Just row.

To learn anything outside of our usual experience is to try on a new way of being. Doing something new--dealing with change--calls for a commitment to be where you are, to be present in the experiment, even while you are uncertain about the outcome. Being present and committed to the moment is as essential in management or self-management as it is in rowing a boat. How, for instance, can you tell the difference between intuition and fear? In the midst of a crisis, a change, a white water passage, a "learning opportunity," what if you get this gut feeling that something is wrong? If the feeling goes away when you drop into the present, into your body, and "just row," it's not an intuition, it's fear. The opportunity is to know the difference between opinion and intuition, between judgments and experience. Because judgments and opinions carry extraordinarily high price tags.     

Got curiosity?

The newest scientific models of decision-making suggest that the way we actually decide to do something is different from the story we put on it later. Organizations think that way, too. The real process of decision-making is hidden. Management is complex--and a key tool is curiosity. A critical question would be: "What experience are we creating?" When you get curious, separate what you notice from the story you tell yourself about it--even if the story is true. Look for the meaningful experience: your own, your employees', your customers', your physicians'. The essential act of management is to notice, to not look away.     

Where can we learn about change?

Presented here are some resources--books, consultants, and personal growth practices--that you might find useful in the struggle to become adept at dealing with change. Mastering change is a long process, but unlike building a cathedral or growing apples, as soon as you start you will have something that you can use--some insight, a different way of looking at what is confronting you, something to help jar you to a more creative strategy.     

Physician anger--Part 1. Changing perception: an interview with Charles E. Dwyer, PhD. Interview by Richard L. Reece.

On January 21, Richard Reece, MD, interviewed Charles E. Dwyer, PhD, to talk about solutions for changing the perceptions of today's beleaguered physicians. He discusses the state of affairs of physician executives in this turbulent industry and how they need to move beyond their thinking about organizations and their current responses to change. The key, Dwyer emphasizes, is influencing people to do what you want them to do. "If you want somebody to do something other than what they are doing now, then you must bring them to perceive that what you want them to do is better than what they are doing now in terms of what is important to them." He also explores how physicians can change their responses to the health care environment: "You can actually decide how you are going to respond conceptually, emotionally, and behaviorally to anything that happens in your life." Part 2 of this interview will appear in the upcoming May/June issue and will provide hands-on strategies for dealing with physician anger, fear, and resentment.     

Is it change? Or is it noise?

How can you tell the difference between mere noise, and a profound change headed your way? Your gut instincts may not always be a reliable gauge. It takes a long time for most people to become an executive leader. If you are typical, you were raised and trained in a different era, with different expectations. You see things with different lenses. So what can you trust? You can trust first principles. Ask yourself what you know about the reasons that changes are happening in this environment. Then ask yourself about what is being proposed--how does it fit with the roots of the changes in health care and your organization? The three change filters presented here can help you to figure out if it's change or just noise. Ask yourself: (1) what are the changes occurring in the health care industry; (2) is your organization ready for change; and (3) how likely is it that your organization will easily adopt this particular change? These three filters together will help you decide what is a truly important change, how ready your organization is for change, and whether it will adapt to this change with ease or difficulty.     

Changing what goes on in your head: how to stop "ain't it awful?"

How can you change your negative thinking? This column describes a process that, on the surface, seems too simplistic to be beneficial, but that works: choose a few good words to repeat to yourself constantly, progress to better thoughts, and then improve what you say to others. If you want to be more satisfied with your work life and your personal life, you must change the internal dialogue in your head. If you have some version of negative internal chatter, you need to substitute positive statements. You need to say something different from what you have been saying every spare minute of the day. You must say it even if it is the biggest lie you have ever heard yourself think. You must say it for days or weeks before you notice a difference in your attitude, relationships, and health. Eventually, you will notice you feel better and people are behaving better.     

What turns you on and off?

When you are exploring your career and where you are headed, it is helpful to consider what aspects of your job turn you on, and of course, those that don't. Energizers are activities that excite and invigorate you or people who lift your heart and inspire you. De-energizers are activities or people who drain you, drag you down, depress you. Make lists of those things that energize and de-energize you either at work or in other situations. Try hard to do something to incorporate or change at least the first five on each list and see if you feel more job and life satisfaction. Responses from 30 participants of a recent Career Choices program are provided to help you get started.     

Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

The water is wide.

