I was reading an interesting article in today’s Ottawa Citizen (and published also in the National Post – don’t click here yet though). The discussion was about an organization’s corporate “culture” that has allowed sub-par effectiveness to continue for many years. It has also lead to decreasing engagement by it’s members, particularly moderate voices, over the last 20 years.
The organization seems to have “…an in-grained culture of secrecy and self-protection…”, and an instinct to “circle the wagons.” After one particular failure, there was denial and the sense that “they just can’t recognize that they had done something wrong.” After another scandal, the organization’s task seemed to appear as “a horrific cluster of the ineffective, the abusive and the self-serving.”
This organization is none other than the peacekeeping arm of the United Nations. This should be an object-lesson for all organizations whose mission is sidetracked by the internal culture of the leadership. Look at the loss of engagement seen in peacekeeping due to this culture: prior to the 1995 failure of UN peacekeepers to prevent the slaughter of Bosnians in Srebrenica, about half of all peacekeepers were from Western countries. By 2008, less than 10% of peacekeepers were provided by the West.
In the 1990’s, the Coalition of Family Practice and other grassroots groups became more active and eventually had influence at the OMA Board. People wonder why this didn’t result in wholesale changes to the OMA’s approach, why this didn’t result in a more activist agenda? Why, as family practice was literally dying in Ontario, did a group dedicated to the preservation of Family Medicine not succeed in making larger strides to do so? Eventually, the crisis reached its conclusion, the government threw a lot of money at the problem and reversed the cuts to medical school enrollment. I really don’t think that the 1990s’ version of a Coalition really moved things along much faster. Why not?
Maybe it is because of “Corporate Culture.”
I have read a lot of stories on Concerned Ontario Doctors’ Facebook page about hospital corporations’ approach to their fiscal challenges – increased workload on staff, reduced support systems, overcrowding, rationing, and then the repression of staff’s ability to speak out about what they see day after day. Are all these hospitals run by incompetents? Or is there a shared “hospital leadership culture” that allows senior management to look the other way, or not even have to be exposed to the results of the decisions they make, except on spreadsheets? In one hospital that I wrote about recently, the senior admin team walked around the hospital on a weekly basis, interacting with all levels of hospital staff, giving them an opportunity to literally show them the challenges they are dealing with. No one attacked them, everyone was respectful. The staff with the assertiveness to approach and engage with the admin were looked at as potential leaders, not potential insurgents. They were given roles on committees and task forces to improve the issues that they themselves identified. Did it work 100%? No, but it sure did change the tenor of the relationship between the leadership and the staff.
A friend of mine who has a background as a lawyer who worked on governance for non-profit organizations told me that the OMA doesn’t likely need a new corporate structure, but it needs a new corporate culture. It needs to go through a process that brings it back to its real purpose, to represent physicians. It needs to do the work to avoid the well-worn path of keeping information from membership and making decisions secretly and instead become a more open, responsive organization. It needs to look at long-held practices and perks that may influence who seeks out leadership roles within the organization and make changes that will allow for broader involvement. She has gone through this process with other organizations and this results in a better organization that is more engaged with and has more engagement from its members.
Putting new people into the same culture will not necessarily change the culture. The Board members take direction and advice from the staff who do the bulk of the work at the OMA offices. The right message has to involve them as well. Changing only the Board members may change the agenda of the organization, but eventually, the decision-making process will follow the same path. Without more fundamental changes to the culture at the OMA, there will be no improvement in its ability to engage with and make the most of the energy and expertise of its members.
So while other well-meaning groups, such as Concerned Ontario Doctors, the Coalition of Ontario Doctors and various Sections of the OMA all try to determine next moves, next ideas and next strategies, I hope that they all look within and ask themselves about how they can model a different sort of culture. I think the Strategic Working Group Facebook event is an interesting and novel approach to obtaining feedback and that this can be made better and more suited to physicians’ needs. I think that the grassroots advocacy needs to continue and should be supported by our organization to ensure that physicians are seen as a group that stands with patients and other health care professionals. I see no good reason why these sorts of activities cannot be undertaken under the umbrella of an invigorated OMA. I see no good reason why decisions by many groups still seem to be taken under a cloak of secrecy and why the people making the decisions feel unwilling to explain either the need for secrecy or the resulting decisions.
The culture of many of our organizations, including our Sections and Districts as well as the OMA as a whole, is in need of a culture shift. We need to acknowledge this and move forward with this work on this specific issue. The evolution of corporate structure is underway (see https://hbr.org/2014/12/understanding-new-power); the OMA has to lead the way out of the top-down, secretive castle and towards empowering and engaging members. Now, more than ever, we need bridge-builders, not tanks.