Preface
The long term goal of the Clinical Catalyst Primer is the improvement of the performance of clinical teams and the quality of practice and life of individual team members. The Primer lays the foundation for the achievement of this goal by providing general concepts drawn from a variety of areas including engineering, management, and clinical science. The overall theme is on the concepts essential to participating in successful change within organizations of all sizes. The Primer focuses on the clinical team and the environment in which they exist. The material is designed to be read and enjoyed by busy professionals who are either directly or indirectly involved with patient care. Recommendations for further reading are provided for each area. I hope the examples, concepts and suggestions will encourage healthcare workers to constructively participate in successful change; avoid poorly designed change efforts; and improve their degree of success and satisfaction within their clinical teams.

In my opinion, there are three reasons for healthcare workers to have a thorough understanding of change. First, I have come to the conclusion after playing many roles in healthcare that understanding and successfully participating in change is the most important skill I possess outside of my clinical skills. Healthcare workers will be required to consider many opportunities to change in their careers both in their clinical areas and the environment in which they work. The successful participation in meaningful change and the ability to avoid participating in poor changes will allow healthcare workers to preserve the most valuable resource in the healthcare industry, the healthcare worker's time and energy. By preserving their own time and energy they can create the opportunity to keep up with changes in their clinical areas, devote time to providing quality of care and service to their patients, participate on various taskforces and committees, and cope with change brought to them by others. Beyond their work environment, by preserving their time and energy, they will be able to devote time to their own health and happiness including their life outside of work. The Primer provides concepts and information which can be useful to healthcare workers in preserving their time and energy.

Second, it has been my observation that most of the job dissatisfaction among healthcare professionals concerns nonclinical issues such as interpersonal issues, performance appraisals, meetings, decisions made by others, and the healthcare worker's lack of involvement in decisions that affect their ability to do their job. The common denominator across all of these issues is the healthcare provider's desire to change the situation. Worker dissatisfaction and frustration arise from the lack of concepts and skills to constructively tackle the various issues. Ideally organizations would provide the necessary training to their workers, but in my experience this rarely happens. The Primer begins to fill this void and is therefore a prescription for dealing with dissatisfaction in the workplace.

Third, as healthcare workers gain competence and confidence in their clinical roles, they often serve in "nonclinical areas" either as informal or formal leaders. These "nonclinical areas" can range from appointment or election to roles of formal authority such as chiefs of service or board of director positions, through standing committees involved in hospital or clinical care, to taskforces involved in making recommendations to solve specific problems. These various positions involve a wide range of issues which often overlap including regulations, budgetary matters, quality and service issues, personnel issues, or community relations. Most organizations provide for some training in these non clinical areas. Based on my experience this training is limited and often doesn't translate into acceptable performance when it comes to successfully managing change. In my opinion poorly skilled leaders attempting to lead change and solve problems within organizations are a major source of frontline healthcare worker dissatisfaction and waste within healthcare. I have also come to believe that leaders who are unable to skillfully manage change represents an enormous lost opportunity for healthcare organizations to improve care and service to their members, as well as the skills and satisfaction of their workers. Therefore, the Primer is written to help leaders improve their skills and for frontline healthcare workers to manage the performance of their leaders.

