Leadership in Action Create an Effective Change Discussion


Read the attached article. 
Why might leaders have to overcome resistance to create this kind of change? Consider the question from the perspective of different stakeholders in the case.
Can you think of another case, where similar kinds of collaboration or coalitions might be necessary for successful problem solving or goal achievement?
[reply the answer 1&2 each one 150words]

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A More Egalitarian Hospital Culture Is Better for Everyone
By Pauline W. Chen, M.D.
May 31, 2018 New York Times
Perched atop a hill overlooking a major thoroughfare, the massive brick tower was a holdout from
decades earlier. With green tiles lining the walls, black and white linoleum flooring, and hallways
redolent of an antiseptic whose recipe hadn’t changed since the 1950s, the hospital had a distinct
postwar feel, and an unchanging culture to go along with it.
For surgical trainees like me in the 1990s, the institution’s resistance to change was best embodied by a
four-page, single-spaced document affectionately known as “The Hernia List.” An unofficial register of
patients waiting for a hernia operation, the list had come about because every time a patient
experienced an operative complication, a new clinical rule was added to the list of preoperative
prerequisites. By the time I was training at the hospital, every prospective hernia patient had to submit
to an endless drill of testing and specialist visits before even setting foot in the operating room. Patients
spent months “on the list” waiting to get “clearance” for what was considered a relatively common
No matter how much we trainees bristled at the wait and the antediluvian regulations our patients had
to tolerate, we felt powerless to question them. We understood our place at the bottom of the hospital
totem pole, and the ritual seemed too deeply entrenched to ever change.
“This hospital is like an elephant,” sighed a fellow trainee one afternoon as he thumbed through the
infamous list. “When she goes to the right, you must go to the right. When she goes to the left, you
must go that way, too.”
I remembered the list and my colleague’s words after reading a recent study in BMJ Quality and Safety
proving that, in fact, hospitals can change and that a more open and egalitarian hospital culture can help
patients do better.
Health care experts have long known of a link between patient outcomes and a hospital’s organizational
culture, or the way hospital employees feel about their roles and their interactions with one another.
Heart attack patients who are treated at hospitals where nurses feel powerless and senior management
is only sporadically involved in patient care tend to fare more poorly than patients hospitalized at
institutions where nurses are asked regularly for their input and chief executives hold regular meetings
with clinicians to review patient results.
The problem has been getting large hospitals — the proverbial elephants in our health care jungle — to
make those types of changes, measuring those cultural changes, then gauging if those changes result in
improvements in how patients do.
Researchers have had no way to measure hospital culture; and even with generous support from
nonprofit organizations and pressure from government entities and patient advocacy groups,
institutions that have attempted to transform had no way to assess if those cultural changes were
statistically significant. Many ended up making changes not across an entire hospital but in only a single
department like the emergency department or in only one aspect of patient care like the infection rates
of catheters placed in major veins.
But over the last few years, one group of researchers has discovered both a specific set of strategies that
target hospital organizational culture and a reliable way to measure the effect of those strategies.
Implementing that strategy, called “Leadership Saves Lives,” the researchers were able to show in their
most recent study that hospitals could undergo significant cultural changes that could affect patient
outcomes in as little as two years.
“Leadership Saves Lives” requires that each hospital create a “Guiding Coalition,” a group of more than a
dozen staff members, ranging from high-ranking administrators to clinicians, nurses and technicians
from across the entire institution. The coalition members participate in regular workshops, discussions
and national forums on ways hospitals might improve, then help their respective hospital translate
newfound ideas and information into clinical practice.
To assess the clinical effect of the intervention, the researchers decided to look at heart attack patients,
individuals whose care depends on the staff in several departments in a hospital. The researchers
implemented “Leadership Saves Lives” in 10 hospitals of varying size and from different regions that all
treated large numbers of heart attack victims but shared below average patient outcomes. Over the
course of two years, the researchers regularly surveyed and interviewed all the guiding coalition
members using the research tools they had developed specifically to measure cultural change.
The researchers found that all 10 hospitals changed significantly, but six hospitals experienced
