By Vikas Narula and Felix Ankel (@felixankel)
You are a postgraduate dean hired to align health professions education with clinical operations in a large health system. The health system has grown exponentially in the last 10 years and now has merged with a medical school. The health professions education landscape is a mosaic of legacy postgraduate programs that have had a tradition of excellence and functioned independently from each other separate from the clinical enterprise. In your first two years, you craft and communicate a vision to move from a knowledge based to a competency-based system, guide the enterprise through a robust strategic planning exercise, and enlist top operational and educational leaders as sponsors for the strategic plan. At year thee and four, you find yourself questioning your efficacy. On one hand, you have realigned the educational organization chart, set clear benchmarks for success and meeting some outcome metrics. On the other hand, everything seems more difficult than necessary to implement. The learning culture seems inward focused and resistant to change and most conversations seem to focus on fiduciary matters, rather than strategic or generative ones. You ask yourself. What am I missing? What other tools can I use to understand structural roadblocks to change?
Most organizations have formal lines of authority structures around an organizational chart (the “org” chart). Benefits of a “org” chart include ability to clearly identify individuals accountable for financial and outcome metrics. A potential unintended consequence of hierarchical org charts is occasional communication flow that is unilateral in an environment lacking sufficient psychological safety to invite needed criticism. Most work in organizations is performed in networks that are independent of the org chart. The most common networks are advice, trust, and communication networks. An essential skill of a #meded leader is to understand and create effective advice, trust, and communication networks. One discipline to help understand networks is social network analysis.
Keyhubs, a Minneapolis-based software and services firm specializing in social network analysis, has been working with organizations big and small since 2008. In the following case study, they worked with a large Minnesota-based medical clinic to identify key influencers and social networks in the clinic setting to help in a change transformation initiative. The network insights were instrumental in shifting attitudes, driving change adoption, and improving culture through intrinsic relationship channels around trust, change agency, and communication.
Challenge: Uncover the informal leaders as a foundation for improving morale, strengthening culture and enhancing patient care.
Approach: Keyhubs designed a custom survey looking specifically at areas of clinic influence, patient care excellence and work culture dynamics.
The Team Player Role Model network reveals two individuals (41 and 23) that are critical to the cultural fabric of the clinic. Between the two of them, they touch over 85% of the staff.
Yet, when we look at their position in the formal hierarchy (below), we find them on opposite ends of the chart. The informal dynamic uncovers a much more efficient method to managing/developing talent and driving change versus a traditional top-down approach.
Result: The evaluation revealed hidden influencers and talent within the clinic that were not fully understood or appreciated. With this information, the client was in a much better position to manage talent and drive change via their informal leaders.
Social network analysis can provide a rich source of information for understanding a work network. Often the analysis reveals hidden influencers that are critical for the success or failure of an initiative. It can also shed light on the informal dynamics that lead to team play and morale. This information can help #meded leaders to create plans to retain and reward top informal performers, recognize “unsung” heroes, and profile role models to use as blueprints for new hires.
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