Keys to Building a Great Healthcare Culture (Part 1 of 3)

David Birdsall

David Birdsall , MD

Chief Operations Officer

Published February 25, 2016

Every organization wants a great culture. But what does that really mean? And as a leader, how do you get your workforce there?

In this blog series, adapted from Vituity's popular webinar, I'll explore the following topics:

Part 1: Why culture matters
Part 2: What culture do you have? What culture do you need?
Part 3: Transforming your culture.

Let's start with a fundamental question.

What Is Culture?

In my opinion, the most useful definition of culture comes from the European Business Review:

"Every organization has its own unique culture; defined as the set of deeply embedded, self-reinforcing behaviors, beliefs and mindset that determine "the way we do things around here."

Like an iceberg, culture is largely invisible. If you ask your nursing or medical staff to describe your hospital's culture, they'd probably have a hard time. However, it's likely that everyone in your organization shares an unspoken understanding of the rules and their place in the pecking order.

Culture represents your organization's core, its true self. It's expressed continuously by what your people do and say. For this reason, it can't be faked or changed through directives. It has to be changed through hearts and minds.

Culture Is Mission Critical

Developing and maintaining a positive culture probably isn't in your job description as a leader. But make no mistake, it's one of the most important things you can do.

Culture touches everything in your organization. It influences behavior, relationships, decisions and ultimately, effectiveness. A survey of top supply chain executives found that they viewed culture (or lack thereof) as the number one barrier to business success.

Culture has elevated many ventures — and crushed many more.

On the positive side, the best and the brightest minds compete to work for culture-conscious companies like Google, Twitter, Facebook and even the fully unionized Southwest Airlines.

On the negative side, we have the culture of unchecked greed that tanked Enron. Glaring cultural differences made the $35 billion Sprint Nextel merger a disaster.

Perhaps the saddest example is the 2012 Australian Olympic swim team. They were strongly favored to win most events, but brought home only one Gold Medal.

An investigation cited the team's "toxic" culture as a major contributor to their downfall. Coaches overlooked hazing, intimidation, flagrant disregard of team rules and even substance abuse. The athletes regretfully called London the "Lonely Olympics," saying team cohesion was destroyed and that everyone basically competed as an individual.

Culture and Healthcare

Now that we've discussed tech, airlines and Olympic swimmers, let's talk about what this all means for hospitals and health systems.

As a vice president and former regional director of Vituity, it's been enlightening to work with dozens of hospitals over the years.

Very often, when a department is struggling, team members will point out why their department is different. Maybe they're in a part of the country where recruiting top-notch providers and staff is difficult. Maybe the facilities are outdated, cramped and uncomfortable. Or maybe they have high patient volumes, high acuity or a challenging population.

Granted, these difficulties are real. But I also think these departments are underestimating the role culture plays.

In my day, I've seen hospitals with every advantage struggle with staff retention, patient satisfaction and quality. And I've seen hospitals with stark disadvantages excel at all of the above.

Performance areas directly impacted by culture include:

Patient satisfaction. Pretend you're at a restaurant where the servers are upbeat, working as a team and having fun. They clearly take pride in their service. It all translates into a positive dining experience.

Research suggests that hospital patients, like diners, are attuned to the general vibe of a place. One literature review found a compelling correlation between employee engagement and patient satisfaction scores. In another study, patients expressed a strong preference for provider teamwork versus bureaucratic, top-down management.

Provider satisfaction. Provider and nursing teams are truly the lifeblood of any healthcare organization. Engaged team members will partner with administrators to solve problems and move the organization forward. What's more, high employee retention rates can add millions to a hospital's bottom line.

A recent Cejka Search survey showed that both physicians and administrators attach a high importance to workplace culture. Both named respectful communication, patient-centeredness, supportive management of errors and transparent communication as key cultural attributes. However, administrators rated their organizational culture much more positively than did physicians at the same hospital. Clearly this opinion gap must be addressed.

Some experts have proposed adding provider care to the "triple aim" paradigm of healthcare reform. In order to effectively redesign care delivery, they say, we must care for the people who care for patients. This requires purposeful investment in provider wellness and job satisfaction.

Medical staff alignment. Hospitals thrive when administrators and providers work toward common goals. But for many hospital leaders, getting all their physician groups on the same page is a perennial headache. Once again, the roadblocks are often cultural in nature.

Alignment, of course, is a two way street. David Miller of Healthcare of Strategy Group has written an excellent article about what's needed from the administrative end:
  • Physicians should be treated as customers within the organization.
  • Physician knowledge should be viewed as a valuable asset that is crucial to the organization's success.
  • Leaders should seek physician input and defer to physician expertise when appropriate.
  • Physicians should be kept apprised of important hospital decisions.
  • Physicians' contributions to quality outcomes should be recognized and rewarded.

The culture of the physician groups involved also plays a role. Recently, a Vituity medical director from my region sat down with a new administrator who was concerned about ED utilization. The medical director could have been defensive. Instead, he listened and validated the administrator's concerns. Later, he went back to clarify information and proposed potential solutions.

Vituity culture focuses on shared problem solving. We want our clients to see us as true partners who invest in their success. When we're developing future medical directors, we explicitly teach the behaviors that will strengthen these relationships. And we only appoint clinical leaders who exemplify these values.

Next Steps: Defining Your Culture

Now that we've covered the importance of culture, let's get a little more hands-on. In my next post, I'll show you how to assess your current culture, plus work with your team to determine the ideal culture for your organization.

Partnering to improve patient lives

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