Generative Relationships Increase Community Wellness and Reduce Health Risks
By Paul Plsek, MS
Paul E. Plsek & Associates and Author, Creativity, Innovation, and Quality
Editorial Board Member, Health Care Innovations Exchange
In their study of innovation in telecommunications, Lane and Maxfield (1996) coined the term "generative relationships" to describe how novel partnerships give rise to innovative practices. Generative relationships "…occur when interactions among parts of a complex system produce valuable, new, and unpredictable capabilities that are not inherent in any of the parts acting alone" (pg. 216). These interactions are most likely to occur under the conditions of:
- aligned directedness: common, general direction, purpose or desire
- heterogeneity: differences, diversity of ideas and competencies
- mutual directedness: interest in ongoing, recurring interaction
- permissions: implicit or explicit permission to engage in explorations
- action opportunities: ability, willingness to engage in joint action
Zimmerman and Hayday (1999) developed a simple tool for assessing the generative potential of a relationship, and Plsek and Wilson (1999) have applied the concept to health care innovation.
The Innovations Exchange profile, "The Multi-Stakeholder, Community-Wide Collaborative Prevents Disease and Promotes Health," illustrates the potential of generative relationships.
The Foote Health System Health Improvement Organization brought together health care professionals, schools, businesses, and faith-based communities to create a variety of initiatives that improved wellness and reduced health risks across a community.
When novel relationships feature prominently in an innovation there are several important implications for potential adopters. The pattern of relationships is likely to be integral to success. Adopters who replicate only the mechanics of the innovation without attending to relationship building may not achieve comparable results.
Because health care financing is based on traditional processes, the benefits from a partnership-driven innovation may not accrue to the one expending the resources and effort. Working out equitable funding flows that fit local conditions is a key activity for the adopter.
Lane and Maxfield’s five conditions for generative relationships provide further, specific insight into the elements of relationship building. For example, the condition of "aligned directedness" suggests that it is essential to spend time in dialogue to identify common purpose or desire. If it is not clear that the innovation serves everyone’s needs, it may be difficult to implement and even more difficult to sustain.
The condition of "heterogeneity" may present special challenges. Innovation is more likely to occur when the parties involved have substantial differences and a real diversity of ideas and competencies. However, it may take considerable effort by all parties to truly understand and deeply value these differences.
When there is aligned directedness and valuing of heterogeneity, the desire to interact associated with the last three conditions often follows naturally. But potential adopters need to support this desire with locally adapted structures and resources, such as committees, project teams, joint educational sessions, and collocation of staff.
The condition of "permissions" may also require local adaptation and careful attention. Partners need to be patient and actively supportive of each other as they guide innovative changes through the maze of challenges from local organizational politics, professional societies and regulators.
References:
Lane D, Maxfield R. Strategy under complexity: Fostering generative relationships. Long Range Planning. 1996 29(2):215-231.
Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. BMJ. 2001 323(7315):746-9. [PubMed]
Zimmerman BJ, Hayday BC. A board’s journey into complexity science. Group Decision and Negotiation. 1999 8(4):281-303.
