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Five dynamic tensions in contemporary medical staffs: Introduction and overview

Medical Staff Leader Connection, April 2, 2008

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There is a saying making the rounds in healthcare today: If culture and strategy are not aligned, culture eats strategy for lunch every time. The Greeley Company has certainly found this to be true for medical staffs. In our work across the country, we have found that medical staff culture can best be understood as a series of underlying dynamic tensions, sometimes referred to as polarities. These five seem to characterize many medical staffs:

1. Collegiality and excellence
2. Freedom and commitment
3. Appropriate independence and mutual accountability
4. Appreciation and continuous performance improvement
5. Stability and change

The effective medical staff strikes a balance and displays the positive characteristics on both ends of the spectrum. This balance allows for a flexible culture that ensures the physicians' and the hospitals' success.

Culture is not changed easily, and change requires strong leadership. In order to facilitate the necessary culture changes, leaders must:

• Espouse new beliefs and values in the hospital's mission, vision, and values statements
• Lead by example
• Communicate with fellow physicians about the new culture and the reasons for the change
• Build strong social capital and earn respect from peers
• Hold fellow physicians accountable when they resist change

The job of medical staff leadership is to understand the existing culture, define the desired culture, and effect the changes necessary to shift the dynamic tensions.

This series is designed to acquaint medical staff leaders with these polarities and help them decipher the characteristics that define their medical staff culture. The articles in this series will examine each dynamic tension in more detail. Next time, we will discuss collegiality and excellence.

William K. Cors, MD, MMM, CMSL
Vice President Medical Staff Services
The Greeley Company

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