HUMAN DYNAMICS at Allina Healthcare System

Results - whether customer satisfaction, process outcomes or service excellence - are dependent on an organization's ability to learn, to innovate, and to redesign its work in response or anticipation of what is happening in the environment. The ability of an organization to do this is based on the quality of its decision-making and the ability of its people to work together. We believe that the quality of decision-making stems from The five disciplines of a learning organization, as articulated by Peter Senge. Central to those five disciplines is personal mastery - knowing one's self - and that is the work of HUMAN DYNAMICS.

Our organization at Allina is large and complex. We are an integrated health service network which consists of providers (physicians, nurses, therapists, and alternative therapy providers), delivery systems (clinics, hospitals, nursing homes, and community sites), and products, which are the health plans. We have twenty thousand employees, almost nine thousand physicians, twelve hospitals, six managed hospitals, two nursing homes, fifty-five clinics, and one million people enrolled in our health plan. Our total revenues exceed 1.8 billion. Our ability to deal with diversity and complexity is absolutely essential.

We have merged several times in the last few years. As a result we face a challenge of cultural integration. People are coming together from all parts of the organization, from many different disciplines and positions, to focus on what they have in common. HUMAN DYNAMICS provides us with an integrating force for working with the fundamental essence of being human and how individuals operate. It is through this kind of awareness that we have been able to be more effective in doing boundary work, to more effectively tell the truth, to more effectively confront our differences, and to explore the things we have in common that can help us move the work forward.

Additionally, we are widening our vision of ourselves. We have begun to transform from a health care organization, attending primarily to the treatment of the sick, into a recognized innovator in community health improvement. Without abandoning our obligation to the sick, we need to move upstream - to try to identify ways to prevent illness or any decline in function. This shift has required us to think in new ways and to come together in new ways.

In these unprecedented times we acknowledge that our competitive advantage lies in our human capital - our collective intellect. It is really a two-fold advantage. The first comes in being able to learn what we need to be good at faster than anyone else. The second advantage is a level of service excellence: an ability to relate to people and work with them to understand and manage their experience of care or service. This requires a strong relational base - the ability to know another person - and Human Dynamics is an essential foundational piece for that.

Peter Senge speaks about how many people come into organizations and put on a mask. They behave in ways that are contrary to their natural way of being because they believe that is what they must do to meet the profile of corporate success. Over time this acculturation chips away at self esteem and energy and the ability of an individual to maximize his or her contribution to the organization. In Human Dynamics we are asking that the mask be taken away. We are saying that distinctions in human functioning should be celebrated, for each PERSONALITY DYNAMlC brings forward a unique perspective. Collectively, these different perspectives provide what is required to see the whole, to see systemically and to do our best work.

We recognize that nothing will work in our business systems unless the people systems that deliver them are healthy. Also, since our business is health improvement, each one of our twenty thousand employees is a walking billboard for our business.

In the first quarter of 1991, Human Dynamics was introduced to thirty department managers at Allina in a four-day seminar. Since that time more than seven hundred leaders and managers have attended the four-day seminar. Enrollment for the seminars has been through a process of attraction: participants who had experienced Human Dynamics referred the seminars to their colleagues throughout the organization. There has been no promotion or overt advertising. The participant satisfaction rating has averaged 5.8 on a six point scale, with one being dissatisfied and six being exceptional. The current waiting list to attend a Human Dynamics experience is one year. There have been multiple comments that this is the why of techniques and skill training. If we understand why people have different communication and information needs, then perhaps the need for specific conflict resolution and other kinds of training would be unnecessary. There would be such grounding in effective communication that we would not have to continue intervening at the symptom level of dysfunctional communication.