particularly profound cultural transformations. The staff of these hospitals spoke of an institutional shift
from “because I said so” to “focusing on the why’s.” Instead of accepting that every heart attack patient
had to undergo certain testing or take specific drugs because the chief of the department or
administrator had previously established such clinical protocols, for example, it became more important
to provide the data that proved such rituals were actually helpful. Staff members in these hospitals also
said they received, and appreciated, increased support from senior management and a newfound
freedom to voice opinions in “more of an equal role, no matter what position you are.”
In contrast, providers who worked in hospitals without such profound changes described a persistent
expectation of deference to authority, a tendency to blame and make promises without follow-through,
and a work environment “so squarely in the box that we can’t even see the edge,” in the words of one
provider interviewed.
One hospital in the study, for example, had been struggling for years with poor outcomes because
patients often had long wait times between the onset of heart attack symptoms and the initiation of
appropriate in-hospital care. Many of the hospital’s administrators and clinicians assumed that little
could be done because of their rural location. But the hospital’s EKG technicians knew of a new and
relatively inexpensive transmitter that could immediately relay EKG results to the hospital.
“But the EKG technicians never felt empowered to speak up,” Dr. Bradley recounted. “The hospital
C.E.O. never even knew that the problem of relaying EKG results existed but could be solved until he
came together with the technicians in their hospital’s Guiding Coalition.”
The researchers discovered that the degree of an institution’s cultural change was directly linked to how
patients did. Hospitals that made more substantial changes in their work culture realized larger and
more sustained drops in heart attack mortality rates. Among the four hospitals in the study that
experienced less dramatic cultural changes, there were improvements in patient outcomes, but the
improvements were not sustained.
“What is different about this work is that it has proven that cultural change is possible and can save
lives,” said Dr. Patrick Geoghegan, professor of mental health and social care at Anglia Ruskin University
in Britain, who is spearheading a program based on Leadership Saves Lives in the National Health
Service. “You can have all of the best policies, procedures and strategies, but if the hospital’s
organizational culture is not receptive, then you will fail.”
Dr. Bradley noted that if hospitals respond to challenges by embracing practices modeled in the Guiding
Coalitions, like regular meetings that bring together hospital staff members from all levels and
disciplines “in a psychologically comfortable and trusting place to speak the truth and to have
meaningful conversations,” then these relationships and the cultural changes they inspire will “drive the
sustainability of your improvements.”
“It takes bringing people together and redefining leadership as a role that anyone at any level can take,”
she observed.
More research is needed, but in the meantime it is clear that for patients, having some sense of a
hospital’s organizational culture can be a critical part of deciding where to get care, since the attitudes
and interactions among administrators, doctors, nurses and other providers can affect outcomes. “We
think we just need to get the best doctor,” Dr. Bradley noted, “but witnessing how staff treat each other
is a pretty strong signal for how they will treat and care for you.”
Hi Class,
The resistance to change comes from various aspects, and for the hospital, its immutable
culture and atmosphere are the biggest obstacles to change. Surgical trainees describe
the hospital as an elephant, slow and full of framed mechanical operations, and have a
huge impact on the efficiency of treating patients. From the perspective of nurses or
technicians, because of the huge power gap, nurses are usually unable to do anything
about it, and management seldom directly participates in the treatment of patients,
which leads to a lack of awareness of specific matters by leaders. This cultural
environment makes patients have to endure cumbersome rules and regulations
repeatedly, which delays valuable treatment time and treatment efficiency. Leadership
Saves Lives provides hospitals with a solution to cultural changes. This strategy unites
leaders, clinicians, nurses, and technicians, and redefines leadership as a role that
anyone can assume. Undoubtedly, this provides an equal communication platform for
all people, and on this basis, improves the internal relations of the organization and
promotes trust. In the Leadership Saves Lives strategy, each participant is a leader in
their own field, and their relationship and behavior will drive the cultural changes in
the hospital and inspire the sustainable improvement of these changes.
I would like to take Southwest Airlines as an example. It is different from the
“Leadership Saves Lives” strategy dedicated to the transformation of hospital culture.
Southwest Airlines adopts the corporate culture that regards everyone as a big family,