Trying to predict what cardiology will look like in 10, 25, or 50 years is an almost absurd act of imagination. Perhaps even more than most branches of medicine, it has been changing so fast that it is hard to recognize from year to year. When we contemplate the changes that cardiology and the rest of health care are facing, we know that none of these changes will ever be "just technical." They will all be deeply human, and each one will be very difficult for some people. As people and organizations, we all come to that point where we have to change. Where we are is not working, we can't go on like this, we have to do something different. After boldly setting off to go someplace new, after some basic work is done to escape the original presenting problem--we reach the Great River. This is a point at which small, incremental changes won't do and we truly need to see ourselves differently. There is no bridge, no easy way across. This is where we must gather our resources and courage, remind ourselves of why we came this far. Yet many of us don't, and settle for something comfortable rather than cross that wide, turbulent river.     

Dealing with a shifting paradigm.

In 1970, T. S. Kuhn, in The Structure of Scientific Revolutions argued that scientists work by creating a comprehensive model--a model he called "a paradigm." A paradigm, Kuhn said, is an encompassing world view that tells us what facts to pay attention to and what to ignore. He contended that, although we may think that we consider all the facts and ask all the questions, there is always some ordering and selection going on, and we must first be prepared by our paradigm to make sense of what we see. He stated that one of the first signs that a paradigm is shifting is the discovery of facts that seem significant and indisputably true but cannot be explained by the current model. The essential elements, according to Kuhn, that are required for a paradigm to shift are a strong stimulus, a rapidly changing environment, and the realization that whether the change is good or bad is essentially of no significance. The parties most closely involved are frequently the last to appreciate that the shift has occurred.     

Organizational politics: did you hear?

How do you define organizational politics? The underground system of communication, the grapevine, what's really going on in the organization, rumors, knowing who really has the power? However you define it, all sources agree you'd better not ignore it. According to one physician executive: "Organizational politics is how things really get done, who really has the power, how decisions get made. Things are not always what they appear to be on the organizational chart." Presented here are some thoughts about organizational politics from physician executives and their stories of when it helped or hurt their careers or prevented them from accomplishing something in their organizations.     

Mentoring: women learning from others

Informal mentoring allows a relationship to evolve naturally over time much like a friendship, without an official obligation or commitment to coach someone. However, some women prefer a more formal, organizationally driven approach to mentoring. In either case, both represent an opportunity to learn and grow. In Learning from Other Women, Carolyn Duff interviewed many women to understand their expectations, preferences, and experiences. Mentoring, Duff says, "begins with affinity between two people, but the focus remains around work. It's a magical thing that happens when one person sees something in another person and wants to help that person grow." This column explores some of the barriers, as well as how to ask for help and benefit from a mentor. Whether you like the word "mentoring" or not, whether your organization has a formal program or not, always be thinking about how you can learn from others. Keep your eyes and mind open, look around to see who is doing what you want to do.     

Watching the falling barometer

How can physician executives create a vision, a strategy, in the face of such overwhelming forces for change? The answer has two pieces. The first is the Weather Channel: scanning the future for warning, for opportunities, for new business possibilities. The second leads us to such questions as: What is your situation? Financially? In market terms? It leads us, as well, back to the question: For you and your institution, what is your reason for being in this business? In other words, what is your foundation? If you can become clear about who you are and what you are here for in the long run, and match that with some sense of the technologies and the political and financial pressures headed your way, then you can begin to create a vision of a future that works for you. In the coming years, we will begin to create entire new ways of doing health care, new roles for hospitals, new types of medicine--and the time to begin the creation is now. If you wait until the hurricane hits, it will be too late.     

Management,productivity and risk—The way ahead

Any world in transition is not short of things to argue about and we are now in transition. How our arguments are settled, whatsoever may be the virtue of the settlements, may be important. It has recently been suggested, for example, that 10 British governments have made over thirty fiscal interventions in the conduct of manufacturing industry since the Second World War, in addition to such general economic encouragements as tinkering with the minimum lending rate and the exchange value of the currency. A few of these ups-and-downs are the result of policies argued about during general election campaigns, to be sure, but even they, as well as all the others, are largely based on the advice of experts of one kind or another. But when we ask ourselves from where these experts seek the foundations of their advice, we discover a professional world no less short of its internal dissensions; when successive governments take sides with the different schools of experts, we may expect to find our transitional world also in violent oscillation. Expert controversy then may become mere intellectual brawling; this can be noticed within the professions and even lead to some soul searching.... As Johnson observed, after his efforts to secure the reprieve of a well-known preacher had failed: “Depend upon it, Sir, when a man knows he is to be hanged in fortnight, it concentrates his attention wonderfully”. There is much concentrating of the attention just now. But we need to ask what to concentrate it on; nothing is as bad as the ill-conceived plan efficiently carried out, with its insistence on answering the wrong questions rather than in identifying the right ones. In the regenerative confusion of these iron times, our first need is to recognise the most discriminating questions obscured beneath the distractions of constant change; it is a need no less imperative for a profession like operational research than for the most quick-witted and evasive of party politicians. The doubts thrown on the credentials of our trade by Russell Ackoff's two recent papers are no more than the sentiment of the music hall song: “All dressed up but nowhere to go!” It is, in other words, easy to arm oneself with technique—indeed, with an arsenal of different techniques—but much more difficult to know what to do with it. There is no general theory of search, because if you do not know what you are looking for you do not know how to sample your experience. You must therefore start to guess. Decisions about the future, whether or not taken on the advice of experts, call for intelligent conjecture (if they are to be thought out) or just for simple guesswork (if they need not be). But since experts do not like risking their reputations, they are averse to guessing; they prefer to bank on the certainties of the elapsed past rather than to grope blindfold into the future. This paper suggests that action learning may be one means of concentrating attention upon the questions dying to be asked.     

