Greg's Blog

The whole Enron scandal has left me very suspicious and paranoid of organizations, in general, and researching for my paper has reinforced this. I just don’t know if you can believe what any organization is espousing externally. It may or may not have any basis on the internal culture. In fact, the internal culture could be suporting false external posturing. I see this external posturing initially in a mission statement. Members of an organization sit down early on and record the raison d’etre for the organization. But is it accurate? It’s certainly for public consumption, so is it honest or just a marketing tool? Even if it was accurate once, is it still? Or has the culture completely gone a different direction due to external forces or internal conflict?
I have been trying to find the official written mission statement of my department without much success. But I don’t think it really matters. The real goals, priorities, and culture of the department exist no matter what the mission statement says. No one ever consults the mission statement. If it ever existed it is no longer relevant.
So my thought is that organizations need to revisit their fundamentals. They may have changed and for the better. But without sitting down and reevaluating what has occured within and to an organization, it runs the risk of running amok, or pulling an Enron.

I thought I might just jot down some thoughts as I made it through the three chapters on organizational leadership. The first chapter spoke about founding leaders. In my organization, which has been around for 60 years or more, I think we are functioning under the assumptions and culture of our previous leader, who was the chairman for 25 years or so, and, I think, basically reinvented the department. I will explore this more in my paper, but it’s interesting to note that my current chairman (who was been present for virtually the entire reign of the previous chair)has acted much differently, and yet the underlying culture established by the previous chairman has stayed pretty steady. If things are going well, the founders culture rules depsite whjo may be currently in charge. It implies it might be harder to change culture than simply leave and establish a new one (which seems to be a pretty common practice in business).
In the next chapter he talks about how leaders ingrain their philosophies, assumptions, and beliefs. The first three was were paying attention to what is important, emotional outbursts, and infering what is unimportant but what the leader doesn’t pay attention to. I couldn’t help but apply this to my leadership position as residency director. Do I pay attention to the issues and concerns that really matter to me? Am I communicating clearly to the residents what is important by focusing on it? Am I consistent in what I measure and evaluate them with? When I have an emotional outburst (which I surprisingly do every so often, is it about something meaningful? When I brush off an issue or convey my unconcern for it, is it appropriate? I have been having a hard time getting through the rest of the chapter because I find myself soul searching. I guess I could just ask them.

This class has got me thinking about whether the institution I work for is really a learning organization. I would be willing to bet all the administrators would say yes, while I would absolutely disagree. Where I work there is a variety of teaching going on, but I don’t think the organization learns well if at all.
Case in point occured earlier today. The head of the hospital and the head of the physicians came to the orthopaedic department meeting to talk about safety events. There has a been a huge institution wide campaign over the past three years to decrease serious safety events. This has entailed training, marketing, and, in general, a bunch of cow manure. They tell us this morning that the rate of safety events has not decreased at all. So the whole campaign failed.
In addition, they brought in an outside physician “expert” in safety, and according to him the real fault lay with the physicians themselves. So, bottom line, we did this huge campaign without your input that failed miserably and we got some other guy without your input who actually says it was your fault all along. Are you kidding me?
This goes against everything we’ve been learning. Isn’t it possible that we, the people who work here and are apparently at fault, have the knowledge and experience and expertise to solve our own problems? Aren’t we uniquely equipped to teach one another ways to solve these problems? Aren’t there successful departments that may be able to assist other departments whose numbers aren’t so great?
Not according to our vaunted CEO. Some “expert” said it was our fault and you numbskulls need to shape up or else (he actually had a four point list of consequences that I won’t get into). So, I think the question is settled. My workplace is not a successful learning organization like the ones we’ve been reading about.

This was a very interesting topic to me and applies easily to the world of medicine. There are a lot of experienced physicians and surgeons. If you live long enough you become experienced to some degree or another (those who reflect and spend time to analyze their experience are much better off, but that is a different class). Being an expert is something else entirely. You don’t have to be experienced to be an expert. You just need to be the only one (or one of a few) who have a specific experience or expertise. That requires the individual to “break new ground” or “think outside the box.”
You have to try something new to be a true expert or authority on a subject. Otherwise, you are just becoming more experienced in a field where someone else is the expert. The kicker is the potential for failure. It’s easier to let someone else try the new idea, prove it works, and then implement it. At least then, if it fails (and just because it worked for someone else doesn’t meant it will for you), there is someone else to blame. Based on some research in the meical literature and a study of mentoring I attempted to implement a structured mentorship program in my residency. The literature said it was helpful, and the residents said they wanted it, and it has been a resounding failure. I couldn’t get the attendings or the residents to buy into it. So I have moved on to try other options in an attempt to improve the program.
The problem is that each individual and each organization is different. So even if there are many experienced advisors or expert consultants offerring guidance, it may all be worthless. It isn’t guaranteed to work just because it may have in the past or it’s the new idea on the block. You still may be better off becoming your own expert in your own organization and finding your own innovative solutions to problems. I would guess (without any proof) that the most successful organizations create their own solutions to the most complex problmes, and, therefore, remain the most successful organizations.

