

What sets healthcare organizations apart from other types of organizations?

SC: The healthcare system is currently under a lot of pressure to perform better. Healthcare professionals are frequently asked to adjust or modify the way they work in order to provide better care to patients. But healthcare professionals need to meet different professional goals; they have different roles, cultures and interests. Conflicts are inevitable.

Suppose a health authority grants one group responsibility for a particular procedure, and it was previously the sole responsibility of another group. Any side that perceives a loss of autonomy or authority is likely to strongly resist the change.

But other kinds of changes may encounter opposition simply because they disrupt the normal and accepted way of performing a given task. Take the example of incident reporting for patient safety. If the primary care unit in a hospital has implemented an effective incident reporting system, the hospital might wish to have another unit, for example the mental-health team, adopt that system. However, differences in the culture and professional practices may be incompatible with the new reporting system and prevent its adoption by the mental-health team.

What can managers do to ensure that the required change can be implemented?

SC: One of my studies concerned a collaboration across healthcare organizations in a primary care context. The study showed that to be successful in implementing the change, managers needed to build a winning coalition of professionals and staff who have complementary skills and resources. But to build such a coalition, time needs to be invested in finding common ground across professionals and staff, in putting together trust between professionals and staff involved, and in building the credibility of the change process.

Therefore, there needs to be somebody whose job is to manage the change process. That approach is ultimately going to bring more success than asking busy healthcare practitioners to take on additional change-management tasks. When you don’t have a person that owns and manages the change process, you are likely to see a dilution of change focus and a loss of momentum.

What type of management style or approach should be encouraged, given the need for professionals and staff to coalesce around significant change?

SC: The research provides evidence about the benefits of having a small number of individuals (e.g., managers, professionals) with complementary competencies and resources in bringing important organizational changes to fruition. But this approach might create a lack of clarity. There might be ambiguity about who is responsible for what, which can lead to duplication of efforts or to one or more tasks falling through the cracks. I have also studied situations in which intractable conflicts developed among the members of a management group, and the teams working under them deteriorated as a result.

The risks of these scenarios are at the heart of a big debate about how leadership should be organized. In particular, when and how to share or distribute leadership. Shared leadership happens at different levels, for example, within teams, organizations, and inter-organizational collaborations. Change-management processes, such as the need for integration between healthcare teams, sometimes point to the need for shared leadership. On the other hand, for the reasons I mentioned, shared leadership isn’t necessarily a panacea. Without doubt, understanding when and how leadership can be shared, and what type of collective leadership is appropriate in different change-management settings, will continue to be a hot topic for any healthcare organization for the foreseeable future.