J Gen Intern Med
February 2024
A system's ability to function-its "systemness"-depends upon the mindsets and behaviors of its people, but what exactly is it that individuals do to constitute effective systems? Systemness requires three kinds of ongoing conversations devoted to (1) developing and maintaining a shared purpose or goal, (2) developing and maintaining a systems perspective-understanding how all the various parts fit together in service of the shared purpose and integrating many unique, diverse perspectives to gain a more complete understanding of the situation at hand-and (3) managing the myriad interdependencies of all the people involved in the work. These conversations are needed across all levels of scale, from one patient's care plan to the implementation of strategy for a whole organization. The three conversations of systemness will only be effective to the extent that people are willing to express their unique perspectives and to be responsive to and influenced by what they hear from others.
View Article and Find Full Text PDFIntroduction: Quality improvement and implementation science practitioners identify relational issues as important obstacles to success. Relational interventions may be important for successful performance improvement and fostering Learning Health Systems.
Methods: This case report describes the experience and lessons learned from implementing a relational approach to organizational change, informed by Relational Coordination Theory, in a health system.
Introduction: A core challenge of a multidisciplinary and multi-organizational translational research enterprise such as a Clinical and Translational Research Award (CTSA) is coordinating and integrating the work of individuals, workgroups, and organizations accustomed to working independently and autonomously. Tufts Clinical and Translational Science Institute (CTSI) undertook and studied a multifacted intervention to address this challenge and to create a culture of systems thinking, process awareness, responsive to others' needs, and shared decision-making.
Intervention: The intervention, based on relational coordination, included 1) relational interventions, in three staff retreats and a diagnostic survey to provide feedback on the current quality of relational coordination, and 2) structural interventions, in the launching of five new cross-functional teams with regular meeting structures.
Healthc (Amst)
September 2016
Choosing Wisely began at a time when a polarized national debate on healthcare reform stymied effective conversation on effective and efficient resource use. The ABIM Foundation sought to change attitudes and culture and promote the idea that removing waste is an integral component of providing high quality care by using an approach of constructive engagement to persuade specialty societies to identify five wasteful tests or treatments within their field.
View Article and Find Full Text PDFPurpose: In addition to structural transformations, deeper changes are needed to enhance physicians' sense of meaning and satisfaction with their work and their ability to respond creatively to a dynamically changing practice environment. The purpose of this research was to understand what aspects of a successful continuing education program in mindful communication contributed to physicians' well-being and the care they provide.
Method: In 2008, the authors conducted in-depth, semistructured interviews with primary care physicians who had recently completed a 52-hour mindful communication program demonstrated to reduce psychological distress and burnout while improving empathy.
One factor contributing to the limited success of organizational change initiatives is the use of an outmoded conceptual model: the organization as machine. This metaphor leads to the creation of detailed blueprints for desired changes; invites unrealistic expectations of control; and creates anxiety, blame and defensiveness when events inevitably do not proceed according to plan, thus hindering the work. An alternative conceptualization--the organization as conversation--portrays an organization not as a reified object upon which we can act but as self-organizing patterns of thinking (organizational identity and knowledge) and relating (organizational culture) that exist in the medium of human interaction in which we participate.
View Article and Find Full Text PDFContext: Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.
Objective: To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.
Background: Calls for organizational culture change are audible in many health care discourses today, including those focused on medical education, patient safety, service quality, and translational research. In spite of many efforts, traditional "top-down" approaches to changing culture and relational patterns in organizations often disappoint.
Objective: In an effort to better align our informal curriculum with our formal competency-based curriculum, Indiana University School of Medicine (IUSM) initiated a school-wide culture change project using an alternative, participatory approach that built on the interests, strengths, and values of IUSM individuals and microsystems.
Introduction: Commissioned by the Wisconsin Medical Society in 2003, the Wisconsin Citizen Congress project aims to get at least 5000 physicians and 100,000 citizens in a partnership for health and health care improvement in Wisconsin. The power of activated citizens and a citizen-physician partnership is one of few hopeful answers to current policy failures in health care. Citizen Congress II aimed to validate and extend the results of Citizen Congress I.
View Article and Find Full Text PDFThe purpose of this study was to learn how primary care physicians experienced the introduction and evolution of an individual physician pay-for-performance program. Thirty primary care physicians participated in audiotaped focus groups 13 and 26 months after beginning the program. Transcribed audiotapes were used to group comments into themes.
View Article and Find Full Text PDFThis paper explores and contrasts personal philosophies based on two different core values, control and relation, with respect to expectations, social relationships, habits of perception and interpretation, and ways of feeling grounded in the world. The paradigm of control is widespread in medicine and certain other health professions, but because it fosters unrealistic expectations, evokes fear and shame, and inhibits effective partnerships, it can actually compromise health outcomes. The paradigm of relation calls attention to interpersonal process and fosters receptivity and adaptability, thus enhancing partnership.
View Article and Find Full Text PDFJ Gen Intern Med
January 2006
Relationship-centered care (RCC) is a clinical philosophy that stresses partnership, careful attention to relational process, shared decision-making, and self-awareness. A new complexity-inspired theory of human interaction called complex responsive processes of relating (CRPR) offers strong theoretical confirmation for the principles and practices of RCC, and thus may be of interest to communications researchers and reflective practitioners. It points out the nonlinear nature of human interaction and accounts for the emergence of self-organizing patterns of meaning (e.
View Article and Find Full Text PDFThe biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient's subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care.
View Article and Find Full Text PDFThe social environment or "informal" curriculum of a medical school profoundly influences students' values and professional identities. The Indiana University School of Medicine is seeking to foster a social environment that consistently embodies and reinforces the values of its formal competency-based curriculum. Using an appreciative narrative-based approach, we have been encouraging students, residents, and faculty to be more mindful of relationship dynamics throughout the school.
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