Healthcare by its very nature has become divided into teams. This division into teams results from the need for a variety of professionals working together in many areas of specialization providing care 24 hours a day year round. In my opinion the functioning of the clinical team is a major factor in the satisfaction and success of individual healthcare workers. I believe that healthcare professionals who are skilled at their jobs and possess skills in team work and effective change are the key to success for healthcare organizations. The success of medical care organizations, therefore, is determined by their ability to create an environment that allows the development of effective teams. Although similar to other industries, especially service industries, the medical industry is also unique in many aspects. The unique nature of the work is very intimate and deals with individuals and families under the stress of maintaining health and coping with illness. The work requires sufficient time to be done well. The developing complexities of treatments and the wide range of specialties necessitate many interfaces between teams and individuals with different job descriptions and create unique challenges. The need for licensure and the implications of mistakes which bring legal and regulatory scrutiny add to the difficulties faced by healthcare organizations. The focus of training of healthcare workers is on patient care, very autocratic, and deficient in skills necessary to work effectively in teams or large organizations. The leaders of most healthcare organizations continue these attributes into the culture of their organizations and the healthcare workers accept this as the way things need to be. When viewed within the context of what works in innovation within organizations in general and more specifically the improvement of clinical teams, the chance for successful innovation is very small. The good news is that with very smart, partially educated healthcare providers working to provide caring and service for their patients there are isolated examples of partially successful innovation. Therefore, the Primer provides information, examples, stories, processes, and recommended further reading to lead to improved innovation within healthcare organizations with the focus of developing an environment to allow for the growth and nurturing of "Sustainable High Performing Clinical Teams".

The Clinical Catalyst Primer represents a continuing project. Given the wide scope of the information covered I have provided references and recommended further reading. The table of contents indicates the scope of the Primer as currently planned and indicates which articles are available. Part I provides the reader with the fundamental concepts which allow for the understanding of change in clinical environments. This section begins with basic information on the concepts of sustainability and systems and ends with the definition of "Sustainable High Performing Clinical Teams". The four basic components for catalyzing the formation of these teams are discussed. These include the application of selected principles of innovation, the elimination of waste, the importance of cooperation, and the appropriate use of investment. The reader will be exposed to the "Clinical Catalyst Process" for creating an environment that will nurture these teams. By reading this section the reader will be able to better understand the power point presentations in the "Clinical Catalyst Presents" series. Parts II to IV discuss innovation by beginning with individuals and progressing to teams and then organizations. Part V goes beyond the organizations and discusses sustainable communities and large systems involving communities. Part VI is a discussion of actual case studies which have been published or the application of the key concepts and examples both published and not in the construction of hypothetical models.

By the finish of this project I hope the readers will have broadened their views of what is possible within their organizations. They will be able to appreciate and begin to eliminate the 50% waste in healthcare today. They will be able to appreciate the difference between the latest "good" idea and an idea that might lead to meaningful change. They will learn the importance of money, the difference between accounting and finance, and the use of gain sharing in innovation. They will appreciate the differences in individuals involved in innovation from innovators to late adapters and the difference between product champions, reinforcing sponsors, and authorizing sponsors. They will be exposed to the difference between politicians and leaders and how the former generally stop meaningful change and the latter can lead to truly outstanding innovation. They will be exposed to a simple decision model to appreciate the best way to make decisions to produce meaningful change. They will learn to appreciate the difference between industrial systems and complex adaptive systems. The importance of cooperation and agreement will be discussed. The reader will be exposed to analysis of systems including the importance of sampling and the interpretation of numbers. The reader will be introduced to important engineering, quality, and service concepts. Beyond gaining a broadened view and wider appreciation of what is possible I hope the readers will have gained the ability to ask the effective questions and contribute to their individual success as well as their organizations. In 1974 when I was interviewing for my Family Practice Residency at the University of California, Davis in Sacramento California, William Burr MD suggested I read a book by Neil Postman and Charles Weingartner titled "Teaching as a Subversive Activity". The book is about constructing learning environments which allow students to become lifelong learners who can cope with complex problems and the "change- constant, accelerating, ubiquitous- that are the most striking characteristic of the world". They define an educated person as someone who is subversive in being able to effectively question and solve problems. My hope is to follow in those footsteps by providing information and stimulating participation in change so healthcare workers become more subversive and can lead successful rewarding professional and personal lives while contributing efficiently to the prevention and treatment of disease, the wellness of their patients, and to health of communities, businesses, and the planet. I hope you enjoy the material. Be well.


References:

Teaching as a Subversive Activity, Postman, Neil and Weingartner, Del Publishing Co. Inc., 1969.