One sunny summer day in July of 1994, the executive team of Gerber Memorial Health Services (GMHS) set off to attend a three-day seminar entitled “Systems Thinking,” sponsored by the Butterworth Management Institute. GMHS is a 73-bed not-for-profit hospital and health system, located in Fremont, Michigan. The organization was one of the first members of the emerging Butterworth Regional Health Network, a group of hospitals interested in sharing resources to meet the needs of west Michigan.

As vice president of Patient Care Services, I was one of those attending the initial session. After three days of intense learning, introspection, and experience with the five disciplines of organizational learning, we understood that we needed to become a learning organization in order to thrive as a rural healthcare system. Peter Senge’s book The Fifth Discipline was perfectly aligned with this goal and the values and culture of GMHS. It would become the foundation of our work. We knew we “weren’t in Kansas anymore.” Our lives had been changed forever.

Our story is much like the plot of The Wizard of Oz, as written by L. Frank Baum and immortalized in the classic 1939 movie. Dorothy lands in the strange world of Oz after her house is carried away from Kansas by a cyclone. She seeks to find the way home by following the Yellow Brick Road. Her intent is to find the Wizard who would bestow on her the knowledge to achieve her goal, only to find that she had the answer within her all along. Here is a summary of our journey.

Dorothy

Similar to the way Dorothy felt when she stepped out of her house to find she was in Oz, our team knew we could not go back to where we had been. We were aware of our destination —to become a learning organization —but didn’t know how we would get there. At first, we felt as though we were “off to see the Wizard,” whose magic would turn us into a learning organization. To get there, we had to “follow the Yellow Brick Road.” In our case, that meant to begin down the path of knowledge and exploration to find out how to become a learning organization.One sunny summer day in July of 1994, the executive team of Gerber Memorial Health Services (GMHS) set off to attend a three-day seminar entitled “Systems Thinking,” sponsored by the Butterworth Management Institute. GMHS is a 73-bed not-for-profit hospital and health system, located in Fremont, Michigan. The organization was one of the first members of the emerging Butterworth Regional Health Network, a group of hospitals interested in sharing resources to meet the needs of west Michigan.

As vice president of Patient Care Services, I was one of those attending the initial session. After three days of intense learning, introspection, and experience with the five disciplines of organizational learning, we understood that we needed to become a learning organization in order to thrive as a rural healthcare system. Peter Senge’s book The Fifth Discipline was perfectly aligned with this goal and the values and culture of GMHS. It would become the foundation of our work. We knew we “weren’t in Kansas anymore.” Our lives had been changed forever.

Our story is much like the plot of The Wizard of Oz, as written by L. Frank Baum and immortalized in the classic 1939 movie. Dorothy lands in the strange world of Oz after her house is carried away from Kansas by a cyclone. She seeks to find the way home by following the Yellow Brick Road. Her intent is to find the Wizard who would bestow on her the knowledge to achieve her goal, only to find that she had the answer within her all along. Here is a summary of our journey.

Dorothy

Similar to the way Dorothy felt when she stepped out of her house to find she was in Oz, our team knew we could not go back to where we had been. We were aware of our destination —to become a learning organization —but didn’t know how we would get there. At first, we felt as though we were “off to see the Wizard,” whose magic would turn us into a learning organization. To get there, we had to “follow the Yellow Brick Road.” In our case, that meant to begin down the path of knowledge and exploration to find out how to become a learning organization.

Scarecrow

We did not know the challenges ahead as we started down our Yellow Brick Road. At first, the learning curve seemed monumental. We attended conferences and studied the work of Peter Senge and others to learn the theory behind organizational learning (OL). After the first year, we came to a fork in the road. We needed a person who would be dedicated to leading and teaching learning organization theory. GMHS management made the decision to hire our first organization development (OD) facilitator. We came to think of this role as being that of the “Scarecrow.” In The Wizard of Oz, the Scarecrow represented the intellect. We needed to find someone to become the “brains” of our organizational learning journey, who would lead us to our destination.

