... the Worst of Times

No, not Valentine's Day. I may have gotten my titles backwards but I wanted to continue some themes from my previous post on dysfunctional environments.

Health Punk commented that "Sounds like a level of dysfunction that requires drastic measures. Jolting an organizational culture can only happen with a severe enough shock." That insightful response is certainly part of the answer. A radical change requires some indication of the change - a signpost, perhaps something as vacuous as a symbol - that things are not the same as they ever were. I am fearful of quoting the Healthcare Anarchist, since the suggestion suffers from Che Guevara's heel (as opposed to Achilles, Che was a great proponent of social justice but for whom violence, killing and destruction where the only way to indicate that social change had taken place). Few of us have Ghandi's inscrutability, but an approach resembling peaceful disobedience may be slightly more attractive.

There are several responses to a dysfunctional environment, the most familiar of which is to go in fighting. The one that strikes me as the most potentially fruitful is one based on openness and transparency, clarity of expectation, investing in staff and laying out a method for resolving conflicts. Of course, there is nothing new here, it represents what is best in American business. We make decisions based on facts and data, performance and information flow. We do not make decisions based on friendships and family or tribal ties, historical maladaptations and the wish to punish prior misbehavior.

One of the questions becomes what happens when a single player behaves transparently, but not all. Transparency works best when everyone makes an credible attempt at it and does not pretend that the need to control the flow of some information has mysteriously disappeared. Lipstick on a pig doesn't mean it not still a pig, but it's pretty pig.

Transparency puts the value of information the most at risk. There are some individuals who recognize that the easiest way to make themselves indispensable to an organization is to control the flow of information. The person who functions as an information bottleneck feels valued. Opening the floodgates of information flow strikes some people as unthinkable. It's sort of like putting your newspaper on the internet for free.

On the other hand, in some contexts, information has intrinsic proprietary value (probably not as much as managers would like to think). In the context of government, for example, a regulatory agency's decision-making process has huge value to those entities being regulated. Can you imagine knowing CMS regulation decision-making process every step of the way. It is quite possible that by making such information freely available, lobbyists and special interests could make the agency's regulatory function impossible to execute.

But management regularly over-values their internal management data and processes. I have recently asked several organizations to share their physician productivity formulas. The responses have ranged from cricket-sounding silence to the delivery of the entire current plan and minutes of the last meeting minutes, so I could anticipate specific objections to specific clauses. There are valid reasons for such variation in response (anti-competitive concerns being foremost), because every situation is different. So is mine. Even using someone else's plan as a template will not reduce the change-management work that will make our performance plan unique to our organization.

As the internet has shown us, our relationship to information precipitates a need to protect it. Controlling the flow of information seems like a reasonable approach, but often contributes to personal and organizational dysfunctions. The free flow of information is inherently threatening and changing the way it flows is one of the greatest challenges.

If one player is transparent, that player must make sure that the very same information does not boomerang to harm it. In time, persistent and consistent transparency of process should begin to encourage other players to try it. Eventually, the more that disparate parts of an organization share their information committed to a common goal, their successes will begin to erase organizational memories that are at the root of so many dysfunctions. Perhaps the goal is not erase them, as much as to replace them with the traces of functional progress.

But attacking the greatest challenges contains some level of fun that minor challenges cannot offer.