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If the research indicates we need to try a new project, we must do it with the awareness of the entire organization. If it works better, we must communicate our results back to everyone else. A learning organization is one that acquires knowledge and shares it with others. In the operating room case I provided earlier, one hospital learned, while the rest of the organization did not. Our challenge was that we were trying new things, but the enterprise was not benefitting from what individuals had learned locally.

We needed strategic and a tactical communication across the enterprise to indicate what we were learning from specific efforts in real time. SW: In closing, what do you believe is on the horizon in healthcare and in military medicine? MN: Healthcare in general has to evolve into the next level… in particular virtual care.

Aspects of medical care will be delivered much like banking or holiday shopping through digital communication between providers and patients.


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On the horizon lies technology with the ability to use remote diagnostic tools. The challenge for U. We have many ships at sea and many sailors and marines deployed in remote places. The expectation is… that loved ones will get the same kind of care on a remote island, on a ship at sea, or in a faraway desert that they would receive in Maryland. Through digitalization, we will diagnose and monitor problems, measure oxygen levels and heart rates, and obtain ECGs on our smart phones and with remote applications. Eventually, we should be able to offer patients 90 percent of their medical care virtually, bringing them in only when we cannot examine them with remote technology.

It will take time, however, as most patients and providers are comfortable with current practices. Saving time and fostering access through technology will be key. Drawing broadly from the human capital school of thought organizational psychology, human resource management, and strategic management , which holds that to achieve HPO status de Waal , asserts leaders must intentionally engage employees to develop and sustain high levels of performance over time.

De Waal , concludes that a set of five major factors with 35 descriptors consistently and significantly contributes to higher levels of organizational achievement: 1 long-term orientation; 2 management quality; 3 workforce quality; 4 continuous improvement; and 5 openness and action orientation see Appendix. De Waal posits that each of the factors is complementary and highly correlated; some derive from the organizational level e.

My interview with VADM ret. Nathan features his experience in successfully leading a unique health services organization, and provides insights into guiding an internationally dispersed health system whose mission lies in delivering world-class service in myriad, sometimes extreme, environments. Based on insights from this interview, we summarize key themes. Long-term orientation: fulfilling mission requires a contextual understanding.

According to de Waal , , factors that contribute to long-term orientation at the organization level include cultivating long-term relationships, providing the best possible service, and developing sustainable partnerships with all stakeholders. An HPO also boasts long-tenured managers, many of which have been promoted from within, thus reflecting a sense of job security among its workforce.

Examining such factors as they align with VADM ret. Navy Medicine is a healthcare system that prides itself on an enduring tradition of service. Complementing this context of service is a shared culture steeped in seafaring tradition and whose adherence to a unified mission is job one partnerships. Understanding mission in context and the unique challenges it poses are certainly germane to effective leadership Pettigrew ; yet, HPO leaders must consider also the implications of mission fulfilment on business operations, particularly through the eyes of their workforce Strebel Navy Medicine, therefore, deliberately and thoughtfully develops all of its managers internally over a long period of time seeking to mitigate operational weaknesses and recognizing individual strengths; hence, healthcare managers are promoted only over the long-term and solely from within.

The process ensures that top managers serve in numerous environments and job classifications so as to challenge and expand individual competence and contribute to organizational stability and capability. Management and 3. Workforce quality: cultivating individual leadership drives organizational alignment. De Waal , asserts factors that enhance HPO management and workforce quality occur at the individual trait level but also that such characteristics must be situated within a supportive and encouraging environment.

Specifically, HPO management is trusted, has integrity, serves as a role model, and is decisive and quick to take action. HPO managers also achieve results through effective, confident leadership making tough decisions with regard to non-performers in support of mission accomplishment. Within this model, workforce quality takes its cues from management who holds individuals responsible and inspires employees to accomplish extraordinary results. To achieve such ends, managers must select or train employees to be resilient and flexible, yet also complementary.

VADM ret. Nathan and others argue that at all levels of the organization, developing a culture of individual leadership and accountability creates a more cohesive workforce and enhances resilience as well as adaptability Chatman and Cha ; de Waal , In Navy Medicine, employees also believe hard work will be recognized, individually and as a team.

They see evidence through engagement that the organization supports them as individuals and acknowledges the burdens of work—life balance on their families. They believe that the organization, in striving to fulfil a purposeful mission, will work to remove barriers and address concerns as expeditiously and effectively as possible. Workforce commitment to mission accomplishment as a whole is, therefore, greatly enriched Rosen et al.

Under the heading of Continuous Improvement, de Waal , focuses on the uniqueness of organizational strategy mission and an approach to process improvement that is both constant and straightforward, the purpose of which is to align all parts of the organization.

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The Thin Book of 360 Feedback: A Manager's Guide

To bolster alignment, performance metrics as well as pertinent financial and non-financial data are shared openly with the workforce. As such, mission is a key driver in recruiting and retention.


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Because its mission requires mobilizing forces from myriad facilities and because the enterprise is spread globally, its strategy must be concise and focused. Nathan contends that if leaders create too many initiatives, the workforce will assume that either everything or nothing is important. The complexity and changing nature of many strategic planning efforts, therefore, overwhelms managers who are then burdened with innumerable initiatives and metrics Strebel Priorities are often confused as a result.

Leaders must distill a handful of their main concerns into a simple, intensive decree. The key is to taper a plan so as to streamline day-to-day operations, to reduce the burden on managers and personnel likely to chase everything, and enable movement on goals and objectives in a systematic, measurable way.

In the end, individual employees will be able to translate strategic priorities into how they perform on the job, and in this case, also in their personal lives. Openness and action orientation: a learning organization communicates effectively. Management has a responsibility to engage its workforce in decision-making dialogue that results in an exchange of ideas that welcomes change, admits mistakes, and drives performance de Waal , If evidence suggests that the inclusion of a best practice is vital to effective operations Pfeffer and Sutton , the enterprise has the responsibility to ensure awareness across its facilities.

If one facility or department has discovered a best practice, or perhaps uncovered a mishap, there must be a mechanism by which to communicate results to everyone else. According to Nathan, a learning organization is one that acquires knowledge locally and shares it with others in real time March et al.

The organization as a whole must benefit from efficacy in the form of evidence-based practices and by efficiency through communication that promotes organizational alignment. Communication, therefore, must be timely, meaningful, and well organized Shortell et al. Through the course of this interview, we highlight several aspects of the U. Lessons learned indicate a combination of epistemologies lies at the heart of informed theory development and evidence-based practice.

We therefore present this paper in the spirit of collaborative learning. By examining the ways the U. Navy Medicine seeks to enhance capability in a multi-faceted environment, we suggest possible directions for understanding how evidence of high performing organizations may be extracted from their experience.