and provides an approachable atmosphere and low power structure. Some executives
are even promoted by retired pilots, which helps the leadership and employees of
Southwest Airlines better move towards the common goal. I believe that this special
culture is the secret to helping Southwest Airlines maintain profit growth for decades.
Pauline, W., & Chen, M. D. (2018). A More Egalitarian Hospital Culture Is Better for
Everyone. New York Times. https://www.nytimes.com/2018/05/31/well/live/doctorspatients-hospital-culture-better-health.
Answer2 ?
The healthcare sector needs to be characterized by continuous change so that it can
effectively deliver safe, effective, and high-quality care (Ayeleke et al., 2018). However,
change does not happen with just a few words, and leaders need to overcome a lot of
resistance in the process. It is clear from the article “Leadership Saves Lives” that
healthcare organizations have encountered many obstacles in moving away from
redundant work rules such as “hernia lists. “Instead of making changes throughout the
hospital, many end up in individual departments, such as the emergency department,
and only in one aspect of patient care, such as infection rates for intravenous catheters”
(Chen, 2018).
These impediments are not unwarranted; a major reason lies in the fact that
change means disrupting and breaking with tradition, a characteristic that makes it risky
to varying degrees. From the perspective of senior executives in healthcare
organizations, change means overturning an established medical process, even if it is
inefficient and complex. However, the receptiveness of the organization’s workforce to
change and the direction of the change to accommodate the changing external
environment are considerations for senior managers. In this context, some senior
managers may behave very conservatively. We can also see from Chen’s (2018) article
that in organizations where senior managers are occasionally involved in patient care,
these leaders are more inclined to manage the organization rather than provide services
to the members of the organization.
For other stakeholders in healthcare organizations, such as surgical interns,
nurses, physicians, and technicians, the conservative and rule-laden environment also
makes it difficult for them to push for change. They “understand that they are at the
bottom of the hospital totem pole, a ritual that seems so ingrained that it will never
change” (Chen, 2018). This negative sentiment can also largely affect grassroots staff’s
confidence in change. Dam’s (2018) study found that greater involvement of
organizational members in a change in threat assessment was associated with their
negative emotions. Taking these different stakeholder perspectives together, it is clear
that for those leaders leading change in healthcare organizations, they must overcome
the conservative attitudes of managers and the negative sentiments of employees before
they can create new change.
One of the best examples I can think of is IBM, which has always been
very focused on leadership implementation in their company. They are acutely aware
that leaders at all levels of the company are at the heart of their transformation journey
(IBM,2015). As a result, IBM strives to create innovative, experiential, and practical
learning opportunities and resources that promote leaders’ understanding of their role
and purpose while preparing them for an increasingly collaborative, self-directed, and
agile environment. The IBM Leadership Academy, open to all employees, can provide
them with a wealth of content on engagement, feedback, coaching, creating purpose
and meaning, focus and energy, and positive thinking. At the same time, IBM has
launched the ACE application to enable employees to provide and receive feedback at
any time. IBM’s initiatives not only increased their engagement in the leadership
process but also improved employees’ understanding of leadership and made them more
receptive to change. On the other hand, trained leaders have the knowledge to driving
change appropriately and efficiently. When a change is implemented in the company,
clear self-awareness of roles allows everyone to know how to participate and contribute
to the change. I think this is why IBM has been able to continuously change itself and
is still a very successful world-class company today.
Ayeleke, R. O., Dunham, A., North, N., & Wallis, K. (2018). The concept of leadership
in the health care sector. Leadership, 83-95.
Chen, P. W. (2018, May 31). A More Egalitarian Hospital Culture Is Better for Everyone.
The New York Times. https://www.nytimes.com/2018/05/31/well/live/doctorspatients-hospital-culture-better-health.html. (Links to an external site.)
Dam, K. (2018). Feelings about change: The role of emotions and emotion regulation
for employee adaptation to organizational change. In Organizational Change (pp. 6777). Routledge.
IBM. (2015, March 9). Leadership development. IBM. Retrieved October 14, 2021,

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Explanation & Answer:
600 words

kinds of collaboration or coalitions

resistance to create this kind of change

perspective of different stakeholders

successful problem solving

patients have to suffer from the cultural loopholes

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