In your own words, what systemic structures did the manager in lesson 2 discover? What effects did the relationships have?

Systemic structure is not readily visible unless a conscious effort is made to find it. Just because managers do not see what is below the organizational waterline does not mean that a systemic structure is not present in the organization. For example, a newly hired manager at an academic medical center was assigned to facilitate an improvement project for a patient care unit. If the project proved successful, the intent was to expand the intervention organization-wide. Despite positive results - as measured by improved efficiencies and increased patient and staff satisfaction - the project was not implemented beyond the original pilot site. When the manager began to explore possible reasons the project was not replicated on other units, he discovered that over the years numerous project teams had designed and implemented successful pilot projects aimed at improving specific problems. However, few of these projects had actually been integrated into the ongoing activities of the organization (i.e., institutionalized). On further investigation, he uncovered the following systemic structures operating in this organization. First, all improvements in the organization were called "pilots." The expectation was that a trial would be conducted for a specified period, results would be presented to the administrative team, and the administrative team would then authorize the project to continue or not. The problem was that this process occurred independently from the budgeting process. When the "special pools" of dollars to fund pilot initiatives were gone, no mechanisms were in place to reallocate funds either in or among departments to support institutionalizing successful improvements or innovations. The label of "pilot" also brought with it other short-term perceptions related to support, staffing, and budgets. Because of these hidden, but real, relationships among the variables required to support change, this academic medical center demonstrated a constant stream of successful improvement pilot efforts, yet sustained improvement in the overall organizational performance never occurred