Don't fix it

Next to doing nothing, fixing a problem is often the worst thing you could do with it. Fix a problem but miss the context, and you still have the problem--only it's bigger, it's weirder, it costs more, and everybody's grumpy. When something comes at you with a "problem" label, use it as an opportunity to connect things up, to explore, to ask the bigger questions, to find the new possibilities. When we react to a problem, we put ourselves into a dilemma. To find fruitful and creative solutions, we need to be in a place of choice, with many possibilities. Real participation--giving people real choice--is the only way you can bring people's intelligence and life experiences to bear on the situation at hand.     

Building trust and collaboration between physicians and administrators

If you think someone else's behavior is blocking you from achieving a goal, think again. As a physician leader, there may be something you can do to take responsibility for a situation and make the necessary changes. Learn how you can help build the trust and cooperation needed to make change happen.     

Managing the deliberately mute

The contrast in communication styles and values between Gen-Xers, now mostly in their mid to late twenties, and forty- and fifty-somethings is obvious. Gen-Xers are focused on the assignment and the deadline; their goal is to do good work in a timely manner. But they are highly skeptical that enthusiasm has any influence on the outcome. When we question them about their taciturn manner, they all give us the same two reasons: They really don't care one way or the other and they're convinced that what they say doesn't matter anyhow. This may frustrate a manager charged with getting the buy-in or enthusiastic participation from the troops, but it's a fact. There are, however, ways to get Xers to talk--provided you really want their ideas and opinions and you acknowledge that you hear what they say. Here are the best techniques from those who successfully manage large numbers of the young, including young physicians: (1) Focus on what matters; (2) don't ask if you're not going to act on the feedback; (3) personalize your request for information; and (4) always do a worst case scenario when you need the buy-in.     

BPR项目的实施:革命性变革和渐进性变革

进入变化时代后,如何应对变化是公司的每一位成员必须面对的现实。理论界一直争论的革命性变化和渐进性变化两种策略各有其长,各有优势。本文探讨了这两种变化策略的特点,比较了它们的异同之处,并且总结了几条如何正确应用革命性变化和渐进性变化这两种策略的规则,为企业正确实施变化管理提供一定的参考价值。     

How do you communicate? Managing the change process

Change is a difficult and emotionally charged issue in any organization. Clear, effective communication is essential to deal with people's fears and expectations. Multiple tools and schools of thought are available to increase organizational effectiveness, including systems theory, TQM, and change management. Physician managers are under the gun to incorporate these ideas and use them to effect organizational change. But the biggest challenge is how to bring the techniques home and put them to use, one-on-one with another person. How can you become a more effective communicator and change agent? The basis for win-win relationships revolves around being aware of how we communicate--not just our words, but our body language and tone of voice.     

Renegotiating health care. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Leonard Marcus, PhD, on May 21, 1999, to talk about his book, Renegotiating Healthcare, Resolving Conflict to Build Collaboration, and the Program for Healthcare Negotiation and Conflict Resolution he directs at the Harvard School of Public Health. Dr. Marcus discusses conflict management and negotiation in an industry besieged by change . He says, "we are, in effect, renegotiating the very assumptions and premises that have guided the health care system over the last few decades." In such a turbulent environment, it is crucial that all stakeholders can move to higher ground and resolve their differences instead of escalating the war. The key, Marcus says, is providing options through interest-based negotiation and mediation, so that the parties can look at the bigger picture and reconnect with what they are all committed to accomplishing in health care. While conflict can be destructive, it also can provide opportunities for people to look at where there are problems, to identify and correct those problems, and achieve something even better than what they began with through the process.