The Bumpy Road to Change

Trying to do too much, too fast. It's great to be excited about the effort, but senior executives should be careful not to overwhelm managers. If you implement one change, like having nurse leaders round on patients, you are likely to be successful, says Studer. But if you implement multiple changes all at once, you risk all of the initiatives failing because your team gets emotionally exhausted.

Narrow approach. Transforming culture is a lot broader and more difficult for people to grasp than a customer service program that focuses on making people smile, says Frampton. Organizations can't just focus on programs; they should take a comprehensive approach. "You really are talking about a belief system," she says.

Morale. "Culture undertakings are impacted by group morale, so you can't do it in isolation," says Frampton. Organizations should have the true support and consensus of the entire senior leadership team. Top leaders need to go out and sell the change to the staff and be role models for it; otherwise, it sets the tone for the organization not to take it seriously. Everyone in the organization needs to be involved in the effort, as well. One challenge that Copley encountered was that it was always the same group of people that volunteered to be on committees.

Underestimating leadership training and development. "The No. 1 issue leaders face is they don't have enough time," says Studer. Many leaders have never been trained to run a good meeting or select or fire staff. If you are asking people to change behavior, they will need to be more efficient."

In addition, frontline managers may not have time to read all the same publications as senior executives or have the budget to attend conferences, but they still need to understand how leaders view the external environment. Otherwise, there can be a "different sense of urgency and execution," says Studer.

Not firing enough people. If organizations keep managers or staff members who refuse to change behavior, it can undermine the whole effort. "It takes the life out of the rest of the people who have been working so hard," Studer says.

What went right?
One of the fundamental initiatives that 98-staffed-bed Griffin Hospital used to drive culture change was visioning exercises. Each month for one year, senior leaders held an off-site retreat with 80 to 100 employees and asked them to put on the patient hat and describe what hospital experience they would like to have.

Executives heard things like a more pleasant environment, unrestricted visitation, and friendly and caring staff. Every month, employees said "friendly and caring staff," Powanda says. "Whatever the reason, they believed either the hospital culture, the practices, or policies prevented them from being friendly and caring. That was clearly a cultural issue. It meant that we didn't have a clear vision or mission about putting the patient first."