In a previous post I mentioned Leading Change in Healthcare: Transforming Organizations Using Complexity, Positive Psychology, and Relationship-centered Care, as an interesting take on creating positive organizations. I had an opportunity to speak with one of the book’s editors, Anthony L. Suchman, MD, MA. In this post I share a condensed version of our conversation. Many thanks to Dr. Suchman for his time.

Q: How did you become interested in organizational transformation?
A: During my training, I was attracted to general internal medicine in part because it involves developing ongoing relationships with patients. After residency at University of Rochester, which is especially strong in patient interviewing, I completed a fellowship in Behavioral and Psychosocial Medicine. I continued at the University as a faculty member and became interested in the impact of organizational environments and culture on the quality of care and health professions education. Later I helped to launch a physician hospital organization and began applying the principles of relationship-centered care to administrative processes.

Q: I’ve heard of relationship-centered care. How does this approach fit with leadership?
A: Rather than approaching an organization a like machine, as traditional management theory does, relationship-centered administration approaches the health care organization like a conversation. It’s a gigantic conversation between patients, clinicians, staff, payers, regulators, and others. Thinking of organizations like conversations changes how we approach transforming organizations.
Relationship-centered care focuses on the relationship between clinician and patient, with the idea that the relationship is an entity worth considering in addition to considering the individuals involved—the whole is greater than the sum of its parts. We apply this same idea to leadership. Relationship-centered administration is a way of leading that focuses on relationships and partnering. Its goal is creating a workplace that enables the full engagement of staff and supports creativity in their work.

Q: Why does your work focus on leadership?
A: We have a health care system that is perfectly designed to burn out our clinicians. Changing the system by changing the culture and workplace experience in health care organizations is an overwhelming challenge, especially for the leaders of those organizations.But there is a way to break down this transformation to a more manageable task. It is to consider that organizational culture is created in every conversation, at every moment, and to ask, “How can I change the pattern of interactions right here, right now to be more collaborative and empowering?” Leaders can change patterns by becoming more aware and intentional about how they work.

Q: How does relationship-centered leadership work?
A: When leaders pay attention to the quality of their relationships, there are many benefits for the organization, patients, and staff. As we wrote in Chapter 4 of our book, “Front-line care and the patient experience are affected by everything we do behind the scenes—the way we conduct staff recruitment and development, resource allocation, performance measurement, strategic planning and every other aspect of administrative work. By undertaking these and every other administrative activity in a relational way and inviting greater engagement, we can build high-performance organizations…What we do in every moment matters.”

Q: What’s an example of applying relationship-centered leadership approaches?
A: Consider the situation where a clinician is displaying some form of disruptive behavior—intimidation or disrespect, for example. The leaders have been made aware of the situation, yet fail to take definitive steps to address it, instead using elaborate workarounds to deal with the effects of the negative behavior for the sake of “keeping the peace.” They fail to recognize the degree to which the behavior negatively affects the rest of the care team—as well as patients and families. Instead of avoiding a confrontation, leaders can recognize it as an act of service to patients, staff, and the disruptive clinician him- or herself to set and maintain behavioral standards, make every effort to help people meet those standards and, as a last resort, remove people if their disruptive behavior continues, doing all this  in a respectful and compassionate way. This ensures that the disrespectful behavior stops and creates a trustworthy and supportive workplace and a positive organizational culture.

Q: Is there anything else you’d like to add about relationship-centered leadership?
A: Every organizational performance dimension you can think of – including clinical outcomes; quality and safety; cost and efficiency; patient experience; staff satisfaction, well-being and resilience; and the capacity to innovate and adopt new work processes – is associated with relational quality. Relationship-centered leadership is state-of-the-art, evidence-based practice. We can’t afford to have any leader at any level neglect this dimension any longer. It’s now an essential competency, and we have to treat it as such in recruitment, training, and performance assessment.