Flying home from Australia over the weekend I found myself reflecting on what I learned. Australia has enjoyed a vibrant economy for more than two decades, boosted by an influx of human capital through immigration, a mining boom, and a robust import-export sector fueled by the rapid economic growth of their Asian neighbors, especially China. Several decades ago Australians also put into place a set of policies to fund public hospitals and higher education and have established a wage structure with one of the highest minimum wages in the world, existing hand in hand with relatively low and stable rates of unemployment.

Still, at The Future of Work conference this past week, leaders from the Australian private and public sectors were calling for more – for better leadership, more collaboration, more workforce engagement and greater utilization of the talents of Australia’s diverse workforce. Australia like other countries still struggles with sexism, racism and ageism in the workplace as well as inherited bureaucratic structures. As Rosemary Kirkby said, “The easiest way to be fast on your feet is to make sure everyone has a voice – and I don’t mean a focus group – I mean built into the process.”

This energetic, well-attended conference was hosted by the brand new national Centre for Workplace Leadership to advance its mission, which is simply “to create, source and share practical solutions that help you become a better leader and do things differently at work.”   We welcome the Centre – led by Peter Gahan and Sarah Fortuna – as our newest RCRC Organizational Partner!

Creating Collaboration

One of the tensions that emerged was between the growing use of Key Performance Indicators (KPI’s) to establish control and hold leaders accountable for functional performance – but in doing so risking subgoal optimization and unproductive competition among leaders. What is really needed is a reward structure that encourages leaders and workers to work toward a shared purpose that connects across functional and organizational boundaries.

Achieving coordination across these boundaries turns out to be a challenge in Australia in a wide array of sectors including professional services as well as mining, manufacturing, logistics and transport. The coordination challenge is particularly great in the social and environmental sector where Australia – like other nations around the world – is facing “wicked complex” problems that require collaboration across multiple stakeholders.

No where is this more evident than in healthcare.  There is a desire for example to have more efficient hospitals. One innovative idea is to provide performance based rewards to individual physicians for their productivity. But not only does this “innovative idea” ignore the interdependence between physicians and other work groups – it also ignores the fact that the hospital itself is situated in a broader work process and is only one player in the production of health and wellness.

Systems Thinking

Given the shift we are seeing elsewhere toward a broader vision of achieving health and wellness in the community – in Scandinavia, Europe, Asia and even the in the US given the new accountable care environment – this particular initiative seemed a bit limited in its scope.  To “fix” the hospital without reference to the broader context, and to focus on physicians without reference to their interdependence with other work groups, would be a true lack of systems thinking.

The Future of Work conference itself was full of systems thinking – and it was followed by a Health System Design working group that convened for the first time the next day.  This group includes leaders from acute care, primary care and community based care who are asking – what do systems thinking and design thinking suggest for healthcare innovation?  How might we redesign healthcare for the current context when Australia, like many advanced industrial countries, is facing a huge demographic challenge and the growth of chronic disease as people are living longer and more sedentary lives?

We started with a couple of provocative insights from systems thinker Russell Akloff, who pointed out in a 1995 speech some limitations in our current methodologies:  “Most applications of improvement science are directed at improving the parts but not at improving the whole.  [As a result] the parts don’t form a system because they don’t fit.”

This comment and our follow up discussion resonated with a concern expressed at Group Health where some of the recent lean improvement efforts left people better at their own jobs but not necessarily better at coordinating with each other. This Australian working group – and likewise our colleagues at Group Health – are interested to see how a more holistic perspective among participants based on the development of shared goals, shared knowledge and mutual respect can foster a more coordinated work process that focuses on each part in the context of the whole.

Community Based Solutions

We also realized that shared goals and shared knowledge cannot be static but rather must be continually updated.  With the challenges that Australia is facing and the high aspirations of its people, this will mean looking beyond the walls of the hospital and engaging with primary care and public sector efforts to proactively foster health and wellness, engaging citizens as partners in the effort.  On my final evening I was invited to a new Australian play called “Neighborhood Watch” – a brilliant and emotional play showing how community connections can foster well-being in the face of illness and loss.  It will be necessary in many places to rebuild our communities to serve this important function.

We are seeing efforts in the Danish municipalities that are worth learning from, featuring efforts to connect a whole array of silos as they look upstream in the production of health and wellness.  These silos include the so-called social determinants of health – employment agencies, education sector, infrastructure, workforce readiness, immigration integration, family support, elder care, home care and so on.  I will share more about these system building efforts next month after my next visit to Denmark and Sweden.

We will also explore organizational change in healthcare and other sectors at the Labor and Employment Relations Association Conference “Renewing Employment Relations for Shared Prosperity: Research, Practice and Policy,” May 29-June 1 in Portland, Oregon.

RC Intervention Database

For those of you who are leading RC interventions whether large or small, reach out to Joanne Beswick at the RCRC if you haven’t already. We have an RC Intervention Database that is growing rapidly and Joanne will walk you through a structured interview if you are interested in contributing.

We are now drafting the first paper for publication from this database.  Still under development, the paper is titled “Interventional Uses of Relational Coordination: Early Evidence from Four Countries” authored by myself and Joanne at Brandeis, and Kathryn McDonald at Stanford.  Given the novelty of interventional uses of RC, we still have much to learn.  Most of these interventions are multi-dimensional with relational, work process and structural elements.  We will present the evidence thus far on August 19 at the ODAM-NES meetings in Copenhagen and we hope to have the paper in the public domain by the end of the year.

Intervention Research Methods

Interventional approaches to research are particularly relevant at this point in time given the strong desire by practitioners to engage in intentional change while documenting process and outcomes in order to learn from and extend their results.  Yoland Wadsworth from Australia will share her living systems research methods with us when she visits Brandeis on April 28th, introduced by Bill Torbert of Boston College.  This cycle of inquiry is not only much needed – it is enormously gratifying and often scary.  But as Eleanor Roosevelt once noted, it’s good to “do something everyday that scares you.”

We will explore intervention research methods at the Academy of Management meetings this summer in a panel symposium Monday August 6th featuring Lotte Baliyn, Ed Schein and Kate Kellogg from MIT Sloan School, Amy Edmondson, Ethan Bernstein and Elizabeth Hansen from Harvard Business School, Anna Perlmutter from Case Western Reserve, and myself from Brandeis University – called “Creating Relational and Organizational Change: The Past, Present and Future of Intervention Research.”

RC Intervention Workshop

Still a handful of seats left in the May 1-2 RC Intervention Workshop.  Participants so far are about evenly balanced between US and Europe, and they include management consultants, workforce educators, and health system leaders. It looks to be quite an amazing group and I very much look forward to learning as well as sharing my knowledge along with my colleague Dr. Anthony Suchman.