Enhancing the informal curriculum of a medical school: a case study in organizational culture change.
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.


METHODS
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.
Cottingham
Ann H
AH
Medical Education and Curricular Affairs, Indiana University School of Medicine, Indianapolis, IN 46202-3297, USA. ancottin@iupui.edu
Suchman
Anthony L
AL
Litzelman
Debra K
DK
Frankel
Richard M
RM
Mossbarger
David L
DL
Williamson
Penelope R
PR
Baldwin
Dewitt C
DC
Inui
Thomas S
TS
D003479:Curriculum; D004059:Diffusion of Innovation; D004501:Education, Medical / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D007196:Indiana; D015279:Organizational Culture; D009936:Organizational Innovation; D009937:Organizational Objectives; D011361:Professional Competence; D012577:Schools, Medical / Q000458:organization & administration*