1. 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

2. 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

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

4. 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.

5. 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?

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

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

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

9. 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?

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

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

12. 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.

13. 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?

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

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

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

17. 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?

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

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

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

21. 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?

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

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

24. 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.

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

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

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

28. Scenario 1

29. Scenario 2

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