Health care organizations today are facing enormous challenges, not the least of which is long range planning in the face of acute systemic uncertainty. In the United States, The Affordable Care Act has been praised by some and vilified by others. The fact is the verdict is not yet known. This “not knowing” fuels the rampant uncertainty. Anyone who works on the financial side of health care institutions is now scrambling to build some sense of coherence into their financial forecasts and budgets. The political storm raging over “Obamacare” makes financial, and for that matter, clinical decision making all the more difficult. Remember former presidential candidate Mitt Romney’s pledge to end “Obamacare” on day one of his administration. How do health care organizations design a 5 year strategic plan within that kind of political context?
I suggest that successful planning will be the result of investment in what social scientists refer to as “social capital.” Simply put, social capital is a reserve of trust that can be used by groups to help solve problems. Social capital might also be looked at as what comes next after organizations invest in physical capital (structures, tools, technology) and human capital (training and development of individuals). Health care leaders that want to maximize the capacity of their organizations to engage uncertainty head-on and use that uncertainty as an opportunity to prosper through innovation will invest in trust building as a precursor to collaborative problem solving. High trust environments encourage every voice in the organization to be heard. Low trust environments leave valuable insights and perspectives unspoken.
There are those who may argue that today’s healthcare organizations simply can’t afford investment in something as vague and touch feely as trust building. The folks at the Harvard Kennedy School’s Saguaro Seminar explain that, “The central premise of social capital is that social networks have value. Social capital refers to the collective value of all "social networks” and the inclinations that arise from these networks to do things for each other….The term social capital emphasizes not just warm and cuddly feelings, but a wide variety of quite specific benefits that flow from the trust, reciprocity, information, and cooperation associated with social networks. Social capital creates value for the people who are connected…” Professor Robert Putnam, the founder of The Saguaro Seminar, has been studying strategies to develop trust and engagement for decades and describes two kinds of social capital, bonding and bridging.
Bonding capital can be thought of as the trust that brings together like-minded folks from similar backgrounds and social/organizational settings. A church group’s bonding capital is built in part upon their common religious practice. Bridging capital is the trust that connects individuals and/or groups from diverse settings and backgrounds. The same church group joining together with a local Synagogue to run a program to help feed the homeless is using bridging capital to transcend religious differences for a greater good. Neither bonding nor bridging capital is possible without trust, the belief that I can count on you (or my group can count on your group) to act with integrity, consideration, and honesty. I like to say we trust when we believe we can walk our talk together.
The unbridled uncertainty that characterizes healthcare today can, if not proactively addressed, destroy an organization. Clinical decisions geared towards what t is best for the patient are increasingly pressured and, at times, dominated by what is best for the financial health of the organization. Productivity is the prevailing clarion call at staff meetings. Clinicians can find themselves demoralized and burned out as their passion for helping others becomes submerged in a sea of administrative directives that boil down to this unsettling message: “Being a highly skilled, effective clinician is just not good enough anymore.” Administrators and managers may isolate themselves from the front line health care staff rather than engage in what may be perceived as a no-win situation in the context of unpredictable reimbursement models that demand squeezing more health care into less time while simultaneously somehow producing improved outcomes and enhanced patient satisfaction.
Health care leaders would be wise to consider investing in the creation of social capital. It is only by bringing front line health care workers, administrators, managers, and financial analysts together in the same room that a way forward will be found. Health care delivery systems are by their nature complex. Compounded by uncertainty, the complexity expands exponentially. Hierarchical management models that emphasize control at all costs miss out on leveraging the most powerful idea generating capacity they have, their people.
I recently returned from Tennessee beginning a yearlong project working with one of my mentors, Tracy Roberts, CEO of Circle Center Consulting. The work involves a leading accountable care organization committed to lowering healthcare costs and improving patient outcomes. The day I returned, I continued my ongoing work with another mentor and good friend Michael Kline of Kline Seminars. We work with local health care teams striving to increase staff engagement in a setting of recent mergers. In both cases, we use a collaborative leadership methodology called Circle Process to bring people into meaningful, productive conversations that create social capital. This process focuses on building trust first so that teams become more engaged with others within their team (creating bonding capital) and more engaged with teams from different departments (creating bridging capital). One participant echoed the sentiment of many when she said, “I so appreciate the fact that we work for an organization where the leader invests in this process where we can be with each other as human beings first.”
There is never a superficial magic bullet or a one size fits all solution. But, there is magic and there are solutions. Circle Process is one of many relational practices that create a space conducive to leveraging the deep self-organizing magic of life itself. It is a practice well suited for health care organizations committed to navigating these uncertain times and emerging as successful beacons of hope for an industry in desperate need of realizing a new path forward.