Growing larger or growing smaller: "blessed are the flexible for they shall not be bent out of shape.".

• Author: Hall, Robert
• Position: MARKETING SOLUTIONS

"WHAT DO YOU THINK IS THE MOST FREQUENT QUESTION I and my team get from cardiac patients? That was the question posed to several of us by Dr. Paul Uhlig, a nationally known thoracic (chest) surgeon. After some lively speculation and discussion, he gave us his answer: "Don't you guys ever talk?"

Dr. Uhlig has worked intently the last few years on improving the experience and medical outcomes of cardiac patients. One specific focus is what happens in daily rounds with doctors and other staff in meeting with patients. He ticks off a list of challenges with the traditional processes: Medical staff uses language that is foreign and intimidating; the story keeps changing as a barrage of medical staff meet with the patient; and often the patient feels left out in key decisions. These factors affect patient outcomes and the financial viability of hospitals. As one hospital executive said, improving clinical quality without addressing patient satisfaction is not financially feasible. Patient communication with doctors and staff is the number one determinant of patient satisfaction.

Growing larger without losing your soul

Virtually every organization out there is dealing with a similar challenge. As organizations grow larger and more complex, areas of expertise grow deeper, more players are involved in customer/patient interactions and service delivery; and, as processes grow more bureaucratic, the question arises: How do we improve satisfaction of and relationship with the end-user customer or patient?

There are two paradoxical challenges that are uniquely related to organization size. First, small successful organizations are concerned about how to effectively grow larger. Often their nimble, personalized, local approach differentiates them from their larger, slower, impersonal and more bureaucratic competitors. Many smaller banks have recruited refugees from large banks who have weathered the perils of acquisition, mergers, bureaucratically numbing processes and rampant downsizing. These folks are often vocal about avoiding a replay with their new employer. So the challenge is how to provide the necessary infrastructure to scale up--without losing their sacred customer and employee relationship culture. Nothing exposes organizational cracks like growth. These organizations sound a tad schizophrenic (remember that old line: I am schizophrenic and so am I) promoting the advantages of their smaller size while struggling to add infrastructure support...