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Elephants in academic medicine.

Wiley Souba¹, David Way, Catherine Lucey

¹Dartmouth Medical School, Hanover, New Hampshire, USA. Chip.Souba@dartmouth.edu

Academic Medicine : Journal of the Association of American Medical Colleges

|October 28, 2011

Summary

Academic health centers (AHCs) commonly face "elephants"—obvious problems that are not discussed, leading to impaired performance and decision-making. Addressing these requires leadership example, as silence and inaction worsen organizational issues.

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Area of Science:

Medical Education
Healthcare Management
Organizational Behavior

Background:

Academic health centers (AHCs) grapple with unaddressed performance issues, termed "elephants."
These elephants represent obvious problems that the academic medicine community collectively avoids confronting.

Purpose of the Study:

To investigate the types, causes, and consequences of "elephants" within AHCs.
To understand why these critical issues remain undiscussed and their impact on organizational functioning.

Main Methods:

A survey was administered to chairs of medicine and surgery departments at U.S. medical schools in 2010.
The survey utilized both web and postal methods to gather responses from department chairs regarding organizational elephants.

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Main Results:

A majority of responding chairs (69%) reported elephants as common or widespread within their institutions.
Misalignment between goals and resources was the most frequently cited elephant.
Consequences included impaired organizational learning, poor decision-making due to flawed information, and decreased morale. Leadership actions often exacerbated these issues.

Conclusions:

Elephants are prevalent in AHCs and significantly harm learning, decision-making, and morale.
The academic medicine community, especially leadership, inadequately confronts these detrimental issues.
Creating a culture that addresses elephants is perceived as difficult, highlighting a need for systemic change and leadership commitment.