The priority has been for executive teams to attend. As a result, we now have many intact executive teams who are using Human Dynamics and looking to deepen their experience with this work. In one of our facilities an executive team has used Human Dynamics to become very intentional in their strengths and contributions as well as to find ways of improving their collective performance. Human Dynamics has given them an appreciation of one another's way of functioning - of acknowledging each person's contributions in an objective way, looking at differences in a way that does not assign blame or intentionality, and avoiding common misunderstandings that might occur. Another management team has used Human Dynamics to break through some of the long-standing tensions and struggles they have had in working together. They have recognized it is distinctions in functioning, not the devaluing of the individual, that has led them into many of the conflicts.

Other priority groups have been work teams (such as process improvement teams), intact groups (such as a neurosurgical specialty operating room team), redesign and change teams. All of these teams are functioning in the context of cross-organizational and cross-functional groups.

Of the outcomes we have seen so far, one of the most exciting has been an intact redesign team for the rehabilitation process which had an accelerated group process in comparison to other groups. They began their work together with a foundation in Human Dynamics. We built on that foundation with work in change management theory, re-engineering and design theory, and quality improvement techniques. This group, when measured against peer groups, demonstrated greater courage in confronting issues and moving from the status quo to something new. They demonstrated greater learning and were able to achieve very dramatic breakthrough results in five areas: customer satisfaction, clinical outcome, increased efficiency, reduced cost and more meaningful work for employees. Some very substantial results were gained. We have not seen that kind of accelerated process with groups that have not had this foundational work in Human Dynamics.

Other promising work includes improving the quality of collective team learning and functioning. Teams are using the understandings to assure that the prospectives and contributions of the personality dynamics are operating and brought to bear on the issue at hand. At one of our hospitals Human Dynamics has been incorporated as the fundamental building block for the quality curriculum. This curriculum is multi-tiered: moving from knowing self, to relationship versatility, to ability to manage change, to process improvement and redesign. Human Dynamics serves as the common thread because there is a collective understanding - people may ask the who, what, where and why of any issue for very different reasons. This collective understanding has contributed dramatically to effectively working with change.

The next step for our organization is to deepen the work. Most managers have now experienced it and their work teams are looking for more involvement. We need and wish to improve the application and sustainment support. Organizing groups have come together to talk about application and new discoveries in their work with Human Dynamics. Those teams are asking for more expert guidance as they explore stress, change and other topics as seen through the windows of Human Dynamics. We are looking to utilize Human Dynamics as the foundational strategy for facilitation in leadership development and preceptor/mentorship curriculum, and to use Human Dynamics to accelerate our design and improvement teams.

The major barrier we are experiencing right now is a bottleneck in meeting the demand for the program. There has been so much change in the organization overall that we have not determined what the end points should look like in terms of development. Therefore, we have not yet committed fully to Human Dynamics as the core development strategy. This has impacted the number of facilitators we have been able to field. Yet, there continues to be a grass roots movement and financial support for continuing the work until an organizational commitment decision is reached. There are currently seven comprehensive strategies for the new Allina organization that are being designed now. In each one the use of Human Dynamics is recommended.

In the foundational work of quality - acquiring and using customer knowledge - Human Dynamics is an especially elegant body of knowledge, practices, and tools to better access and understand the customer. What we have been looking at throughout is developing organizational capacity, improving our ability to learn and to come together, and better knowing our customer so we are able to respond with products and services that meet the needs our customers express and hope for.

When we talk about organizational capacity we are talking fundamentally about three areas: the character of the people in the organization (Who are you?); their capability (What do you know and what do you need to know?); and their capacity (What is it that you do?). Human Dynamics offers answers to each of these questions. It is a body of work, practices, and disciplines to support systemic thinking because you begin thinking about yourself and human functioning in a systemic, connected way. It supports strategic thinking by looking at the gifts of each personality dynamic for focus, process, and purpose. It offers an intentionality in personal development and a focus for that development. It provides a framework for communication, conflict resolution, change management, team process, and understanding one another. It serves as an integrated strategy focusing on human functioning and potential across all boundaries. Most importantly, it provides an affirming language which increases the ability to understand and accept differences.