Healing the Professional Culture of Medicine.

The past decade has been a time of great change for US physicians. Many physicians feel that the care delivery system has become a barrier to providing high-quality care rather than facilitating it. Although physician distress and some of the contributing factors are now widely recognized, much of the distress physicians are experiencing is related to insidious issues affecting the cultures of our profession, our health care organizations, and the health care delivery system. Culture refers to the shared and fundamental beliefs of a group that are so widely accepted that they are implicit and often no longer recognized. When challenges with culture arise, they almost always relate to a problem with a subcomponent of the culture even as the larger culture does many things well. In this perspective, we consider the role of culture in many of the problems facing our health care delivery system and contributing to the high prevalence of professional burnout plaguing US physicians. A framework, drawn from the field of organizational science, to address these issues and heal our professional culture is considered.

Whistle Blowing: A Message to Leaders and Managers Comment on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organizations".

This comment argues that instead of worrying about the pros and cons of whistleblowing one should focus on the more general problem of the failure of upward communication around safety and quality problems and consider what leaders and managers must do to stimulate subordinates to communicate and reward such communication. The article analyzes why safety failures occur and introduces the concept of practical drift and adaptive moves as necessary for systemic safety to be understood and better handled. It emphasizes the key role of senior leadership in creating a climate in which critical upward communication will become more likely.

The anxiety of learning. Interview by Diane L. Coutu.

Despite all the time, money, and energy that executives pour into corporate change programs, the stark reality is that few companies ever succeed in genuinely reinventing themselves. That's because the people at those companies rarely master the art of transformational learning--that is, eagerly challenging deeply held assumptions about a company's processes and, in response, altering their thoughts and actions. Instead, most people just end up doing the same old things in superficially tweaked ways. Why is transformational learning so hard to achieve? HBR senior editor Diane Coutu explores this question with psychologist and MIT professor Edgar Schein, a world-renowned expert on organizational development. In sharp contrast to the optimistic rhetoric that permeates the debate on corporate learning and change, Schein is cautious about what companies can and cannot accomplish. Corporate culture can change, he says, but this kind of learning takes time, and it isn't fun. Learning is a coercive process, Schein argues, that requires blood, sweat, tears, and a certain level of anxiety to achieve the desired effect. In this article, he describes two basic types of anxiety--learning anxiety and survival anxiety--that drive radical relearning in organizations. Schein's theories spring from his early research on how American prisoners of war in Korea had been brainwashed by their captors. He cites the parallels between the "coercive persuasion" tactics the Chinese communists used to control their prisoners (isolating powerful ones and overseeing all communications) and the corporate boot camps that American companies use to indoctrinate their managers. Indeed, heavy socialization is back in style in U.S. corporations today, Schein says, even if no one is calling it that.

Psicología de la organización / Organizational psychology

En este libro he tratado de dar una estrategia, para lograr efectividad organizacional, basada en buena comunicación, flexibilidad, creatividad y verdadero compromiso psicológico. Estas condiciones se tienen que dar 1) utilizando prácticas de reclutamiento, selección y socialización que estimulen a la gente en vez de desmotivarla, 2) facilitando relaciones psicológicas más realistas con base en un contrato psicológico realista y en el reconocimiento de que existen cambios de desarrollo en la gente; 3) procurando una acción de grupo efectiva; 4) procurando el rediseño perpetuo de las estructuras de la organización; y 5) procurando mejorar liderazgo en términos de las actividades de fijación de metas y definición de valores. El argumento es que los sistemas abiertos funcionan mejor si sus miembros se comunican mejor entre ellos, se sienten más comprometidos y son más flexibles y creativos