Emphasize that barrier-free relationships must also extend to other divisions of a
corporation and to external stakeholders. To promote interdivisional coordination and resource
sharing, firms often use interdivisional task forces and common training programs, and create
Discussion Question 23: Have you ever worked for a barrier-free organization? How
were relationships among participants in barrier free transactions and/or projects
managed?
The SUPPLEMENT below addresses the example of the Irvine Medical Center, a
hospital that developed more efficient processes by fostering barrier-free relationships inside the
hospital and with employee unions.
Extra Example: Breaking Barriers at the Irvine Medical Center
In 2008, the Irvine Medical Center, a unit of Kaiser Permanente, wanted to streamline its costliest, most time-
intensive surgeries: total hip and knee replacements. The task was daunting, because the solution required
collaboration among specialists who normally fight for resources.
Neither a top-down administrative mandate nor a surgeon-driven approach would work to improve the processes. A
top-down approach wouldn’t have worked because surgeons in different groups each had their own way of doing
things and would be resistant to an administrative mandate, and each surgery group had little influence on the
practices in other surgery units. Also, the hospital had to get other employees on board, and most of those are
covered by unionized contracts that limit changes in workload and flow.
Kaiser created a collaborative community, the Labor Management Partnership (LMP), that included Kaiser
managers, surgeons, and most of the hospital’s employee unions. The LMP worked cooperatively to find efficiency
gain opportunities. The benefit was that all members felt engaged. As one nurse stated about operating room
procedures, “Usually when we are in the room, we wish it would be done differently, but this time we actually got a
voice in how it’s done differently.” They identified ways to streamline sequential operations, such as by bringing
housekeeping in to begin clean-up as soon as a surgeon begins suturing the patient closed. They also set up an alert
system to ensure that staff knew when they were needed. For example, they trigger the post-op and transportation
staff to prepare fifteen minutes before the end of a surgery. Finally, they found ways in which the hospital could be
more efficient by adding staff. For example, they added a “floater” nurse who could move between operating rooms
to provide extra help or relieve staff on breaks.
These steps all reduced surgery cycle-times and also improved employee morale. They increased the number of total
joint replacement surgeries from two to four per day and freed up 188 hours of operating time room per year. A
survey of the operating room staff showed an 85% increase in job satisfaction.
Seeing the benefits, Kaiser implemented similar LMP teams in general surgery, head and neck surgery, urology,
heart, and other surgery specialties in Irvine as well as in other Kaiser hospitals.
Source: Adler, P., Heckscher, C., & Prusak, L. 2011. Building a collaborative enterprise. Harvard Business Review.
89(7/8); 94–101.
Discussion Question 24: How might approaches such as the Irvine Medical Center’s