For a discipline so fundamentally altruistic, health care is oddly dysfunctional around relationships. That’s changing fast, of course, as providers are finding that cooperation is as critical to caregiving as cutting edge tests and therapeutics. But effective cooperation, particularly in a setting as complex as health care, requires more than a resolve to play well together; it requires leadership to explicitly recognize the need to build social capital across the organization, and implement a strategy accomplish it.

Yet building social capital — the trust and reciprocity among individuals and between groups — is rarely a specific focus of organizational leaders, though we believe it is as essential as financial resources for health care delivery systems. More than a decade of research on social capital in healthcare has found that higher levels are associated with improved coordination, increased job satisfaction and greater commitment among the staff, faster dissemination of evidence-based medicine — and better patients outcomes. As high performance on these measures is as important to organizational health as having a solid bottom line, leadership needs to invest in social capital and cultivate its growth with the same focus and discipline that it has applied to financial capital in the past.

Our full article describing social capital, its roles in health care, and strategies for building it in health care organizations is available here (PDF). The paper draws on the broad social capital literature and the toolkit for building social capital developed by Harvard’s Kennedy School of Government. The strategy at its core depends on nurturing five features of high-social-capital organizations: trust, reciprocity, shared values, shared norms, and openness. Among the tactics leaders can use to encourage these are communicating honestly (which should go without saying, but doesn’t always), building opportunities for interaction, establishing formal statements of responsibility and reciprocity, creating incentives for working together, establishing shared processes, engaging the staff in developing a statement of shared values, and using powerful stories about successes — and failures — in patient care to motivate staff and reaffirm organizational values.

To give just one example of storytelling, consider how the Cleveland Clinic made its decision to ask every patient seeking an appointment whether they would like to be seen today.  That policy did not come from the marketing department, even though it is prominently advertised today.  It came from one patient who sought an appointment, was given one in two weeks, and ended up in the emergency department that night.  The patient didn’t die, and wasn’t harmed in terms of any of the classical “outcome measures.”  But the leadership of the Cleveland Clinic had enough of a sense of “we” that they could decide “we find this intolerable,” and they began asking every patient if they wanted to be seen that day.  You can only make this kind of decision if you have social capital in the bank.

Ultimately, the key to success is authenticity.  Though social-capital building can be nurtured, it can’t be mandated.  As Don Cohen and Laurence Prusak, former director of the IBM Institute for Knowledge Management, wrote in their book In Good Company: How Social Capital Makes Organizations Work, “Social capital thrives on authenticity and withers in the presence of phoniness or manipulation…[Leaders’] interventions must be based on a careful understanding of the social realities of their organizations and (even more difficult) a willingness to let things develop, even if the direction they take is not precisely the one envisioned.”

Our more detailed paper provides a framework organizations can use to begin building their social capital.

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Leading Health Care Innovation
From the Editors of Harvard Business Review and the New England Journal of Medicine

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