I have been terribly behind with just about everything, so I decided to start with responding to some blog posts. I figured I had to do it, and I might get some good ideas for this paper I’m (you guessed it) terribly behind on. Instead, it made me realize I’ve been less than the perfect team member this semester. I have all kinds of good and bad excuses, but none of them really matter. The point is that I was lucky enough to get good team members who have been able to make me look good. Without question, they have been more dedicated and committed than I have been, but have given me the opportunity to add my ideas and skills here and there to help the team and help them. That is good teamwork. Finding the way to maximize everyone’s input and providing opportunities to succeed make for a good team. It would have been just as easy to minimize the chance for the success of an individual (albeit at the possible detriment of the team; in my case, I’m not sure they would have missed me). So, I want to thank my teammates. They deserve the lion’s share of the credit (and probably a better grade). They also taught me that the tasks of the team may not always be equal or divided perfectly, but teh best team allows for this and sets the stage so everyone (including the team) has the best chance to succeed.

Paradox of Perception. The basics of this paradox are that groups are different because they serve different functions, are made up by different members, and have different goals. If everything and everyone were totally uniform there would only be a single collective (communism?), but we know there are a multitude of groups because of an equal number of needs or tasks. The corollary to this is that groups are different but do not exist in a vacuum. Interaction (or even conflict) with other groups is inevitable (and not necessarily bad). The kicker is how interaction with other groups affects the dynamics of the individual groups themselves.
This ties into the intragroup paradox of engaging. Each group requires some sacrifice or loss of self on behalf of its members to become cohesive. In order to adapt to other group needs or pressures or interactions, the original group may ask even more of its members and cause internal unrest. This can lead to poor interactions with the other groups and the effect can snowball.
This is carried further when thinking about power and leadership in intergroup dynamics. First, a leader who is very effective providing guidance, aid, etc for his/her constituents may not have the same talents in dealing with other groups, some of which may have more or less power. dealing with other groups requires another set of skills. Furthermore, making concessions or changes to improve intergroup dynamics (as mentioned before) may upset the intra group dynamic and require a different leadership style.
The chapter goes on to describe power struggles between groups as the “haves” vs the “have-nots.” The fallback position is the “haves” ignore what they don’t have or rely on other groups for while the “have-nots” forget the valuable resources/talents they do, in fact, have. For me, the important lesson here for the leader is to remind both groups of the reality of the situation in order to facilitate effective intergroup interactions. The challenge is then selling any necessary changes to the constituents.
Which leads into the beginning of the chapter and conflict. Conflict with an outside group can be used very effectively to unify members. The “us vs them” mentality can help forget differences and increase the cohesiveness of a group. For me, a good example of this is World War II. After Pearl Harbor, the debates among those who wanted war and those who wanted to stay out of Europe essentially ended and the nation strove toward a common goal.
Luckily, that went well for the US. If things don’t go well then there is inevitable conflict between the nay-sayers and the doers. This can lead to more internal strife and poorer results in the external conflict. The Viet Nam war seems like a reasonable example of this to me. As the war went bad support at home became more divided and so on.
The conflict between groups arises from competition for scarce resources. By definition, if a new group forms it is out of a need for that group, but it is also indicting pre-existing groups as inadequate to fill that need. Thus, competition and conflict is developed among groups.

In between all the circular language that is rampant in this book, I actually liked some of the points made in this chapter. The first is the paradox of authority. First, for a group to be bigger than the sum of its parts, the authority figure must authorize the members to perform actions. For me, this is saying a leader must delegate tasks to the appropriate people based on their talents. The interesting follow up is how these individuals react to that delegation. On the surface, a leader would want everyone to simply acquiesce, say “yes, sir!” and get it done. Resistance, questioning, or discussion is seen as negative reactions. But the opposite is true. If the “actors” simply acquiesce, then it is unlikely they are investing themselves fully or most effectively (or learning very well either, in the context of a teacher and learners). If there is questioning or resistance, the “actors” feel comfortable enough with the leader to bring up concerns and care enough about the outcome to try and maximize it. This, for me, is a valuable lesson moving forward.
The next paradox is dependency. I like to think of the extremes to clarify this issue. Basically, if you are truly independent than you are essentially isolated. You may be great at what you do and don’t want or need any assistance, but eventually the time will come for integration or aid and the truly independent individual is at a severe disadvantage. The truly dependent person is nothing more than a “taskdoer” or robot. They can be told what to do and do it effectively, but the energy of having to tell them all the time is draining. In my profession, this is a key balancing point. It requires judgment, which is learned in the course of training. Interns have little independent thought, and that is the way it should be. They are worker bees. As you progress through residency you get entrusted with the ability to think on your own and make you own decisions, but you must learn when to ask for help. Even when training has finished many decisions are made with the input of others and not in an independent fashion. Having the humility to be dependant is usually beneficial to the patient (not to mention the medicolegal ramifications).
The paradox of creativity to me is similar to not resting on your laurels. The paradox is that to move forward you must initiate creative and new ideas at the expense of old or traditional ideas. It is easy to rest on your laurels, but eventually you will be passed by. It emphasizes that the old HAS to be discarded to bring in the new. The clothes in the closet that hold special meaning or memories have to go to make room for the new clothes. It is an important point to remember when making changes at work or in an educational curriculum.
The paradox of courage raises an interesting issue. If there is no doubt to the outcome of a decision, is it courageous to make that decision? No, it is a “no-brainer.” Real courage comes from making decisions whose outcomes are uncertain and could potentially be deleterious. To be creative real courage must be rewarded and fostered. Otherwise, fear paralyzes new thought, innovation, and progress in a group

