Journal of General Internal Medicine

, Volume 23, Issue 6, pp 715–722

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

  • Ann H. Cottingham
  • Anthony L. Suchman
  • Debra K. Litzelman
  • Richard M. Frankel
  • David L. Mossbarger
  • Penelope R. Williamson
  • DeWitt C. BaldwinJr.
  • Thomas S. Inui
Original Article

DOI: 10.1007/s11606-008-0543-y

Cite this article as:
Cottingham, A.H., Suchman, A.L., Litzelman, D.K. et al. J GEN INTERN MED (2008) 23: 715. doi:10.1007/s11606-008-0543-y

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.

KEY WORDS

organizational culture changelearning environmentinformal curriculummedical educationprofessional competence

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Ann H. Cottingham
    • 1
  • Anthony L. Suchman
    • 2
    • 3
  • Debra K. Litzelman
    • 1
  • Richard M. Frankel
    • 1
    • 4
    • 5
  • David L. Mossbarger
    • 4
  • Penelope R. Williamson
    • 3
    • 6
  • DeWitt C. BaldwinJr.
    • 7
  • Thomas S. Inui
    • 1
    • 4
    • 5
  1. 1.Medical Education and Curricular AffairsIndiana University School of MedicineIndianapolisUSA
  2. 2.University of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Relationship Centered Health CareRochesterUSA
  4. 4.Regenstrief Institute, Inc.IndianapolisUSA
  5. 5.Richard L. Roudebush VAMCIndianapolisUSA
  6. 6.The Johns Hopkins University School of MedicineBaltimoreUSA
  7. 7.Accreditation Council for Graduate Medical EducationChicagoUSA