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Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Culture Change

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An Erratum to this article was published on 16 November 2010

Abstract

Background

Calls for organizational culture change are audible in many health care discourses today, including those focused on medical education, patient safety, service quality, and translational research. In spite of many efforts, traditional “top–down” approaches to changing culture and relational patterns in organizations often disappoint.

Objective

In an effort to better align our informal curriculum with our formal competency-based curriculum, Indiana University School of Medicine (IUSM) initiated a school-wide culture change project using an alternative, participatory approach that built on the interests, strengths, and values of IUSM individuals and microsystems.

Approach

Employing a strategy of “emergent design,” we began by gathering and presenting stories of IUSM’s culture at its best to foster mindfulness of positive relational patterns already present in the IUSM environment. We then tracked and supported new initiatives stimulated by dissemination of the stories.

Results

The vision of a new IUSM culture combined with the initial narrative intervention have prompted significant unanticipated shifts in ordinary activities and behavior, including a redesigned admissions process, new relational practices at faculty meetings, student-initiated publications, and modifications of major administrative projects such as department chair performance reviews and mission-based management. Students’ satisfaction with their educational experience rose sharply from historical patterns, and reflective narratives describe significant changes in the work and learning environment.

Conclusions

This case study of emergent change in a medical school’s informal curriculum illustrates the efficacy of novel approaches to organizational development. Large-scale change can be promoted with an emergent, non-prescriptive strategy, an appreciative perspective, and focused and sustained attention to everyday relational patterns.

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Acknowledgments

The authors wish to acknowledge the editors and reviewers of JGIM for helping us improve the clarity of the presentation.

Conflict of Interest Statement

The authors have the following relationships with for-profit institutions: Ann H. Cottingham, MAR, none; Anthony L. Suchman, MD, MA, paid consultant to the Relationship-Centered Care Initiative; Debra K. Litzelman, MA, MD, none; Richard M. Frankel, PhD, grant received from the Zimmer Corporation; David L. Mossbarger, MBA, none; Penelope R. Williamson, ScD, paid consultant to the Relationship-Centered Care Initiative; DeWitt C. Baldwin Jr., MD, none; Thomas S. Inui, ScM, MD; grant received from the Zimmer Corporation.

Author information

Authors and Affiliations

  1. Medical Education and Curricular Affairs, Indiana University School of Medicine, Indianapolis, IN, USA

    Ann H. Cottingham MAR, Debra K. Litzelman MA, MD, Richard M. Frankel PhD & Thomas S. Inui ScM, MD

  2. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Anthony L. Suchman MD, MA

  3. Relationship Centered Health Care, Rochester, NY, USA

    Anthony L. Suchman MD, MA & Penelope R. Williamson ScD

  4. Regenstrief Institute, Inc., Indianapolis, IN, USA

    Richard M. Frankel PhD, David L. Mossbarger MBA & Thomas S. Inui ScM, MD

  5. Richard L. Roudebush VAMC, Indianapolis, IN, USA

    Richard M. Frankel PhD & Thomas S. Inui ScM, MD

  6. The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Penelope R. Williamson ScD

  7. Accreditation Council for Graduate Medical Education, Chicago, IL, USA

    DeWitt C. Baldwin Jr. MD

Authors
  1. Ann H. Cottingham MAR
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  2. Anthony L. Suchman MD, MA
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  3. Debra K. Litzelman MA, MD
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  4. Richard M. Frankel PhD
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  5. David L. Mossbarger MBA
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  6. Penelope R. Williamson ScD
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  7. DeWitt C. Baldwin Jr. MD
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  8. Thomas S. Inui ScM, MD
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Corresponding author

Correspondence to Ann H. Cottingham MAR.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11606-010-1577-5

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Cottingham, A.H., Suchman, A.L., Litzelman, D.K. et al. Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Culture Change. J GEN INTERN MED 23, 715–722 (2008). https://doi.org/10.1007/s11606-008-0543-y

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  • DOI: https://doi.org/10.1007/s11606-008-0543-y

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