Conversations allow us to inquire, exchange and process information, expand thinking, and negotiate and transform that information into a common perspective that is different than the sum of its parts.
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Within all living systems, the balance between energy consumption (entropy) and energy infusion (negentropy) is necessary for the maintenance of a steady state for optimal systems functioning (homeostasis). An example of this in healthcare practice is the effect of caretaker rest (energy infusion) on patient care (indicates status of system’s functioning). The relationship between decreased caretaker rest and decreased cognitive and clinical performance on the part of the caretaker and concomitant medical errors has been well documented (Reed, Fletcher, & Arora, 2010).
The evolutionary capacity of a system depends on flexible and adaptable patterns of organization that facilitate its ability to deal with environmental challenges and opportunities. The most agile, adaptable, and successful healthcare teams are those that are able to routinely evaluate who needs to be present and who has the most cogent information or expertise. Diverse perspectives and a broad range of information is essential for sound clinical decision making (Briskin et al., 2009; Wheatley, 2005). Inclusionary practices such as incorporating caregivers and support personnel into the healthcare team and equal recognition of each team member’s contribution broaden the perspective of the team. In addition, increased psychological safety and willingness of members to share information facilitates the generation of innovative solutions for improved patient care (Meyer & O’Brien-Pallas, 2010; Nembhard & Edmondson, 2006).
Applying Systems Theory
When attempting to study, understand, and effect change in a social system, it is helpful to understand that there are levels of the system, which include individual, interpersonal, group, organizational, and community.
Individual: One person.
Group: Three or more individuals working toward a common goal or purpose.
Organization: A social structure, often made up of groups, that pursues a collective goal to deliver some product or service.
Community: Anything beyond the organizational level. This includes other organizations, governments, or global social networks.
Systematic analysis and intervention is often targeted at the level of system where the impact will be the greatest. Successful change agents, whether they are leaders or members of groups, learn to differentiate between system levels and to shift attention from one level to another and make an informed decision about the best level at which to intervene based on a realistic appraisal of the change agent’s sphere of influence (Gillette & McCollom, 1990; Wells, 1995). While the primary focus of this text is the group level of system, individual and interpersonal levels will also be explored. Table 1-1 shows group-level intervention in relation to the other levels of system.
TABLE 1-1 Intervention at Each Level of System
LEVEL OF SYSTEMS CASE STUDY: Stephanie’s Dilemma
The vice president of hospital facility services, Stephanie Scardola, was struggling with a problem.
A new human resources (HR) director for facilities services, Colin Doyle, was hired six months previously. In the past, this position was filled by former administrative assistants in the hospital system and served as a professional development step towards a more responsible management positions. Most of the people who held this position left within two years to go on to another position in the hospital or in another hospital system. The committee felt that it was time to hire someone with more HR experience and with an outsider’s point of view even though the compensation and job level was still the same.
Colin came from a small, nonprofit company and has eight years of HR experience. He never worked in a hospital nor did he have union experience; however, the committee hired him because he was the most experienced candidate, had a master’s degree in HR, and was professional and knowledgeable. This HR position reports to both the vice president of facility services and an HR director from the hospital’s central HR department. The duties include partnering with managers in the facilities department, helping them deal with union and nonunion discipline issues, being responsible for getting people paid properly, and making sure all of the proper paperwork is in order and sent to central HR.
When Colin was first hired, he performed well. He conducted several employee orientation training sessions and was able to put two new policies in place to assist the facilities services managers in handling some situations on their own. Unfortunately, problems began a few months later. Colin was not keeping up with emails, he made some vital mistakes with some employees under union contracts, and he overpaid two employees, along with other issues.
Stephanie met with Colin about all of these issues and each time there were valid reasons why errors occurred. He informed Stephanie that employees often took issues directly to central HR, bypassing him, and therefore he did not know about those problems until it was too late to solve them. Managers were either not coming to him with issues or also were coming after the damage was already done. He did remind Stephanie that he was on a learning curve and some of the mistakes were due to his own lack of experience. He also needed to become more familiar with the new union contract. On a personal level, he said there was too much on his plate; he was a single dad and could not work late every night.
About three months earlier, the Director of Facilities Management left his position and Stephanie had been filling this role as well as taking care of her duties as a member of the senior team of the hospital. Due to this position, she was getting direct feedback from managers that Colin did not answer his emails. Although he was responsive when addressed in person, he was sometimes a bit glib and rule based and answered questions too quickly. The managers were also concerned that when Colin spoke to the union employees he was too sympathetic toward them. He seemed to buddy up to them and seemed to lose his professional demeanor.
The Chief Executive Officer (CEO) found out that the Director of Facilities Management position was open and would remain that way for six months. The managers, at this point, were all reporting to Stephanie. Stephanie was extremely busy running the operation and working with funding and other issues outside of the organization, which were more critical parts of her responsibilities.