Could you look at the three different employee’s views on the artifacts and underlying assumptions of the culture in your department? Maybe this would help to clarify/explain biases?

I think it would be interesting to talk with the person with 40 years of experience to see how technology and new practices/advances in the field have impacted the culture of the deparmtent.

-Andrea

What are the espoused beliefs of your department and the cultural artifacts? Does each supervisor have his/her own ideas of this? Chapter 5 in Schein is about mission/vision, goals, and measurement. Do the staff rotate between shifts so that everyone has exposure to these supervisors or is the schedule set? I was just wondering how staff would deal with the different management approaches. It sounds like there are three subcultures in place within your department. I could see that maybe the night shift is slightly different – is that a slower time for the department?

I think to change the culture the manager needs to get all three supervisors together, with the staff, and develop shared goals for all shifts and design a common measurement for these goals. From there adjustments can be made/recommended based on performance and maybe those who are not performing could be let go/asked to retire.

I think that my first attempt at leaving you commnets went somewhere in cyberspace. So if this is a second posting I apologize.

I can relate to how a new program can have total failure. If the safetey program was a “top down” directive and not collaborative effort, it is bound to fail. When I was full time at the univeristy we had a chair who dictated a change in the way the clinic was run. He didn’t even stay around to see the program be implemented and it was a total faillure that has since been scrapped.

The concept map was a challenge for me too. I think that it helped to a practice map on a subject that I knew so that I could concentrate on learning how to do the map rather than learing the content.

Mike

I think the decision making process in hospitals – allowing nurses to make decisions for example would require a complete culture shift. In patient care-related decisions the physicians have the ultimate power – which I think is appropriate in some situations. I think in others though it would be helpful to ask for other health care worker input. But the culture works against this as we struggle to implement multi-disciplinary rounds.

On top of that hospitals are silos of departments – I wonder what would happen if those fell and different disciplines came together to cover certain patients.

I have been thinking along these same lines you have the past few weeks and its nice to read your thoughts!

-Andrea

I think we all feel torn between obligations. I don’t know this can be overcome except by coming to the realization that we choose to do the things we do. This does not take away the difficulty of writing a paper or doing the assigned reading for class but it does tend to take away the feeling of having outside influences directing ones life.

It sounds as though your manager is taking some steps in creating hallways and opening communication so that collective meaning can be made. How can the meetings be changed to include everyone that you think needs to be there? Have you discussed this with your manager? Is there real resistance to doing this?

The EPIC group sound great but my question is like the one above. Does the group have real power to make changes? What if management disagrees with the solution?

I am also struggling and feel torn – it is hard to learn about what could help our organizations learn and be better but not have the power to change/implement these new ideas.

Does your EPIC group allow for implementation or the ability to act on what was discussed?

Could you share what your division/area has learned with others? Sometimes I think that the healthcare field is so subspecialized that we may limit ourselves in thinking that ideas that we come up with may not transfer across areas. This may be an artificial limiting – maybe the ideas would work in other areas or need minor adjustments. But the major thing missing is a mechanism to share these ideas with other areas.

In regards to your how the roles of management and employees have changed – I agree with you. We are asked to problem solve and work in teams but the reward systems have not adapted to the knowledge age in some places and it causes a disconnect.