Organizational Change in Complex Systems: Organizational and Leadership Factors in the Introduction of Open Dialogue to Mental Health Care Services

Lennon, Elizabeth; Hopkins, Liza; Einboden, Rochelle; McCloughen, Andrea; Dawson, Lisa; Buus, Niels

doi:10.1007/s10597-022-00984-0

Cited by 10 publications

(9 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Building on these therapeutic and organizational principles, adopting OD throws various "paradigmatic givens" of the mental health system into question, which may also lead to implementation obstacles. This tension has been dealt with in more depth in another essay (von Peter et al, 2021) and summarized in a more recent publication describing how the OD approach leads to "challenges between core clinical values, and conflicting expectations of professional practice and performance" (Lennon et al, 2022). As a result, the implementation of OD may "generate organizational, professional, and personal resistances" (Søndergaard, 2009), leading to major problems in its acceptance and adoption in practice.…”

Section: Introductionmentioning

confidence: 99%

Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry

Peter

Eissing²,

Saliger³

2023

Front. Psychol.

View full text Add to dashboard Cite

Building on both therapeutic and organizational principles, adopting Open Dialogue (OD) calls various routines of the current mental health system into question, resulting in potential obstacles with implementation. This perspective paper aims to reflect on power relations as potential disruptive factors in enabling the OD approach in mental health care. Drawing on data from a small implementation study, followed by reflections from three perspectives, we conclude with a discussion exploring the potential of understanding OD as a fundamental human practice to reduce these power-related obstacles.

show abstract

Section: Introductionmentioning

confidence: 99%

Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry

Peter

Eissing²,

Saliger³

2023

Front. Psychol.

View full text Add to dashboard Cite

show abstract

“…For example, expert interviews revealed various obstacles both on a meso- and micro-level, such as a lack of support from the senior or executive management. Thus, as shown in results from other studies, it may be argued that the implementation of OD inevitably leads to challenges and can only succeed through an adaptive and committed leadership ( Lennon et al, 2022 ) and organizational change management processes ( Buus et al, 2021 ).…”

Section: Discussionmentioning

confidence: 92%

“…Concerning the implementation, various obstacles have been described, related both to OD structural and therapeutic principles ( Buus et al, 2021 ). A recent interview study mentioned, for example, that OD is not a “manualized” treatment method, explaining why this may generate tensions in organizational implementation that “favor specific and standardized practices” ( Lennon et al, 2022 ). In another ethnographic study, the core values of OD are described as being in conflict with the “expectations of professional practices and performance” ( Dawson et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Implementation of open dialogue in Germany: Efforts, challenges, and obstacles

et al. 2023

View full text Add to dashboard Cite

PurposeThe Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany.MethodsThis article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated using a thematic analysis approach.ResultsWhile having to adapt to the fragmented German health care system, OD has been mainly implemented from outpatient service providers and stand-alone services. About half of the teams implemented OD under the conditions of cross-sectoral model contracts and, thus, are considerably limited when it comes to OD implementation. Altogether, OD is not implemented to its full extent in each of the institutions surveyed. Similarly, the expert interviews revealed various challenges that mainly relate to the realization of OD’s structural principles, whereas the implementation of its therapeutic benefits remains less affected. However, these challenges have managed to lead to great commitment by single teams and a certain level of implementation of OD-related concepts.ConclusionOD in Germany can currently only be fully implemented under the cross-sectoral care model contract system that is often temporary, thus significantly hindering its continuous development. Any evaluation of OD’s effectiveness in Germany thus needs to take into account the fragmented nature of the country’s health care system and control for the multiple barriers that impede implementation. Reforms of the German health care system are also urgently needed to create more favorable conditions for the implementation of OD.

show abstract

“…The seven principles of open dialog (immediate response, responsibility, flexibility, psychological continuity, a network perspective, dialogism, and tolerating uncertainty) are interdependent in their work to support a network’s journey through a transitional and chaotic period. In both therapeutic and organizational change processes, a balance is needed between the open-endedness of possibilities, and the safety and stability of a team taking on their share of the responsibility for holding the process ( Lennon et al, 2022 ). We are left encouraged by participant motivation to continue on this path with hopes that this paper may contribute to striking a sustainable balance.…”

Section: Discussionmentioning

confidence: 99%

Anticipation dialogs in Vermont’s system of mental healthcare: Sustaining the growth of a dialogic practice culture

Alpern¹,

Binshadler

Oakley³

2023

Front. Psychol.

View full text Add to dashboard Cite

Open dialog is both a therapeutic approach and a way of organizing the system of mental healthcare that has been evolving in Finland since the 1980s. In Vermont, over the last decade, there has been an organic statewide effort to begin to integrate dialogic principles into the public system of mental healthcare. Because of the organic nature of these initiatives, there have not been coordinated systemic changes to support dialogic practices. To learn what visions participants in dialogically informed practice contexts have for the future as well as what structural innovations would support these visions anticipation dialogs were offered at three dialogically informed community mental health centers and one public psychiatric. The anticipation dialog was developed in Finland during the late 1980s to aid stuck professional and social networks in finding ways to move forward looking back from an imagined positive future. Twenty-seven multidisciplinary staff members and one service recipient participated in the dialogs. The authors conducted a multi-step process of thematic discourse analysis of all 4 anticipation dialogs. Findings underscore dilemmas entailed in growing a dialogic practice system, including the toll systemic uncertainty takes on workers in the system and the simultaneous pull to offer some amount of open-endedness to the system change process in the spirit of inclusiveness, mutual trust, democracy, and reducing hierarchy. Other key findings influencing sustainability of dialogic practices in community mental health include integrating dialogic work into roles rather than adding them to existing responsibilities. Our experiences indicate that anticipation dialogs may be a way of conducting systemic research that contributes to the forward momentum of system innovation. Offering a greater length of time for organizational anticipation dialogs would be valuable, as would centering the voices of clients and their networks.

show abstract

Organizational Change in Complex Systems: Organizational and Leadership Factors in the Introduction of Open Dialogue to Mental Health Care Services

Cited by 10 publications

References 30 publications

Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry

Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry

Implementation of open dialogue in Germany: Efforts, challenges, and obstacles

Anticipation dialogs in Vermont’s system of mental healthcare: Sustaining the growth of a dialogic practice culture

Contact Info

Product

Resources

About