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According to the Census, racial/ethnic minority populations are growing at such a fast rate that by 2050 more than 50% of the population will belong to a minority group (US Census, 2001). The increasing diversity of the U.S. population is one of the many changes that health care delivery organizations need to proactively address in order to better serve their community and improve their performance. In this paper, we argue that cultural competency not only is important from a societal perspective, i.e., reducing health disparities, but can also be a strategy for health care organizations to improve quality, lower cost, and attract customers. We provide detailed recommendations for health care leaders and managers to adopt in order to successfully serve a diverse patient population.

Leaders in health care today are faced with a wide array of complex issues. This chapter describes an innovative physician leadership development program at the Cleveland Clinic intended to enhance the leadership capacities of individuals and the organization. Propositions regarding the program's impact on organizational innovation, organizational commitment, social capital, and the human element of physician practice are offered for future examination.

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health care organizations.

This chapter uses the structural and relational dimension of social capital theory (SCT) as a lens for examining the impact of the supervisor–subordinate relationship on nurses' perceptions of the usefulness of their workplace networks, sociability, and affective commitment. A survey was used to collect data from 1,064 Australian nurses.

The findings suggest that nurses rely on very small workplace networks (typically only one other person) with which they have strong ties. Further, in over half of the cases, the supervisor (the Nurse Unit Manager (NUM)) holds the centric position. Moreover, for those nurses who did not include the NUM in their workplace network, their position appears even worse. For example, the usual reason given by nurses for not including the NUM was that the NUM was unavailable. This is a concern for health care management because the past two decades have delivered many changes to the nursing profession, including a reduction in the number of nursing positions and subsequent higher workloads. The consequences suggest that without effective workplace networks, nurses are working under conditions where solving problems is more difficult.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

This chapter reports on an action research case study of integrated obstetric care in the Netherlands. Efficient and patient-friendly patient flows through integrated care networks are of major societal importance. How to design and develop such interorganizational patient flows is still a nascent research area, especially when dealing with a large number (n>3) of stakeholders. We have shown that a modification of an existing method to support interorganizational collaboration by system dynamics-based group model building (GMB) (the Renga method, Akkermans, 2001) may be effective in achieving such collaboration.

The increasing complexity and dynamicity of their environment compels health care managers to search relentlessly for effective management instruments. One strategic tool that both academics and practitioners have deemed critical to the success of any health care organization is the development of a meaningful mission statement. However, despite the seemingly omnipresence of the concept, studies indicate that creating an effective mission statement seems to be extremely difficult, if not downright frustrating for a lot of health care managers. This inability to create an effective mission statement roots for the greater part in the fact that the previous literature has provided little practical guidance on how health care administrators should formulate and deploy mission statements. Given the increasing pressure on health care organizations to develop an effective mission statement, this chapter (1) provides a detailed analysis of the mission statement concept based on a thorough literature analysis and (b) offers empirically based recommendations on how to successfully formulate and implement a mission statement within a health care organization based on a systematic analysis of relevant empirical research. These analyses and the derived evidence-based recommendations will help health care managers to revive their mission statement and make it more than a piece of paper.

Change within health care systems is constant as it relates to the external and internal demands that require continual adaptation by providers. This chapter provides a summary of the history and research contributions related to the study of culture and change through the lens of the nursing profession. The review focuses upon nursing research publications and the knowledge gained, ranging from the earliest to current studies. There has been a substantial increase in research interest regarding the relationship between nursing culture and ability to change; however, there is a considerable gap that remains in understanding subgroups such as individual nursing units or departments, consistent use of tools to measure culture, and interventions that have made a difference over time. From a practical perspective, this discussion provides insight into the importance of recognizing the importance of assessing culture and integrating cultural feedback into operational improvement plans.

One of the top domestic issues of concern to Americans is access to high-quality and affordable health care, and there is a growing concern about how institutions struggling to survive within this trillion-dollar industry will increase their effectiveness in the future. This chapter outlines a process of leadership development using an action learning approach in one Midwestern health care system over a period of three years. The process addresses both the development of the individual leader as well as the collective leadership capacity in an effort to sustain organizational learning and effectiveness over time. A model is presented that covers four phases or Four C's of development, which includes movement from individual Competency development, to the development of social capital through the enhancement of Connections and Creation of shared understanding, ultimately expanding Capacity for change within the organization. We also address other factors that must be taken into consideration that will either enhance or impede the concentric movement such as culture, sponsor support, and alignment of systems and structures.

In response to the growing evidence that disruptive behaviors within health care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model – Toxic Organization Change System – that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.