1. Paukstis, Beverly RN, MS, CHPN

Article Content

There is an accepted and honored theory in business about the growth and development of an organization. It suggests that, over time, an organization moves though a series of sequential stages of development. The deduction that organizations, composed of living beings, morph likewise[horizontal ellipsis] as living organisms, has created opportunities for businesses as diverse as churches and china factories, hospitals, and hotdog makers, to examine their own work and where it fits within the cycle, as explained by numerous authoritative works-and many of those there are from the Harvard Business Review, periodicals, to tomes such as The Fifth Discipline by Peter M. Senge, a leading commentator and educator in the business world; there are chapters examining the phenomena. The Oxford Textbook of Palliative Medicine, edited by Doyle, Hanks, and MacDonald, carries references to team growth and development in cycles.


In the first stage, the infant, birth or start-up, a group forms around an idea that the individual members believe is worthy of a group effort. There is passion enough to motivate the members. There are overlapping tasks, and generally, there is one person in charge. Behaviors are backed by the united beliefs, and there are usually no written rules. If there is any staff, it is usually a secretary; therefore, internal systems are not necessary. There is teamwork, and members relish in the lack of bureaucracy seen by many as the death knell to success.


Eventually, because of the success of the idea and the strong commitment and purpose of the group members, the second stage evolves. This period, also called youth or growth, occurs when the infant/birth stage no longer meets the needs of the environment, the idea it is serving, and vice versa. Hallmarks of this period include growth in number of members of the group, labor division, some written rules, increase in clerical support, attention to budget and information systems, and questioning of the process by a few members originally seen as founders.


Within this second stage are several sequential cophenomena. Initially, there is sustained excitement over the acceptance of the idea. Gradually, there is conflict over goals and processes. If the leadership remains entrepreneurial, there is failure of management. Conversely, the success lies in the formation of tighter systems, policies, budget responsibility, and leadership that truly manages. This type of leadership guides the processes through acts that start out as direct and move into collaboration. This period can last from 4 to 8 years; within this time, there is usually the sort of crises that many term midlife. The outcome determines if the organization will enter the sustained third stage, the mature stage, also called prime-or will it succumb to the cycle called aging or decline-one source calls it dry rot.


The author, Judith Sharkin Simon, in her book The 5 Life Stages of Nonprofit Organizations, another perspective is given. She notes:


1. Stage one: imagine and inspire ("Can the dream be realized?")


2. Stage two: found and frame ("How are we going to pull this off?")


3. Stage three: ground and grow ("How can we build this to be viable?")


4. Stage four: produce and sustain ("How can we keep this going?")


5. Stage five: review and renew ("What do we need to do redesign?")



It is a common thread that evaluation of the landscape that provoked the idea needs to be reexamined, and the change that evolves from the healthy check-in with reality promotes the living and learning organization that creates its future. Central to that, however, is a fierce loyalty to the core principles that conceived the original idea.


Beverly Paukstis, RN, MS, CHPN


Board of Directors


Hospice and Palliative Nurses Association