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Leadership: Working Horizontally, Collaboration & Internal Buy-In


Can taking an employee-centered approach to leadership succeed in healthcare organizations? 

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Anyone who has searched "Leadership" in a library catalog can tell you that the theories on leadership and resources available outnumber those on just about any other topic. Sadly, most of these resources are filled with jargon that often proves meaningless when it comes to implementing actual leadership strategies in an organization. That being said, there are a few principles of leadership that hold true across experts, across industries and across organizations. Truly successful organizations work horizontally, in collaborative environments with large amounts of internal buy-in.

Horizontal Organizations in Health Care

The term "horizontal organization" has become synonymous with a lack of middle management between line employees and C-suite executives. Designed to streamline communication processes between those who perform task-related work and those that create and manage the "big picture", horizontal leadership has become the norm as businesses strive to compete in a global marketplace. However, hospitals and medical centers have stubbornly relied on vertical "silos" instead.

For example, a 70-year-old woman who presents in the emergency department with abdominal pain is referred to the hospital's general surgery department who orders a CT scan. Once the CT is complete, radiology interprets the results and discovers an ovarian mass. The woman is then referred to women's health who admits the patient and schedules surgery. The patient never sees it, but the Division of Medicine, Division of Surgery, Division of Diagnostics, and Division of Women's Health have all touched the patient in some way, rarely communicating with each other except to pass along chart notes. Each of these vertical "silos" have their own set of service providers, patient care managers, department administrators, and C-suite level leaders who, in some way, impact how the patient receives care. With separate reporting structures, separate areas of specialty and separate ways of diagnosing and treating a patient, communication tends to travel up, rather than across departments. As a result, customer service, in this case patient care, suffers as decisions are only made after scaling the brick walls to communication between divisions.

Some may argue that the redundancy protects the patient as each department has an opportunity to review the work of the previous one, checking it for errors before proceeding. Other hospitals have added layers to their organization to separate patient care from operational needs such as payroll and purchasing in an effort to allow clinical staff to focus on diagnostic and treatment processes. Still others add a layer of patient advocates that oversee the movement of a patient through division silos in an effort to speed up the treatment cycle. In reality, the answer to higher quality patient care is not more vertical leadership but less.

Collaboration in Patient Care is the Key

There will always be a certain amount of "silo-ing" in a hospital as each department's function remains distinct from another's. General surgery does not perform the same task as diagnostics nor should they. Yet hospitals and medical centers have a distinct advantage over other vertical organizations trying to "go lean". Every clinician is committed to a singular, over-arching goal - high-quality patient care. With that in mind, the restructuring process becomes much easier as each department begins to collaborate rather than compete with others. That's not to say a CEO can say, "We're going lean!" and it will be so. Everything from budget to metrics to hiring must be turned 90 degrees to reflect such a commitment to patient care.

Take the process of deciding how a hospital's budget will be determined for the year. Currently, in a very vertically-oriented process, C-suite executives determine each department's budget based on the department administrator's needs, wants and contributions to the overall hospital. Silos compete directly with each other for a piece of the pie, creating an often contentious relationship between departments. Now, turn that budgetary process into a more horizontal approach where everyone is committed to a more collaborative patient care process. Suddenly, budget is no longer determined by a department administrator's sales pitch, but rather by how that expenditure will impact the quality of care. New equipment can be purchased without jealousy from other departments because everyone understands how that new equipment will impact the organizational goals.

If patient care is everyone's primary concern, suddenly the way a patient travels through the hospital will also change. Let's go back to our 70-year-old woman with abdominal pain. The emergency department she enters is a part of a horizontally-oriented medical center. It is possible that her treatment would be overseen by her first point of contact, in this case the ED, until it could be handed off to those that would treat her, in this case women's health. With a singular point of contact, the protection offered by vertical layers is replaced clinicians who are familiar with her case and can act as patient advocates for the care she needs. Her experience would not change dramatically, she would still be seen by general surgery, receive a CT scan, and be transferred to women's health, but she would receive the care she needs faster and more efficiently.

Getting Internal Buy-In

As is the case with any major organizational change, the level of internal buy-in will ultimately determine its success. Fortunately, hospitals and medical centers already have a certain amount of buy-in from their employees when it comes to patient care. The challenge is to then show department administrators and clinicians alike how flattening the organization, eliminating competition and enhancing collaboration will ultimately lead to better patient outcomes. Functional changes, such as how a patient navigates the hospital's processes, and operational changes can then be addressed once the commitment to collaboration has been communicated. That's not to say that change will be easy, but in the end, it will be worth it.

How do you feel your hospital or medical center's structure impacts your patient outcomes? Have you had any experience "going lean"? Join the discussion, tweet us @Connex

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