Revitalizing Health Services under the Shadow of the Coronavirus Pandemic.

Vol 10 #14  November 17, 2021

Alan Eppel

Society and the healthcare system have been under duress since the worldwide spread  of the  coronavirus. For physicians, nurses and other healthcare workers on the front lines there have been intense work demands coupled with fear regarding the transmissibility of the virus. Successive waves of pandemic infections have increased fatigue, burnout and resulted in traumatic symptoms among healthcare workers.  Significant numbers of healthcare workers have quit their jobs because of these pressures and impacts.

A backdrop of increasing effects of climate change and political and military conflict across the globe have added to a sense of apprehension,  a  pervasive sense of anxiety and even pessimism.

Organizational renewal is difficult in this environment. Conventional methods include strategic planning and reformulation of the organizational vision and mission statements. But there are limitations to these approaches. In particular the subunits of the organization have different values, different environmental demands and different “customers”. These subunits include inpatient wards, outpatient clinics, community outreach programs, surgical operating suites, laboratory services, imaging services etc.

A physician or nurse working in a busy hospital emergency room has very different demands and required responses in comparison to an individual working in a geriatric unit or endoscopy clinic.

Many physicians and healthcare workers may be jaundiced about the relevance of the organization’s vision and mission. Large group events devoted to developing vision and mission are often ineffective because of the large number of ideas and viewpoints that lead to a watered-down, overgeneralized and uninspiring result. Most of the staff in an organization are unlikely to remember the mission or vision and may not be able to identify with it in any case.

James Collins and Jerry Porras write in the Harvard Business Review [1] that many mission and vision statements

 “…turn out to be a muddled stew of values, goals, purposes, philosophies, beliefs, aspirations, norms, strategies, practices, and descriptions. They are usually a boring, confusing structurally unsound stream of words that evoke the response ‘True, but who cares?’

Redefining Purpose: a New Approach

A different approach is for each service, team or unit to develop its own vision and mission. This starts with each individual member of the service or unit developing their own personal vision or mission. Collins and Porras [1] identify four components of an organization’s vision:

• core ideology,
• core values
• core purpose.
• envisioned future.

The articulation of core purpose should start from the bottom up, inverting the usual methodology. It should begin with the unit of service delivery in the healthcare organization: for example an inpatient unit; an outpatient service; a community clinic. At this level  the organization’s mission statement is often viewed as a plaque on the wall to which clinicians become habituated and rarely commit to memory.

At the organizational level a core ideology is essential: core ideology “defines the enduring character of an organization – a consistent identity that transcends product market lifecycles, technological breakthroughs, management fads and individual leaders”. At the unit level it is the “core purpose”  that has most day-to-day relevance, “It captures the soul of the organization”.

Developing a Core Purpose

Core purpose is not a series of goals but is an overarching idea that can motivate and inspire. Team members have chosen the type of work they do and the environment in which it occurs because these are consistent with their own self image and sense of meaning of life.

For a  team to develop a core purpose it is necessary that each member of the team derive their own views. A personal purpose may not be identical to the team purpose but needs to be concordant with it. Similarly the team purpose must be concordant with the organizational purpose.

If personal purpose and team purpose are  incompatible this will be a source of job dissatisfaction, poor performance and conflict.

In healthcare organizations most professionals are motivated by idealism and a commitment to their calling. However they will have other purposes for example “paying off my mortgage”, “being able to travel” “ starting a family” “paying off my debts from medical school “ “developing my skills and level of expertise” “doing research, publishing, getting promotion”  “making a contribution to society” “to utilize my creative skills”

For most professionals there is a desire to be successful. Their self-esteem is tied to that. Healthcare workers want to work in a successful organization with a good reputation. This permits an identification with the organization and leads to pride in one’s work.

Articulating a Team Purpose

The Core purpose should be stated in a vivid and vibrant way.

1. Each member of the team can be asked in advance to reflect on their own purposes and to document these. An individual core purpose is the individual’s reason for wanting to be part of the organization.
2. A meeting of the full team is convened in which personal purposes/mission are shared.
3. A core purpose for the team is derived from the personal purposes. Core purposes in organizations are its reason for being

Many vision and mission statements can be trite with repetition of words such as “excellence” “innovative” “cutting-edge” “quality” “leader”. We can learn from highly successful organizations [1]:

McLean Hospital

Dedicated to improving the lives of people and families affected by psychiatric illness.

Cleveland Clinic

Caring for life, researching for health, educating those who serve [2].

Menninger Clinic

To create a healthy world by excelling in the art and science of mental health care.

Karolinska Institute  

To advance knowledge about life and strive towards better health for all.

 Merck

To preserve and improve human life

Nike

To experience the emotion of competition, winning, and crushing competitors

 Sony

To experience the joy of advancing and applying technology for the benefit of the public

Telecare Corporation

To  help people with mental impairments realize their full potential

Google’s vision

To provide access to the world’s information in one click.”

Google’s mission 

To organize the world’s information and make it universally  accessible and useful.

Conclusion

The elucidation of individual and unit core purposes can help restore self-esteem, meaning and cohesiveness leading to greater clinical effectiveness and sense of achievement.

References

1.Collins J. Porras J. Building your company’s vision. Harvard Business Review September – October 1996.

2.Cleveland Clinic Mission, Vision and Values https://my.clevelandclinic.org/about/overview/who-we-are/mission-vision-values