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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

Use Of Design To Advance Collaborations Among Multiple Organizations with Strong Professional Identities

This paper begins to answer the question: How can 'design' help, or fail to contain, anxiety associated with collaboration across organizations for purposes that all espouse when each group has strong individual identities? The paper draws on two foundational ideas: ? Emery and Trist's (1973) argument that under conditions of turbulence, connections and collaborations among dissimilar organizations are key to adaptation, Trist's (1983) description of 'tuning in' and 'working through' as prerequisites to successful design. Disruptive change (Christensen et al, 2004 ) in a field requires thinking in ecological terms. An ecological view calls for an ability to shift back and forth from parts of the field to their interrelationships, their shared larger context, and to emergent phenomena. This paper will explore challenges faced within the field of healthcare in the U.S. as primary care providers attempt to make sense of, and adapt to, profound changes driven by economic, regulatory, and policy shifts as well as the impact of disruptive innovations. A number of forces are driving change in healthcare in the U.S., led by pressure to reduce healthcare's overall use of resources as represented by the percentage of GDP it comprises, and recent legislation (the Affordable Health Care Act) that is beginning to be implemented with its emphasis on access to primary care. These and other forces are reshaping the healthcare field in the following ways: When change driven by external forces disrupts an entire field, tasks are often too complex for any single organization to accomplish by itself. During times of disruptive change, there is an increased demand for collaboration across multiple, often dissimilar organizations in the field, for example, Apple and its relationships to music. In U.S. healthcare, as the external pressure to collaborate has increased, it is not surprising that some responses to that pressure inside the field have been defensive. Examples include the polarization and splitting of nurses and physicians, clinical and administrative functions, specialists and generalists. Other defensive moves follow what Emery and Trist (1973) describe as defensive mergers in turbulent environments, in this case used to create scale, e.g., formation of large physician groups, hospital systems, and group purchasing collectives. We will explore these dynamics in a case in which related groups in the field struggled to adapt to the wider context through increased collaboration across their multiple organizations, under the leadership of a convening entity, we call 'The Foundation.'