The case study below describes how a paradigm shift from a bureaucratic-hierarchical to a more dialogue-oriented management was supported by

Setups for management learning (Garbsch, 2012).

Figure 21.3. Setups for management learning (Garbsch, 2012).

an in-house program. The overall in-house program setup aimed at simultaneously enhancing individual management learning and organizational learning.

The description of the case study has the following structure: (a) case for action, (b) intervention architecture and (c) challenges.

(A) Case for Action

The General Hospital Linz (AKh Linz) is a public Austrian hospital (60,000 in-patients, 350,000 out-patients, 21 medical departments, 2,700 employees) and is owned by the city of Linz. In 2000, as part of the city's decentralization process, the hospital was transformed from a municipal department to a public company and in 2007 into a health-care organization in the form of a limited company. It faces strong competition from other regional health organizations. In 2002, the hospital's management introduced a new management tool (Balanced Score Card [BSC]). In 2005, the call for conception and realization of an internal leadership development program with the following targets was presented:

• communication and embedding of the hospital's strategy (according to the BSC)

• expansion of management competencies (entrepreneurial thinking and acting, service focus)

• broad impact on the organization through organizational-change projects

• interdisciplinary and cross-occupational learning

The project was assigned to the Department of Organizational Development and Group Dynamics of the Faculty for Interdisciplinary Research and Education (IFF) at the University of Klagenfurt. The program was established as an internal university course and was carried out twice (2005-2007, 2007-2009).

(B) Intervention Architecture

The intervention architecture aimed to coordinate participants from the hospital's internal subsystems within proper settings so that individual management learning as well as organizational learning (through internal solution-driven processes for organizational problems) would become possible.

The client system was represented by the following groups of participants (see Figure 21.4):

• Top management (Top M.): including the medical, nursing and administrative director assigned the task of placing orders and continuously adapting them through active co-steering(3 members).

• Internal project manager (IPM): internal administration and co-steering of the overall program together with the external project management

• The steering group (StG.) consisting of top-management and second-management level leaders (heads of administration, senior physicians, leading medical-technical staff) as well as internal and external project management (PM) and the unions representatives assigned with step-by-step monitoring and evaluation of the program (12 members)

• The sounding board (Sound B.): Superiors of the program's participants in the top and second management level assigned the task of instructing and supporting the participants (mentor-role) as well as giving feedback on the progress of the program. The sounding board included about 16 members.

• The course group with 20 participants (leaders of the third level of all occupational groups) assigned the duty of individual learning.

The course consisted of 5 seminars, each 3 days, covering the following topics: Basics of Professional Leadership, HR and Team Development, Marketing within the Health Care System, Strategic Management, Project Management, Process Management

• 5 project teams (members of the learning group and other internal experts necessary for carrying out the projects) assigned the tasks of conception and execution of relevant strategic-change projects, like: a) reducing accidents (downfalls) of patients, b) concept and implementation of a day-hospital unit, c) optimizing the capacity utilization of beds in the departments of internal medicine, and so forth.

The counselor system (IFF) included the following groups (see Figure 21.4):

• Main staff including the scientific-program management and external-project manager (PM) with the duty of program steering and consulting (e.g., project coaching).

• Training staff (freelancers) with the duty of running the seminars (together with members of the main staff).

Counseling System of the In-house program of the General Hospital Linz (Garbsch, 2012).

Figure 21.4. Counseling System of the In-house program of the General Hospital Linz (Garbsch, 2012).

The groups of the client and counseling system combined into the following three architectural elements:

Steering Setup:

The steering setup unified steering group, sounding board, overall internal and external project management and counselors of the core staff. All functions were put together from different hierarchical levels and existing occupational groups. Its function was to evaluate, supervise and steer the program.

Learning Setup (individual learning):

It covered six learning modules and served to develop new mind-maps to lead and create organizational change processes. The learning modules (each three days) covered the themes leadership, human resource and team-development, health-care organizations and their environments, strategic management, project management and process management. The learning setup included the course group as well as training staff and representatives of top management, who were also integrated in the learning architecture as lecturers.

Change Setup (organizational learning):

It aligned five project groups and projects with the goals of the organizational strategy: On behalf of the hospital's top management, the project teams were assigned the implementation of change projects. Project themes were, for example, the conception and implementation of processes for a new admission ward or the development and realization of guidelines for falling prevention for patients. These projects were supervised by additional coaching (five half day workshops with every project group) from the counselor staff.

The program was started with a kick-off and ended with an evaluation (see Figure 21.5).

(C) Challenges

Below, we will illustrate the challenges within the leadership-development process and outline the benefits of the setups responding to the challenges.

Careful step by step contracting of multilevel targets: As opposed to traditional top-down contracts, integrated leadership development programs need a broad acceptance; as such, they must integrate different stakeholder groups in order to develop a shared, step-by-step picture of useful targets and content for all leaders concerned.

Leadership program setup with timeline.

Figure 21.5. Leadership program setup with timeline.

Forming a steering group and a mode of steering: The formation of the steering group has to include the diversity of the organization (different disciplines, different sub-rationalities and functional groups, for example, nurses) in order to take contradictory interests and needs into account as well as to support leadership learning by perceiving and balancing conflicts. Beyond hierarchy and traditional top-down management, the governance of complex integrated setups needs to adopt a new mode of shaping leadership development by steering in a co-operative manner.

Caring for transparency: Especially within the phase of initiating and implementing the setups, transparency turns out to be crucial for success with respect to the selection of the participants of the steering and learning setups as well as for the projects of the change setup. In contrast to the everyday practice of "lonely" top-down decisions, top management has to define both a procedure and criteria for selecting participants as well as for selecting change projects and their management mentors.

Utilizing emerging conflicts: Contradictions of expectations of internal and external stakeholders of the program trigger conflicts if it is not possible to balance them. Therefore, it is important to perceive upcoming conflicts as a learning opportunity for bridge-building and negotiation on individual and organizational levels.

Initiating change projects: Numerous factors determine the selection of timely and urgent targets to be developed and implemented via the OD projects of the change setup. For example, selection criteria for the projects mirrored the new strategic targets of the health organization. So the project groups faced high expectations and at the same time the top management's control. Most of the group members were not experienced but rather just upcoming young leaders. They were enabled to act as entrepreneurs and change agents of the health organization and learned how to negotiate the conflicting interests of different stakeholders of the change projects. The speed of the change projects challenged the slow mode of individual-learning processes and served as provocation for some of the learning setups to be used additionally for coaching of the projects.

Building "cultural islands" within the learning and the change setups: Intensive discussions between all members of the learning group as well as in the project teams allows gaining new insights on different perspectives. The logic of different subsystems can also be explored thanks to the diverse mixture of the groups (physicians, nurses, administrative staff, etc.). Considering and evaluating key learnings with respect to the impact on different roles and organizational units helps to create cultural islands of a new leadership behavior. Traditional norms are suspended to facilitate more open communication (Schein, 2010). The evaluation of the program showed that the cultural islands survived in the organization, even when the programs had ended, and helped to change the organization from within.

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