Keys to Building a Great Healthcare Culture (Part 2 of 3)

David Birdsall

David Birdsall , MD

Chief Operations Officer

Published March 01, 2016

This week on Perspectives, we're looking at the nuts and bolts of organizational culture: why it's crucial and what leaders can do to shape it. Here's a brief roadmap of where we've been and where we're headed:

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

With culture, as with any transition, it's a lot easier to reach your destination when you know where you're going. In today's post, I'll share some tips for assessing your current culture and defining your ideal culture.

Taking Your Cultural Pulse

"Every place has a culture. If it isn't created, stressed, nurtured, and reinforced, it will develop on its own — kind of like the Lord of the Flies — and usually not to a good outcome." — David Birdsall, MD

Fundamentally, culture is exemplified by actions.

To illustrate this, think of Disneyland. Everyone working there is in character: smiling, friendly and helpful. Even the person collecting the trash will stop to answer your questions. They provide such a pleasant experience that you actually start to feel good about the $20 hamburgers and the endless lines.

That's not to say your hospital should be Disneyland. (More on that in a minute.) But what do the actions of your team say about you? Here are a few key areas to consider.

Engagement. Do providers and nurses get involved in the hospital beyond their specific job duties? Examples might include volunteering for hospital-wide committees or leading interdepartmental initiatives.

Environment. My colleague Bonnie Carl, RN, MBA, worked at a hospital where it was common practice to leave your paper towels lying on the floor when you missed the trashcan. As a result, unsightly garbage piled up around the department. Do your team members share responsibility for keeping common areas clean and attractive?

Approachability. Do colleagues smile and greet one another? Do they step forward to assist coworkers who are having difficulty? Or is everyone just looking out for themselves?

In general, any situation where team members hide from one another is bad news. For example, the ED where I work clinical shifts is a Cardiac Center of Excellence. This means we have to run and read ECGs on patients with certain complaints within 10 minutes of arrival. Seeing the tech approach with an ECG to sign immediately can feel a little intrusive, especially when you're busy or with a very acute patient. But we never refuse or grumble, because we accept this task as part of our job.

Teamwork. In a healthy workplace, everyone shares responsibility for the organization's success. In hospitals, this means doctors and nurses pitch in on tasks like changing over patient rooms, stocking drawers, responding to call lights and answering the phone.

This also extends to staffing. In dysfunctional workplaces, team members sometimes manage their schedules by calling in sick, heedless of the impact on their peers. And what about when someone is truly sick, or goes on vacation or family leave? Do they take responsibility for finding their own replacement? And do team members pitch in and cover for one another at these times?

A great example: When a nurse at my hospital goes on break, they hand off their patients to a colleague. So when I ask about a patient, even when it is not their patient, they offer their help. I have found that has had a profound effect on me, and when the nurses have a question about another the patient of another provider who is not readily available, I offer to help as well. Teamwork and good culture begets more teamwork and better culture.

Attitude toward patients. Do team members' actions show patients they are cared about and considered first priority? If not, what other messages are being communicated?

Bonnie Carl once saw an ED team wearing t-shirts reminding patients to respect the doctors and nurses, because "we're saving lives." If you had to go to this ED for care, would you feel like a valued customer? Or more like a nuisance?

Another example: when multiple ambulances arrive at once, how do providers and nurses react? Believe it or not, I've heard of cases where they actually complain in front of the patient. "You're killing us," they'll tell the paramedic. "Can't you go to another hospital?" Were I that patient, you'd be hard pressed to convince me I was in the best hands possible.

Nurse-physician relations. The nurse missed a test! The doctor placed too many orders! If this sort of blaming and squabbling sounds familiar, it probably sounds familiar to your patients, too. Like restaurants, hospitals deliver a better experience when team members work together.

Sincerity and consistency. Are you confident in the caring nature of your providers and staff — even when you're not looking? If a loved one went to your facility unbeknownst to you or your staff, are you confident they would have the patient experience you would want for them?

Visualizing Your Ideal Culture

So now that you know where you are, you need to know where you're going. To determine this, you need to figure out your organization's ideal culture.

The first and most fundamental clues can be found in your organization's mission and vision statements. These often emphasize compassion, clinical quality, community outreach, value, education and research. (But remember, these are only words until you bring them to life with your actions.)

Second, spend some time reflecting on what your customer wants. For example, people come to Disneyland to be treated like royalty. By contrast, people visit Katz's Delicatessen for the food, the history and an authentic New York experience. That means no-nonsense service, getting rushed at the counter, eating fast and getting the heck out.

Disney and Katz's have very different cultures. But people love both places because of their cultures. These businesses are both extremely successful because they deliver what customers want.

In order to figure out what your patients might want, try the following exercises with your team.

Personal stories. Think about a time you or a family member had to visit the hospital. Walk through the entire experience from beginning to end. What did you see and hear? How did it make you feel? Write down as many observations as possible.

Now contrast this with your ideal experience. What would you change?

For the record, here's my story. My mom was undergoing chemotherapy for cancer. She was sick to her stomach and ended up very weak and dehydrated. I knew she needed to go to the ED, but it took some convincing. She was very strong and independent, so she saw this ED visit as a personal defeat.

We ended up waiting three hours to see a doctor. Mom was just as uncomfortable as she was at home, except now she was sick and disheveled in public. Finally, we were directed to a room with a dirty floor where we resumed waiting. No explanation or apology was given for the delay.

When the providers finally appeared, they were rushed and uncaring. No one seemed to be communicating or working as a team, which meant I repeated our story over and over. The department was very noisy, and we could hear people talking all around us —including some personal conversations we could have lived without.

Five or six hours later, mom was discharged feeling physically better but emotionally frazzled. Her experience really drove home for me what a difference culture makes.

VIPs. If your hospital is like most, certain patients get the red carpet treatment. We usually go the extra mile for hospital leaders, providers, staff and their loved ones. One Vituity medical director noticed that the local nuns were treated like VIPs at his faith-based hospital.

These examples are highly instructive, because they show us at our best. The question that follows: doesn't everyone deserve that kind of care? And if so, how do we deliver that experience for everyone?

Which brings us to an excellent stopping point for today. In my third and final post, we'll explore what we can do as leaders to shape organizational culture.

Partnering to improve patient lives

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