Five dynamic tensions in contemporary medical staffs: Conclusion

Dear colleague,

Today’s effective medical staff must understand its own organizational culture. As opposed to bylaws, mission statements, and policies, which define how individuals are expected to behave and perform, culture can be defined as the way a group of people actually behaves and interacts. In its work with medical staffs around the country, The Greeley Company has repeatedly found that medical staff culture can best be understood as a series of behaviors that occur around five underlying dynamic tensions, sometimes referred to as polarities. The five polarities explored in this series are:

• Collegiality and excellence
• Freedom and commitment
• Appropriate independence and mutual accountability
• Appreciation and continuous performance improvement
• Stability and change

Throughout the series, we learned that hospitals cannot manage these tensions by taking an either-or approach. Instead, an effective medical staff manages and balances the positive aspects of each polarity. Through this balance, the medical staff’s culture can be changed to better support the physicians’ and the hospital’s success.

Culture cannot change without strong and effective leadership. As I mentioned at the start of this series, to get physicians on board with change, leaders must:

• Espouse new beliefs and values, often in mission, vision, and values statements
• Lead by example
• Reach out to their fellow physicians to communicate about the new culture and the reasons for change
• Build strong social capital and respect to facilitate the necessary culture changes
• Hold fellow physicians accountable when faced with the inevitable resistance that arises when leaders try to change a culture

 
The job of medical staff leadership is to understand the current culture, define the desired culture, and then effect the changes necessary to balance the dynamic tensions. This series was designed to help medical staff leaders understand how these dynamic tensions are at work in their organizations. Through additional training, education, and development, medical staff leaders can begin to acquire a toolkit to help negotiate, manage, and lead through the change and conflict inherent in the contemporary healthcare landscape.

Best regards,

William K. Cors, MD, MMM, CMSL
Vice President Medical Staff Services
The Greeley Company