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Culture Matters

News  |  By Bob Wertz  
   April 01, 2017

We all understand that money matters. In healthcare, the no margin, no mission maxim is a succinct way of emphasizing the essential need for financial performance if the core goal—delivering on a healthcare mission—is to be achieved.

This article first appeared in the April 2017 issue of HealthLeaders magazine.

That particular mission may vary from one place to another, but in each case, the organization's culture will play a critical role in determining the clinical and financial success.

Now, some may dismiss culture as a squishy concept, but it can have real financial consequences, and we see that in this month's cover story by Senior Nursing Editor Jennifer Thew, RN.

Thew examines the impact of clinician burnout, a phenomenon that, if ignored, can be costly. "One thing burned-out doctors reliably do is leave the practice. When people leave, it costs a quarter of a million dollars to replace them," says Mark Linzer, MD, FACP, director of the division of general internal medicine at Hennepin County Medical Center in Minneapolis.

It might be easy to dismiss the issue and place the responsibility solely on the individual; but Cynda H. Rushton, PhD, RN, FAAN, the Anne and George L. Bunting Professor of Clinical Ethics in the Berman Institute of Bioethics and the School of Nursing at Johns Hopkins University in Baltimore, says burnout is a leadership issue.

"It's a signal that something is off-balance. We don't get burned out because we failed. It's because we've been trying so hard to address issues, some of which are not solvable in our skills and resources and abilities," Rushton says. "I think leaders have to really take stock of the organizational processes, policies, and structures that are contributing to burnout and to allocate resources to support diverse strategies for clinician well-being, recognizing that one size doesn't fit all."

Linzer and a team of researchers identified three categories of effective interventions that place the onus on the organization—workflow redesign, communication improvement, and quality improvement projects. A culture that demonstrates concern for employees will address such matters. The impact: "How you organize and how you manage your personnel and how much you let it just be random motion will determine the difference between a hectic, chaotic place and a well-organized one," Linzer says.

Executives define and shape the organization's culture, but they also need to dedicate the resources to support the tools and programs that will nurture that culture. Ultimately, a positive culture will contribute to positive outcomes for the organization's margin and mission.

Bob Wertz is editorial director for HealthLeaders Media. He may be contacted at

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