Institutional Courage – Letting Go of the Familiar

Melissa Fox, MHA, FACMPE,  FACHE

There’s a pretty amazing quote by William Faulkner which taps into some of our greatest fears as they relate to doing something different: 

“You cannot swim for new horizons until you have courage to lose sight of the shore.” 

This is powerful imagery because it directly confronts the dilemma which many of us face when it comes to doing something differently than what we’ve always done.  It is always much more comforting to stay within the parameters which have been tested, well-traveled, and proven because there is much less risk and we’re less likely to encounter opposition or be seen as outsiders. Also, those areas are familiar to us, making it much easier to demonstrate our expertise or knowledge.   

However, the comfort of staying within sight of the shore means that we can never travel much further than what has already been explored, and innovations simply become a rehashing of what has already been done. 

As care providers, especially within behavioral health or human services, we’ve had many years of swimming within sight of the shore. In some cases, regulatory and reimbursement parameters have kept us confined. In others, the comfort of the familiar and perhaps a pride in our “otherness” has contributed to our not moving as far or as fast as other sectors of care.  However, as we’ve now seen in a healthcare landscape impacted by value-based reimbursement, public health crises, and for-profit entities entering the care arena, it is imperative that community-based agencies are able to lose sight of the shore in order to identify next-level innovations. 

Institutional Courage is a term I use to refer to an organization’s appetite for, and ability to, adopt change.  This means from the highest levels of leadership to the front-line team members, there is a culture of innovation which not only allows for creative thought but creates an environment where it is welcomed.  This of course doesn’t mean that change is easily and wholeheartedly accepted by every member of the organization – that would be unrealistic.  But, it does mean that all team members are aware of change as a reality and they understand the related process. 

To determine if your agency is able to lose sight of the shore and ready to swim for more open waters, there are several self-evaluations I’ve conducted in the past and which you may find useful.  Depending on the results found in my assessments, I would strategically adjust my approach in order to better transition the team or agency from baseline to a more institutionally courageous position.  

  1. Assess your leadership – It all starts and ends here.  If your leadership team at any level is not able to courageously champion change in the agency, then no one else will accept it either. Some warning signs can be, if your leadership is not open to doing things differently or identifying areas of growth that don’t look like existing programming, then there may be an issue. If your leadership’s 5-year strategic plan looks pretty much the same way it did 5 years ago, then there is definitely a problem. 
  2. Assess your institutional vocabulary – If you find that more than a few people continually invoke any phrases similar to “this is the way we’ve always done it” or “we’ve taken pride for many decades in how we do things”, or my personal favorite, “if it ain’t broke, don’t fix it”, then you may have an issue.  The way people communicate in your agency, about your agency, is indicative of the culture.  And if what they are saying is that they don’t want to change, then they won’t. 
  3. Assess your timeline – Critically and honestly assess the frequency with which the agency has changed over the last 3-5 years.  When was the last time a new program or service was introduced that was different from your typical service offering?  What is different now, if anything, than it was 10 years ago?  When was the last time your internal processes were updated/adjusted to align with the shifts in the market?  
  4. Assess your training and leadership development – Does your training include elements of change management education?  How are you training your leaders to create safe places within which team members can adjust to transitions?  If this isn’t an area of strength, your agency could be promoting leaders who are not only averse to change, but who may be actively creating an oppositional environment. 
  5. Assess your technological systems – Data is an asset and should be treated as such.  If your agency data is still on paper, in silos, not easily accessible, and/or not able to integrate with other systems, then your agency is not positioned for change.  Healthcare is becoming more interoperable and integrated not less, so your data needs to be nimble as well.  Imagine your data is gold – you’d want to know where all of it is, be able to access it as you need it, and maximize/multiply it to gain more value. Your systems should reflect this same approach. 

Once these internal assessments are completed, then you can begin creating a transition plan which includes internal communication strategies, training, and even fun ways to help people adjust better to change initiatives. Be ready for pushback and numerous cries of, “the agency just isn’t what it used to be”.  That’s okay because our communities aren’t what they used to be, reimbursement isn’t what it used to be, and healthcare in general isn’t what it used to be.  It would be the definition of insanity for our agencies to remain the same and expect to have any impact or relevance. 

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