Many health care organizations still operate under a "command and control" model, according to Martin Merry, MD, who is a free lance educator and consultant in health care quality, as well as an adjunct professor of health management and policy at the University of New Hampshire.
Under this model, commands come from the top down, and those beneath are expected to be obedient, he
To repair the ills of the current health care system, its leaders need to change their methods to encourage communication and collaboration, he
The current health care system is one where physicians and others work in isolation, often to the detriment of patients, says Merry
Consider the following example of a young woman who may not have died had the physicians treating her
better communicated with one an other, according to Merry
The woman went to the emergency room (ER) with a heart problem.The ER physician treated the woman and told her
to visit her
family physician in the morning, which she
After examining the woman, the family physician sent her
to a cardiologist for additional tests, which a cardiologist later read as seriously abnormal.How ever, none of the three physicians who saw the woman spoke to one another.The test result was reported only after the woman died of a pulmonary embolism.
"All three of these physicians were seeing one piece of the puzzle," Merry
says.Had they been able to come together to discuss her
might not have died.
Leaders must help set up the infrastructure needed to promote better communication, says Merry
.In order to repair what's broken, leaders must begin to break down the "walls of the silos" that keep health care workers in isolation.They should also begin to create communication protocols to help build those bridges.
Develop solid communication
The changes leadership must make are not necessarily something that happens intuitively, Merry
Can all personality types work within this new paradigm?"That's, of course, always the classic question," Merry
says anybody can receive training in the skills they will need to become collaborative leaders.
However, some personality types may be more inclined toward it than others.The first step, he
says, is for leaders to recognize the need for change.Leadership should also
• learn new methods• collaborate with others• articulate the vision of the organization and inspire others to take part in creating itMerry
says leaders should also ask themselves the following question: "Am I creating a fertile field for
• the growth of modern quality/safety science • a fundamentally different form of physician-managerial collaboration?"Merry
sees a shift toward this type of new leadership as inevitable.Quoting Winston Churchill, he
will invariably do the right thing after they try everything else."
A case study: How one NH hospital is taking steps toward changing culture to improve communication
A few years ago, leaders at Monadnock Hospital
in Peterboro, NH, took steps to improve communication among themselves with the ultimate goal of creating a blame-free culture for enhanced patient safety.