The Bumpy Road to Change

So the hospital implemented a whole set of education and training programs to ensure that employees—both new and old—are aware of the mission and commitment to be patient-centered. New employees attend a week-long orientation, which includes a two-day, overnight retreat designed to have them see the hospital experience through patients' eyes. "It's probably the one thing that we believe has contributed the most to changing Griffin's culture," says Powanda.

Existing staff attend a one-day off-site retreat to reinforce the culture. "One of the things we do at those refresher retreats is read recent patient letters—the negative ones. The typical reaction is, ‘Oh, what hospital is that from?'" says Powanda. "When we share that was a Griffin experience, it is very enlightening and stimulates a lot of conversation. The goal is to say, ‘We are good, sometimes great, but we are not perfect.'"

Here are some tips on how to get cultural transformation efforts off to a good start:

Prepare leaders. Find out how senior leaders view their involvement and responsibility in the culture change effort. "We sit down with the senior leadership team and they do some homework," says Frampton. "The team's responses to key questions are discussed as a group."

Acknowledge that the process takes time. For example, it takes about three to five years to become officially designated as a patient-centered hospital by an independent advisory council and regognized on quality checks by The Joint Commission, says Frampton.

Don't do too much. "You have to prioritize," says Tuck. "Look at what are the most important items and deal those first."

Be inclusive. At Griffin everyone goes to their retreats—business office people, engineering folks, housekeepers, security—it is not just clinical staff. "We decided that every employee would be a caregiver," says Powanda.

Senior leaders at Copley have started reaching out and involving staff members who historically have not joined committees or work groups, says Tuck. The hospital is also working to be more consistent in its communication with staff members. You can't just ask people to share their thoughts, Tuck says. "You have to really listen, process it, and respond."

Recognize every culture is unique. Organizations should be sensitive to geographic culture, the culture of the organization, and the personality of the organization. "The Griffin model works here in our culture," says Powanda. "But you can't take this template and lay it over 100 other hospitals."

Changing an organization's culture is akin to walking through a field of land mines. So what should a CEO do if the effort starts collapsing?

Admit it. "The best thing is for an executive to say, ‘We have good intentions, the right goal, and the right mission and values, but our execution isn't what we needed it to be, so we have taken a step back,'" says Quint Studer, founder and CEO of the Gulf Breeze, FL-based consulting firm The Studer Group. Tell the hospital's trustees, staff members, and physicians what worked and didn't work about the process, and then explain what adjustments have been made, says Studer. "CEOs have a real rough time admitting that they made a mistake."

Ramp up communication. Copley Hospital in Morrisville, VT, was struggling to implement a formal patient-centered model of care, so the critical-access hospital's leadership chose to put the program on hold. Next, they focused on opening up all levels of communication. For example, they implemented "It's Your Turn" meetings. On a quarterly basis, Melvyn Patashnick, Copley's CEO, and April Tuck, senior director of human resources and corporate compliance officer, hold meetings to share updates and answer questions from the staff. The meetings last 60 minutes and are held in the early morning, mid-afternoon, early evening, and at lunchtime, so the executives are available to workers on every shift. There is no formal structure; staff members are encouraged to stop by during that hour and ask anything. "The wonderful thing is, they do," says Tuck.

Move slow. Tuck isn't sure when Copley will resume its formal patient-centered culture change—but that doesn't mean the hospital has completely abandoned the effort, she says. Copley is still incorporating many of the patient-centered care philosophies into its strategy; however, implementing a formal program is not where the hospital's focus is at this time, says Tuck. "We are working on the basics—communication, consistency, clarity, and accessibility."

—Carrie Vaughan