How to Jump-Start Culture Change

In seeking culture change, leaders are best served by foregoing any negative messages and instead finding existing pockets of "good "—teamwork-oriented culture that other groups can emulate.

In a time of great uncertainty in healthcare, a catch-all phrase, and the desperate need for it, has become trendy: Culture change.

In many cases, healthcare executives are using this phrase as shorthand for the fact that old working relationships, in many cases siloed, will no longer work going forward. Healthcare organizations are increasingly being held accountable not only for specific outcomes from specific interventions, but ultimately, for the health of the populations they manage.

Executives argue, with justification, that activities that do not bring value to the service being provided will have to be excised. This is certainly true, from a strategic point of view. But at the operational level, the message that is heard is that poor culture is the employees' fault.

Of course no one says it that way, but it is implied, because culture is created not by executive decision, but by the individuals doing the work. In fact, in the trenches, the need to change culture may not be so glaringly obvious. In many cases, it may not even be necessary.

Hold the Negativity
In any organization, even struggling ones, there are pockets of good—teamwork-oriented culture—already. Shouldn't you work toward delivering a positive message rather than a negative one, and toward ferreting out those pockets of "good culture" so that others may emulate them?

I think so. This subject came up recently in a group conversation I was having with several senior leaders from hospitals and health systems from across the country.

"Senior leaders always talk about the need to change culture, but I believe employees get tired of hearing that the current culture is bad, necessitating the need to change it," says Pamela Stoyanoff, executive vice president and chief operating officer of Methodist Health System in Dallas.

"I feel like every organization has pockets of great culture," she says, "and I think it's more important to root out those pockets of good culture to celebrate and replicate them within your organization versus constantly trying to say, "We've got to change our culture."

Stoyanoff offers a practical example. Emergency departments in the four-hospital Methodist system range in patient satisfaction scores from the 40th percentile at worst to the 90th (best). The emergency department is a particularly tough place to achieve great results, she says, because most of them are very busy. But the variables are not so great as to explain the 50 percentage-point difference. 

"If we want to replicate our high performing results in our 90th percentile ED, we have to understand how they got there, and how they work with their staff and their leaders and their physicians," Stoyanoff says.

"So we're having our other ED leadership go to that ED to see what they do. How they hold themselves accountable. How they train people to talk to patients and to keep them informed about delays. Because there are delays in this ED. How do they still get that kind of result, and how can we replicate that through the rest of our organization?"

'Dangerous Territory'
It's not that people don't want to change their culture to one that's more cooperative, less stressful, less hectic, and more accountable to patients. But they often don't know how.

Demoralization can easily set in if all they're getting is negative messaging about the culture as it exists now. And if they're getting that alone, it also shows the powerlessness of the executive behind the messaging. Because they don't know how to change the culture either.

Most employees understand that the culture is them. They therefore receive criticism of their culture as an indictment not only against their ability to work together smoothly, but more importantly, to their commitment to healthcare in general. That's dangerous territory for any leader to tread on.

"People will tell me, 'I've been here 42 years, and I've been through all the changes. I've been through 14 CEOs, and I know I can change. I survived it all before, I can survive it again,'" says Stoyanoff.

That's an extreme example, but it's an attitude birthed from inconsistency, and raised in uncertainty of goals. It also suggests that the leader who's clamoring for culture change is at best out of touch, and at worst, seeking to shift blame for a problem he or she is out of ideas to help solve.

Which is why Stoyanoff, as well as current Methodist president and CEO Stephen Mansfield, are such believers in "rooting out where the pockets of exceptional culture are, and showing others in your organization how it's done really well."

"That's peer pressure," Stoyanoff says. "Everybody learns through that. And it also celebrates that your organization does have places where you're already there."