If You’re Relying on the Org Chart in Times of Uncertainty, You’re Already Behind

SUMMARY: Senior leaders in medicine frequently rely on formal organizational charts as strategy roadmaps, overlooking the critical role of informal networks and their social capital to drive organizational change. The disconnect between formal and informal structures is especially problematic during times of uncertainty when change is required, such as after a merger or major acquisition, in response to evolving market forces, or due to an unanticipated external event like the pandemic.Tools such as the Balanced Scorecard can bridge this gap by aligning decentralized units with enterprise goals. Such systems create understanding and commitment among all unit employees about how their skills and competencies can contribute to a common purpose. Successful institutions mobilize informal leaders early during periods of uncertainty, empowering clinicians and staff to innovate and collaborate beyond job descriptions and departmental boundaries. In this article, we present two case studies on how such an approach works in a crisis environment.