After a few months of searching, we hired our first OD facilitator. At that point, the work intensified. We held visioning sessions and created a “Dream Team” that was responsible for bringing about cultural change. We conducted surveys of the organization to establish a baseline against which to measure progress. In 1997, we conducted Health Quest 97, an event designed to learn what our community wanted from us.

Tin Man

Then we came to the next fork in the road. We had collected much knowledge of what we wanted to create and had a clear vision of where we wanted to go. Additionally, we had learned the language of organizational learning. Now it was time to begin living what we had learned. This would not be the work of the Scarecrow, but of the “Tin Man.” In The Wizard of Oz, the Tin Man longs for a heart. Our first OD facilitator left to pursue other work, and we began the search for someone who could instill what we had learned into the heart and soul of the organization.

Wicked Witch

It wasn’t long after we hired the second OD facilitator and started back down the Yellow Brick Road that the “Wicked Witch of the West” chose to interrupt our journey. In 1998, the federal government enacted the Balanced Budget Act. Provisions of the Act decreased revenues to the healthcare system as a whole. GMHS found itself with a shrinking bottom line. If we didn’t do something quickly, we ran the risk of losing all we had built. The projected loss for the year was $1.2 million.

Lion

Would we have the courage to make the hard choices we needed to make? Could we cut programs that we could not support or for which the government no longer provided reimbursements? Could we reduce expenses to stabilize the bottom line? Could we afford to continue to invest in the tools and concepts of organizational learning? And, finally, in the face of our biggest challenge, did we have the courage to stand up and battle the “Winged Monkeys” of fear and despair? It was time to find our Lion, which in the book and movie represented courage. Our Lion came in the form of the executive team. We decided that if we abandoned the organizational learning initiative, the staff would never again follow us through a cultural change. Why should they?

Using OL tools and processes, we pulled together and created a battle plan. We divided the leadership group into three teams and sent them off to create a new leadership structure. We put safety nets in place, such as generous severance packages that would allow people to safely say “I can leave.” Our president made the hard decision to trim the executive team from five vice presidents to two. Those who left remain friends of the organization. We grieved the loss of our teammates and then moved on.

We have come to realize that we will always be evolving as a learning culture, searching for new answers, and creating our future.

With only two vice presidents and the president left on the executive team, we were afraid that we would not have enough time or exposure to continue the effort. To overcome this obstacle, we formed the Strategic Council. This team of 16 people became the implementers of the strategic plan set forth by the strategic planning body, the Organizational Improvement Council. We regrouped and started back down the Yellow Brick Road. We used OL theory to create our customer service program, improve processes, and design a leadership curriculum. In addition, we put in place a balanced scorecard to measure our progress.

One year later, we were back on track with a positive bottom line. We had reached the Emerald City. Everyone was rewarded with bonuses and celebrations. But where was the Wizard, who would bestow on us the status of “learning organization”? As we reflected one morning in Strategic Council, someone said, “We are a learning organization; the answer has always been within us. Look what we have become.” At that moment, we recognized that we didn’t need an outsider to lead us to our goal; we had reached it on our own.

The Ongoing Journey

Now, six years later, the organization is profitable and healthy, with strong cultural values of trust, integrity, service, and efficiency. Our mission and vision are clear and articulated to all. Our market share has increased by 11 percent. We are adding new services with a patient-centered emphasis and creating healing environments for those we serve.

We have come to realize that we will always be evolving as a learning culture, searching for new answers, and creating our future. When others see our success, they ask, how can we become a learning organization? Our answer is to “follow the Yellow Brick Road.” Their journey will be different than ours, but one day they will know that the answer lies within the people of their organization. Then they will be a true learning organization.

Sue Nieboer, R. N., is the vice president of Clinical Operations at Gerber Memorial Health Services, Fremont, Michigan. Within her responsibilities, she serves as the corporate compliance officer and oversees the Nursing Division, Quality Management Program, and other clinical departments. She is an advocate of organizational learning theory at GMHS and instrumental in sharing the GMHS story with other healthcare organizations in Michigan.