Many years ago I worked for a small systems integrator. One year the company president decided to bring in an outside facilitator for our annual business planning retreat. The facilitator knew the president quite well and was very adept at reading body language. After a rather heated debate that resulted in the management team conceding to the will of the president, the facilitator went around the room asking people why they agreed with the president’s position. After much poking and prodding, the facilitator got several people to admit that they frequently “caved in” to the president’s will. Needless to say, the president was quite upset and claimed that he worked hard to seek consensus. One of the management team who was rather outspoken shot back that what he got was a “forced consensus”.
I was reminded of this story while reading an RFP from an Ontario hospital for a “full review of the work environment at the campus in its relationship with the hospital administration”. According to the RFP (NOTE: I have opted to remove the name of the hospital to avoid further inflaming any discord):
“[Hospital X] formed in 1998 by “directive” of the Ontario Health Services Restructuring Commission and included the amalgamation of [X] previously independent hospitals ….. As a mandated amalgamation, over its 12 years [Hospital X] has experienced variable levels of work environment barriers from internal and external stakeholders and communities associated with the legacy hospitals to support the hospital network. Efforts to change, make improvements, standardize care and implement best practices have, at times, been met with considerable resistance …. Despite some positive steps and improvements, this atmosphere remains between the campus physicians, staff and community, and the LHC management team …. The purpose of this review is to identify the root cause(s) and contributing factors of the work environment and a path forward to resolve these challenges.”
This situation clearly shows how people who have not embraced a forced change can subvert and sabotage any change initiative. Even when efforts are made to build consensus, the result can be a “forced consensus” in which people appear to agree to a particular course of action because they feel they have no other choice. As we attempt to digitize our healthcare system while simultaneously trying to contain costs, I think it is more important than ever to be as open and transparent as possible with all stakeholders and to engage as many people as possible in developing strategies, action plans, etc.