title: Discussing the undiscussable with the powerful: why and how faculty must learn to counteract organizational silence.
abstract: Dialogue is essential for transforming institutions into learning organizations, yet many well-known characteristics of academic health centers (AHCs) interfere with open discussion. Rigid hierarchies, intense competition for resources, and the power of peer review in advancement processes all hamper difficult conversations, thereby contributing to organizational silence, and at great cost to the institution. Information necessary for critical decisions is not shared, individuals and the organization do not learn from mistakes, and diverse perspectives from those with less power are not entertained, or worse, are suppressed. When leaders become more skilled at inviting multiple perspectives and faculty more adept at broaching difficult conversations with those in power, differences are more effectively addressed and conflicts resolved. In this article, the authors frame why this skill is an essential competency for faculty and leaders alike and provide the following recommendations to institutions for increasing capacity in this area: (1) develop leaders to counteract organizational silence, (2) develop faculty members' skills in raising difficult issues with those in positions of power, and (3) train mentors to coach others in raising difficult conversations. The vitality of AHCs requires that faculty and institutional leaders develop relational communication skills and partner in learning through challenging conversations.
authors: Dr. Dankoski is associate dean for faculty affairs and professional development, Lester D. Bibler Scholar, and associate professor of family medicine, Indiana University School of Medicine, Indianapolis, Indiana. Ms. Bickel is a leadership and career development coach, Falls Church, Virginia. Dr. Gusic was, at the time this was written, executive associate dean for educational affairs, Dolores and John Read Professor of Medical Education, and professor of pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. She is now chief medical education officer, Association of American Medical Colleges, Washington, DC.
authors: Mary E
authors: ME
authors: Dankoski
authors: Janet
authors: J
authors: Bickel
authors: Maryellen E
authors: ME
authors: Gusic
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D003142:Communication; D004501:Education, Medical; D005180:Faculty, Medical / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D015279:Organizational Culture; D011209:Power, Psychological