitate the birth of the new culture toward which our field is struggling. The inward look Leadership is a behavior, not just a role. It happens in actions taken by people at every level on the organization chart — from the CEO, to the department head, to the program manager, to the supervisor of a small direct service team, to the newest member of the team. People who claim their own voices to explain meaning, light up a vision, and support hope, are, then and there, leaders. Followership too, is an activity of great value. Leadership and followership are fluid contributions. Today one leads and another follows. Tomorrow they switch. Those who are following have to know three things: 1) that the leader knows the service; 2) that the leader belongs in leadership; and 3) that the leader is not over burdened, has a clear line of sight between today and tomorrow, and is hopeful. Management is a profession. Like healing and helping professionals, a management professional is empowered by training, mentoring and coaching processes that are a mirror image of clinical supervision for clinicians. Experience is not the best teacher. We have all known people who had 10 years experience, and we have known others who had one year of experience times 10. Experience is not the best teacher, rather, it is disciplined reflection on experience, with a master in the profession. Some organizations have convened small management mentoring groups that meet over some period of months. The knowledge, skills, attitudes and behaviors of great managers are learned and become levers of organizational change. Managers leading organizational culture change will commit to continuous continuous (yes, the repeated word is not a typo) learning of the profession of management — become students of organizational behavior. They will lay new hands on the levers that make change possible. They will model the change they want to see. They will become living embodiments of the desired culture. They will make sure that the values and practices they want infused into their organizations are on display in their daily behavior: the questions they ask at meetings; how they spend time; and the decisions they make. Gandhi, who knew a bit about leadership and culture change, said, “Be the change you want to see in the world.” People don’t follow a manager’s words, techniques, or even skills. They follow the person of the manager. Committing candor, transparency and authenticity, leaders/managers will find that people follow. People will follow authenticity because they want more of it in their own lives. Organizations have a weightiness born in their history, nurtured in their inertia, and confirmed in their past successes. Effective managers will free organizations of that weightiness, find new wings, and discover extraordinary opportunities to wed business efficiency and clinical effectiveness. James E. Burgin, MDiv, MAC, is a noted national trainer of leaders, managers and clinical supervisors. His rich background of learning and experience spans both clinical and financial management in behavioral healthcare. He may be contacted at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it References Killman, Ralph H., Mary J. Saxon, Roy Serpa, and Associates. 1990. Gaining Control of the Corporate Culture. San Francisco: Jossey-Bass Publishers. Kissinger, Henry. 1982. Years of Upheaval. Boston: Little Brown. Substance Abuse and Mental Health Services Administration. An Action Plan for Behavioral Health Workforce Development, 135-136 http://www.samhsa. gov/matrix2/matrix_workforce.aspx One person has commented on this article. 1. Untitled Erica, Unregistered This is an excellent article. It captures many of the subtleties of organizational change and points out what is of utmost importance - experience and time do not equate to good management. Model the change you want to see and seek professional training in management and organizational change to be successful! Posted 2008-05-02 14:41:11              |
|
| < Prev | Next > |
|---|