Office of Culture and Experience

Understanding Our Organization – One Mission Reflections

August 30, 2017 • Leadership

When reviewing the first chapter of One Mission: How Leaders Build a Team of Teams by Chris Fussell, several key points emerge:

  • Each of us is drawn to being part of something larger than ourselves, something with purpose, something we can believe in.
  • Leaders need to introduce and consistently reinforce an aligning narrative that will override those held by individual component units in order to create a team of teams organizational model.
  • Leaders should consider an aligning narrative
    • Credibility = Proven Competence + Integrity + Relationships

They found that this new narrative created cultural, then operational unity, breaking down the bureaucratic walls that had once blocked their ability to communicate, collaborate and trust. Ultimately what ensued was a purpose-bound, interdisciplinary team with singular focus on mission. The new culture allowed their enterprise teams the space to react with speed and autonomy to the unpredictable challenges thrown towards them daily. Essentially there were many teams freely operating and engaging with one another in the pursuit of one mission.

When considering this academic year and the creation of the Center for Geriatrics that received its own budget authority and responsibility, there was a need to develop a “One Geriatrics” focus and team development. The newly created Center for Geriatrics inherited several programs, “teams” and “team members” from other departments within UNTHSC/TCOM. There was definitely a need to create a “Team of Teams” approach !

The Center for Geriatrics consists of 28 interprofessional faculty and 27 staff assigned and assembled into various programs/teams within the Center. For example there is the 1115 Waiver STEP Team providing in home transitions of care, the Reynolds IGET IT Program team developing and delivering interprofessional geriatrics education, the HRSA WE HAIL Program team collaborating with the county hospital (JPS Health Network), a private university (TCU) and a community partner (United Way Area Agency on Aging) to deliver interprofessional geriatrics education to health profession students, residents and practicing health care professionals and deliver services to older adults and their caregivers, the Geriatrics Clinic GAPP team, the Palliative Care and Hospice team, the TCOM Academy of Medical Educators faculty, the Clinical Trials group, the Neuropsych/Geropsychiatry group, etc.

A purpose for the entire Center for Geriatrics was developed and articulated “to provide high quality geriatrics education for all health profession students in order to meet the needs of an aging Texas and America and ultimately improve the care for older adults and their caregivers”. The clinical services, research efforts and community engagement activities provided by the Center for Geriatrics supports the purpose of creating an interprofessional  healthcare workforce of the future. Each of the programs and “teams” within the Center for Geriatrics were engaged in the development of purpose and strategic plans. Committees where created to include faculty and staff from the different programs and “teams” within Geriatrics. Two examples include the Leadership Committee and the Strategic Planning Committee. The Leadership Committee consists of faculty and staff leads from the various programs and teams within the Center for Geriatrics that meets monthly to review key strategic and functional issues, provide transparency and engage these individuals in decision making for the Center for Geriatrics. The Strategic Planning Committee meets monthly and is staff lead and consists of faculty and staff from the various programs and teams within the Center for Geriatrics. This committee has been assigned review the Gallup Survey Results to focus on Employee Engagement within the Center. They have engaged the Office for People Development for assistance in a Design Thinking Approach towards improving Employee Engagement. Some of the successes so far has been the development of a monthly Center for Geriatrics newsletter, monthly birthday celebrations, one on one empathy interviews with faculty and staff and annual strategic planning meeting arrangements.  The Monthly Center for Geriatrics meetings that include faculty and staff occur where the “One Geriatrics’ is reinforced and the activities of the various programs/teams are shared with everyone.

As I was reflecting on the One Mission article and how these concepts have and could be applied within the Center for Geriatrics I came across an Institute for Healthcare Improvement article by Kate Hilton where she discussed Seven Engagement Principles when organizing people to lead change and face uncertainty that are very applicable to moving forward towards “One Mission”

  1. Know why you care. Motivating others to join in action requires answering two questions: (1) What will we do? and (2) Why should we do it? Knowing what we will do is a matter of strategy. Knowing why we should do it is a matter of heart. As longtime organizer and Harvard Kennedy School Professor Marshall Ganz teaches, we share our own motivations to ignite them in others. Sharing and eliciting others’ stories is a powerful way to inspire people’s passion and turn it into action.
  2. Clarify purpose. On the basis of shared motivations, develop a mutual purpose together. When people perceive and — better yet co-create — a clear and consequential purpose, they work for their own benefit as well as the interests of the whole. A shared purpose enables individuals to become stewards of the collective good.
  3. Share power. Listen to the wisdom of those who are closest to what needs to change. Those with lived experience of a problem have the power to solve it — and keep it solved. Unleash their agency to act. Sharing power means growing power.
  4. Celebrate courage. Leaders foster the conditions for change by identifying exemplary behavior. Senior leaders should publicly celebrate innovators and early adopters who show courage and take initiative. Senior leaders should also model courage by embracing uncertainty and trusting others. In doing so, leaders cultivate resilience, share leadership, enhance agency, and increase joy in work.
  5. Move to action quickly. It is better to make a small-scale, low-stakes change and see what happens than to get paralyzed in preparation and analysis. In improvement science, this process is known as the Plan-Do-Study-Act (PDSA) cycle: (1) co-plan the test and predict results; (2) do the change and observe results; (3) study the data and compare with predictions; and (4) act on the learning to develop the next test. The PDSA cycle enables us to learn from an idea before knowing whether it will result in improvement.
  6. Build a coaching culture. The change process is hard. The best change-makers seek coaching and give coaching, creating room for everyone to improve their skills over time. A leader who coaches takes responsibility to help others to achieve shared goals. A leader who receives coaching signals openness to learning from others.
  7. Count engagement. Build a culture of (ac)countability. By all means, measure health outcomes. But don’t stop there. Count networks engaged, partnerships formed, leaders developed. Count new ways of thinking and acting, and new cultural norms forged. Develop a real-time measurement system for engagement.

(Kate Hilton, Faculty, Institute for Healthcare Improvement (IHI) and a Founding Director & Senior Faculty, ReThink Health. Other contributors: Jackie Lynton of IHO People, Alexandra Nicholas of Ko Awatea, and Jessica Perlo of IHI).


Janice Knebl

Director, Center for Geriatrics

Interim Chair, Internal Medicine

HSC Fellows Candidate 2017