Suturing an Organization. (Next).

IN THIS COLUMN...

Before you fix the problem, enact great change or make a far-reaching decision, take time to notice, listen and get involved. These acts provide the best insight, the best treatment, to heal an Organization's wounds.

You know about wound care -- you have been there. You know the importance of it, the struggle with the details, the normal course of healing, what to watch for, the formation of scar tissue, the infectious suppuration.

You know what is necessary for the body to move forward, how the scar tissue must be broken down in physical therapy, how sometimes wounds must be reopened, bones re-set, how difficult it is for the body to come back to "normal," to its pre-trauma state.

Organizations could use the same attention.

Organizations undergo trauma as much as people do. Every time something is done to an organization, or a part of an organization -- reorganization, merger, downsizing, re-orientation, new management, new productivity demands -- it sustains trauma and must heal before it can move on, before it can get to the job at hand.

This is easy to miss. We tend to treat organizations as if they are infinitely plastic, as if the people in them have no memory and no emotions, only training and capabilities. Then, we get frustrated when we try something and find resistance, passivity and workarounds, rather than cooperation.

Tell the people in your organization, "We are now part of MotherLove MegaCare Health, Inc., a proud new tradition bringing together the latest technology and the deepest human compassion" -- and that sea you are suddenly swimming in is the memory of all those years that they gave themselves heart and soul to the suddenly vaporized organization they called Local General Memorial.

Tell them, "Now that we downsized, we will simply have to work smarter, not harder, to increase our productivity."

That sigh you can almost hear is the phantom pain of a severed limb.

What are the sutures of this wound, the dressings and the antibiotics? How does the organization heal from trauma and regain full strength and range of motion?

The wrong question

You may well be asking yourself, "So what do I do?"

But notice that both the core problem and its solution are right there in the question, hidden in plain sight. You're tempted to take it on your shoulders, to think that you should and could somehow solve this, that you could make it happen, that you could don a mask, find those silver bullets, whistle for your horse and be the Lone Ranger.

Here's what's real. You can't do it alone.

We are writing this one day after the destruction of the World Trade Center. Clearly this mad and barbaric act cannot serve us, even as a metaphor, in a discussion of managing health care.

But the moment throws in high relief a somewhat more familiar feeling -- of something far away, something we cannot touch, going desperately wrong.

One correspondent told us of the impulse it brought up, the impulse to tuck in her child, to have tea with her mother and touch her hand. Another wrote of wanting to "bring the folks I love around the hearth."

This is the feeling that many of us have when contemplating the mess that is health care, of watching something large and beyond our grasp veer horribly wrong. And the impulse is precisely right. Faced with what we cannot control, we should ask ourselves, "What can I put my hands on? How can I strengthen the bonds around me?"

The challenge, then, is to ask not, "What should I do?" but, "How do I participate in this? How can I help catalyze something positive and healing here?"

None of us is powerful alone.

Three tools

Every tool of healing is used to strengthen bonds within the organization.

The first tool is recognizing the trauma and being on the lookout for its manifestations. Denial may work in poker, but it's worse than useless in dealing with real people.

The trauma of change and stress will show up differently in different people. The problems of the organization, the problems you are trying to solve as a manager, are not the same problems the people in the organization face.

They each deal with their piece of the problem. It's too easy to get stuck by "going global," to think about the problem in its largest context. To recognize the trauma of change you must recognize the actual people involved and their actual experience.

It's somewhat like working in an emergency room. In the midst of the swirling chaos, give each moment, each encounter, your total focus as if it were the only one.

You must also recognize your own participation in the process. And you have to recognize that doing nothing is something. Treating this as "somebody else's problem" is participation of a kind. If it touches you, you participate.

The second tool is listening.

In listening, quality counts. To listen is to listen -- not to defend, re-explain or give excuses. Good listening is about giving substance and credence to what is being said. It is an exploration, an attempt to discover what is true about what the person is saying. It's not about what you already know; it's about what you can discover. Listen to enlarge and challenge your own perspective.

The third tool is getting involved with the people who are affected.

Maybe you have to downsize a department. Maybe there is nothing you can do about it -- the reimbursement disappeared, the program shifted to another facility. But you can do a lot about how you do the downsizing.

Your best consultants already work for you. Ask them. Sure it will hurt. But it will hurt far less than the world of hurt that happens every day in America when bosses don't ask their employees for their perspective. You may or may not be able to address their concerns. But you asked and they know you asked.

There is a bond in asking, listening, making yourself vulnerable and making employees part of the solution, not just part of the problem.

Spies

As you use these tools--noticing, listening, getting involved--with heads of departments and services, facilities managers or directors, you also model the tools as something they can use.

As a manager, are you trying to give others the tools they need to navigate change? Or are you just telling them what to do?

As a physician, you deal with the concrete, the tactile, the actual. It's somebody's father lying there, fear in his eyes, pain still twisting his gut a day after you said it should subside.

As an executive, though, you are one level, two levels or even three levels removed from the actual work that people do. Whether the work is mopping the floor, filling out forms or trying to find a good vein for an IV, you don't have your hands on it.

It can be hard to feel the rhythm of it, the points of frustration, the obstacles. You need spies. You have them. Talk to them. Ask them.