Improving Organizational Communication and Cohesion in a Health Care Setting through Employee-Leadership Exchange

Article excerpt

In the 1990s many health care organizations underwent reengineering. One of the unintended consequences of this process was a drop in employee morale. This article describes a project to improve morale in one hospital by fostering employees' constructive expression of dissatisfaction and of innovative ideas to senior leaders in the context of Employee Leadership Council meetings. Importantly, although formulated on the basis of employee suggestions, the hospital's president and chief executive officer initiated the project. After describing these councils, we examine the results of this experiment in employee-leadership exchange and explore the ramifications for the councils of the CEO's intimate involvement. Finally, we review lessons that might be transferable to other organizational settings as well as those that have implications for managerial understandings of organizational culture.

Key words: organizational culture, participatory action research, employee satisfaction, leadership, organizational change, United States

Children's Hospital and Health Center, San Diego (hereon, Children's), is an independent, nonprofit health care organization, offering comprehensive pediatric medical care through secondary and tertiary specialty outpatient clinics and inpatient care. Children's enjoys high public regard; of 178 pediatric hospitals in the United States, Child magazine ranked Children's seventh (Sangiorgio 2001). Employees generally take pride in being part of such an esteemed organization. Nonetheless, at a time when health care organizations are under intense pressure to do more with less, employee morale is one of management's topmost concerns.

Here, we examine a unique project undertaken to promote positive morale by fostering direct employee-leader communication in meetings convened by Children's senior leader for the express purpose of gaining insight into the organization as well as to provide direction on how to address issues raised. Senior leadership's role in managing change by fostering a positive cultural response among employees has received great attention of late (Committee on Quality of Health Care in America 2001; Haskins 1996; Hupfeld 1997; Lavin Bernick 2001; Ogbonna and Harris 1998a). We seek to add to that body of knowledge, supplementing not only management and organizational studies literature but adding to the applied anthropological literature as well, by demonstrating the value of actively including the topmost layer of senior leadership in organizational research. In the process, questions regarding the notion of organizational culture and its management are highlighted.

The anthropological perspective we bring to bear disallows our acceptance of the monolithic notion of culture typically seen in the management literature. Our research fully supports the view that Children's, like any hospital, may be thought of as a conglomeration of social groups: nurses, foodservice workers, managers, physicians, and clerical staff. Each group has developed its own culture. These partial cultures, which are based on occupation and departmental affiliation, are fragmenting forces. A concerted effort to encourage more cross-group interchange was clearly warranted by our findings.

Findings also suggested that, to engineer effective organizational change, it is essential not only to acknowledge the various divisions that exist but also to harness existing force fields of cohesion or aspects of the existing cultures for use in leveraging positive change. Horizontal linkages already exist between departments as do vertical ties that bind (vice-president, director, manager, supervisor, and staff affiliations in given divisions); these need to be capitalized upon.

After describing the context in which the project that led to these findings was instituted, we explain the theoretical underpinnings of the exercise. We then describe the Employee Leadership Councils (ELCs) at which employee-leader exchange took place and examine the results of this project, which continues to evolve. …