2018 Conference – December 5-7 THE HIDDEN REEFS Navigating the Organizational Cultures of Healthcare & Community-Based Organizations for Success National Center for Complex Health & Social Needs 2018 Conference – December 5-7 Jane Pirsig, MSW, MBA Advocate Aurora Health Alliance for Strong Families and Communities

The Cultural Web The patterns or model of the work environment Cultural Paradigm – the set of assumptions about the organization which is held in common and taken for granted in the organization Fundamental of Strategy by G Johnson, R Whittington, and K Scholes 2012

Organizational Structures The Paradigm Stories Symbols Power Structures Organizational Structures Control Systems Rituals and Routines

Stories The past events and people talked about inside and outside the company. Who and what the company chooses to immortalize says a great deal about what it values, and perceives as great behavior.

Stories What reputation is communicated? Who are the heroes and villains? Do stories relate to strengths /weaknesses, success, failures, conformity, mavericks? What core beliefs do the stories reflect? What important events and personalities are flagged?

STORIES – Health Care Faith-based Legacy Technology – 1st Gamma Knife in Midwest Free Clinic Director rides bike through snowstorm “World Class” practitioners / patients

STORIES – Community-based Organization Founding “father/mother” is Executive Director Year closed with $1 in bank Resident sought safety in building Internal promotions

Symbols The representations of the company that can be seen, heard, or touched.

Symbols Are there particular symbols which denote organization? What status symbols are there? What language and jargon are used? What aspect of strategy are publically highlighted?

SYMBOLS – Health Care Organization Logo Scrubs, Stethoscope, RN Name Badges Clinical / medical language i.e., “frequent flyers” Strategy: Best Care Building Based

SYMBOLS – Community-based Organization Third Party Logos – United Way, COA Casual Dress, “running” shoes Private offices Donated Furniture Community / Home-based Service Provision

Power Structures The pockets of real power in the company. This may involve one or two key senior executives, a whole group of executives, or even a department. The key is that these people have the greatest amount of influence on decisions, operations, and strategic direction.

Power Structures How is power distributed in the organization? What are the core beliefs of the leaders? What are the main blockages to change? How is power used/abused? How widely spread is power? On what is power-based?

POWER STRUCTURES – Health Care Hierarchal Compliance / Regulations Board of Directors focus: governance model

POWER STRUCTURES – Community-based Organization Single, linear Practice rather than Business based Single Practitioners Board of Directors focus: Operations

Organizational Structure This includes the roles, responsibilities, and reporting relationships and unwritten lines of power and influence in organizations.

Organizational Structure How formal/informal are the structures? How flat/hierarchical are the structures? Do structures encourage collaboration / competition? How is communication delivered? How does workflow through the structure? Reporting lines?

STRUCTURE – Health Care ORGANIZATIONAL STRUCTURE – Health Care Clinical vs. Operations Linear Workflow Efficient

ORGANIZATIONAL STRUCTURE – Community-based Organization Team-based Practice-based Multiple Funder driven Fluid

Control Systems The ways that the organization is controlled. Formal and informal ways of monitoring and supporting people within and around an organization.

Control Systems What is measured/monitored to be reported? What is rewarded / punished? What drives controls –history, strategy, external? Are controls systematic or informal? What process/procedure has strongest/weakest control?

CONTROL SYSTEMS –Health Care Productivity; number of procedures, visits Finance Compliance/Regulation Clinical Outcomes

CONTROL SYSTEMS – Community- based Organization Funder Reporting Requirements Budget “Cap” Community Perception Number of clients, activities Behavioral Outcomes

Rituals and Routines The daily behavior and actions of people that signal acceptable behavior “taken-for-grantedness” about how things should happen and can guide how people respond to issues.

Rituals & Routines Which routines are emphasized? Which would look odd if changed? What are key rituals? Informal / formal? What do training programs emphasize?

RITUALS & ROUTINES – Health Care Clinic Workflow for All EHR Documentation MD/RN Directed Focus on Body

Community-based Organization RITUALS & ROUTINES – Community-based Organization Multiple Workflows Frequent Disruptions Fluid Documentation Delayed Decision-making

Scenario 1

Scenario 2

NAVIGATION Assessment Connection / Conversations Modeling Transparency & Change Developing pathways to accomplish