Tuesday, December 20, 2011

Threat Vs. Opportunity: Framing Change (in medicine)

According to Professor Michael A. Roberto, groups can frame change in two ways, as a threat or as an opportunity.

Framed as Threat:

Advantages- Groups commit significant resources to face threats; their response is rarely insufficient. Also, they are more inclined to take risks.
Disadvantages- Groups' responses are typically rigid and based on strategies that worked well in the past; change "calcifies outdated models of how the world works."

Framed as Opportunity:

Advantages- Groups utilize more diverse, divergent, and creative thinking. They develop and capitalize on new strategies for achieving their goals.
Disadvantages- Groups don't commit sufficient resources and don't take risks.

Roberto concludes that the best response to change is, unsurprisingly, a mix of both. Groups should marshall significant resources, be prepared to take risks, but also encourage divergent and creative thinking while guarding against reliance on outdated strategies.

He uses the newspaper industry as an example. The most successful papers fully invested in exploring how they could use the internet to better tell the news by developing rich, interactive websites, incorporating bloggers, and publishing multimedia. 

Perhaps this is a good lesson for how the medical world can consciously look to optimally frame the changes that the digital revolution hold for us? Here, I apply Roberto's five rules about optimal framing to the medical world:

Rule 1– Don't allow leaders to force their particular frame on those underneath them. Basically, allow doctors, residents, and med students the freedom to pursue their own vision, sheltered from insistance on what won't work.

Rule 2– Don't stick to one or two stock assumptions of the situation. Rather, welcome different overall perspective, some broad, some narrow. Perhaps embracing social media and other digital tools may relieve doctors' already considerable time burden?

Rule 3– Abandon hardened metaphors. Perhaps the doctor-patient relationship needs drastic revision?

Rule 4 Bring implicit assumptions to the surface. A classic is the assumption that patients want to see a doctor rather than wanting to feel their questions answered and to have solutions offered (see the rampant use of alternative therapies.)

Rule 5 Change the reference points. The need for truly patient-centered care is growing in relevance. Perhaps we should focus on patient concerns for empathy and communication rather than just disease status, like blood pressure and hemoglobin A1C.

Any contributions of examples for the five rules?

"The test of a first-rate intelligence is being able to hold two opposed ideas in the mind at the same time, and still retain the ability to function." F. Scott Fitzgerald The Crack Up 1936

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