This is supposed to be a synopsis of Chapter 5 in the Smith and Berg text, but it may end up being more of a critique. I’m not sure that the topics discussed are truly “paradoxes.” I would consider them more as challenges to the balance of successful group life. Take the first “paradox:” the paradox of identity. By definition, a group is a collection of individuals (each of whom, unless they are a stuffed animal, have an identity). The group cannot exist without the individuals, and the group identity cannot exist without input from the identities of the individuals. The real question is how do you balance those individual identities to form a constructive or successful group identity (I am assuming we are forming a group with a specific purpose in mind). If the individuals identities get lost the group will fail; likewise, if the individual identities are too strong there will be strife and (if issues don’t resolved) the group will fragment.
Involvement is another important issue to group success. The key, again, is to find balance. That doesn’t necessarily mean that each person is involved in the exact same amount. It means that all the members are actively involved to the level that suits their desires, talents, and group norms. The group has to be satisfied with the amount of member involvement or there will be resentment (if the members think one individual is underperforming) and annoyance (from over-involvement). I am not sure if this is a paradox or just a challenge for teams and groups to overcome.
Individuality is another challenge. A group cannot survive too much individuality, but it needs the particular contributions of each individual to be successful. A balance must be struck. It is best for each individual to contribute with his/her unique talent. I this way, everyone gets involved, is needed, and contributes. People make the group too much about themselves and those who do nothing only create resentment.
The last “paradox in this section concerns boundaries. Sometimes, these are concrete and pre-determined (a surgical or basketball team, e.g.). Sometimes they can be very fluid (the Republican and Democratic Parties, e.g.). The boundaries, ultimately, define who a group is. The problem is, the individuals in the group define the boundaries. As boundaries/definitions change (because of the membership), the group may become less or more inclusive or even more or less attractive to the current members. For instance, the founders of the Tea Party may no longer recognize or even like what the party has become. The current members may not even want them to be a part of the party (no pun intended). The challenge for successful groups is to manage the boundaries in such a way to maximaze results. If we need more mebers, e.g., let’s recruit in such a way as to not lose our identity.

I’m not sure 5 areas is enough to cover all the problems I’m having, but I will try and keep it to the point. One area I need to work on is data collection. I have one survey I have made up, but I am eager to get feedback on how I might make it better. I never really have had a course in survery design (is there a course in that?). I have tried to include variables on the survey that will address “quality of orthopaedic education” (a hard target to hit), but are there other questions I should be including? Is there a way for me to effectively change the survey over time. I don’t want it to be constantly changing, but you had suggested design revisions in between cohorts.
Also, I wonder if I could expand the tools to include interviews, or if that will complicate the issue by making it a mixed method type of study design (another area I am having problems with). Originally I was shooting for a purely ninja type of qualitative study, but can I include interviews as a data collection tool and incorporate it into that study design? Or should I just mention that as a weakness of the study design? Now you understand the heading to the post.
Lastly, I’m not sure I understood your comment about the experimentor effects and how an “audit trail” might help. If you could explain I would appreciate it. Thanks for all the help, and if this post shows up timed after 5 PM its because of daylights saving time.

     Ethnography and phenomenology are two different types of qualitative studies with two different objectives.  Ethnography is the study of a culture (a group of individuals with a shared pattern of beliefs or feelings) while phenomenology is the study of the essential experience of individuals who share a phenomenon.  Ethnography has been used to study religious behaviors, child reering, and other cultural issues.  Phenomenology focuses on each individuals perspective on how an event was experienced.  It can be used to study students feelings about studying abroad or attitudes towards advisors or counselors, for example.

     Data collection for ethnographic studies begins with observation.  The goal of the investigator is to observe naturally occuring behavior as much as possible.  This could mean complete emersion into a society or even becoming a participant observer.  Extensive notes are taken.  The second method of data collection is interviewing.  Certain participants are selected and interviewed in depth.  These interviewees may be chosen because they are atypical and represent a minority of the culture, or they may be very representative of the established norms of the group.  Key informant interviews or focus group interviews may be used. Interviews are the mainstay of phenomenologic studies.  Participants are chosen because they have a shared experience and are willing to share thier own particular feelings about it.  The interviews are long and in depth and often taped for accuracy.  Data collection for phenomenologic studies relies exclusively on the interview to identify themes and common issues.   Ethnographic studies also can employ document analysis as a third method to gather data. 

     Data analysis and interpretation for both types of study can be very arduous and difficult.  The amount of data can be overwhelming.  Field notes and interviews have to be meticulously transcribed, analyzed, and coded.  Data is then summarized and finally interpreted by the investigator.  This entire process is time consuming, labor intensive, and is often revised and repeated.