Hospital Culture

[Tony]

Okay, let's start tackling some real issues. Like the previous discussion mentioned, let's offer insights on what the problem really is, but let's also think about possible solutions. The first one I want to bring up is the difficult, elusive, but increasingly important issue of organizational culture.

It's the culture that determines whether physicians and nurses work together well.
It's the culture that determines whether communication and coordination is adequate in patient care
It's the culture that determines whether the patient is really put first.
It's the culture that determines whether patients feel like projects or numbers or a collection of organs or human beings.
It's the culture that determines whether important new initiatives are embraced or ignored.
In many ways, it's the culture that determines whether a hospital truly meets its mission.

So what are the best ways you've seen/read on how we can create (or transform) a working culture that fosters teamwork, respect, and real compassion?

Would love to hear your thoughts (I'll be chiming in, too)

[Mike]

Great topic Tony, this is a big ticket item in hospitals and really gets to the grassroots of how a hospital meets its mission. Where to start...I would say hospitals are a form of a baseball team culture. The employees are free agents if you will with unique and highly sought after skill sets. These folks are in high demand and can basically find employment anywhere they go. They/we work in fast paced high risk organizations where the stress level is high much of the time.

Hospital cultures are very segmented as well. Not only are they segmented by profession i.e. nursing, medicine, ancillary services etc. but also intra-professionally within in each discipline i.e. Nursing - ER, ICU, Med/Surg; Medicine - Surgery, ER, Attendings Residents and the list goes on. Each group has their own expertise they bring to the table and each are jocking for position on many issues depending on the impact. Bottom line hospitals have very dynamic cultures.

The culture of any organization I think gets its direction from the executive leadership. Hospitals typically divide their executive level into specific directorates based on the clinical component - Director of Nursing, Director Medical Services, Director of Surgical Services etc. Even with the delineation of control over certain organizational aspects there needs to be a united front on common issue that effect organizational culture, otherwise you end up having interdepartmental wars.

I'll comment more on this when time permits but I have seen a trend with hospitals that have obtained Magnet status that seems to be unique. Of the 245 or so hospitals in the country that have obtained this certification you will notice that their job occupancy rate is very low compared to other hospitals. Why is this? Well I would have to say that the work environment in these organizations - culture - puts everyone on an even playing field. I have not had the opportunity to work in a Magnet hospital but I have spoken to folks that have and they all enjoyed working there. People were professional, respectful, patient care was an active focus not just something talked about.

Would like to hear from anyone that has worked in a Magnet institution to add to this.

[Denny]

The issue of culture is a big one and one that cannot be shifted just by focusing on the tangible actions of people . Causing a shift in culture can be potentially difficult because an actual "culture" does not exist in hospitals or really any workplace. There is no definite "culture" that you can see and touch. There are only different conversations and interactions that people are having in real time. What gets labeled as the "culture" is really only what people perceive is happening around them and to a large extent what they expect to happen in any given situation. For example, if a nurse expects a doctor to ignore them, they will act consistently with someone who is expecting to be ignored. This in turn has the doctor think it doesn’t matter what they say, because people will go and do their own thing anyway. A “culture” is then assumed where people do not listen, and others act out of line or work around people.

For leaders, the most critical thing they can do to shift a "culture" is find out what the conversations are that their people are having. Not only is it important to know what people are saying to each other, but also what are they saying to themselves about the way things are. When a leader knows what people are saying about "the way it is around here," the leader then has an opportunity to address the issues and make a difference.

Another key tool for the leader is really creating for every associate the right conversation and commitments for their role. What is it that you want every employee to say about their role and responsibility? When somebody is clear about their purpose and objectives, they are free to deliver on them. When a challenge presents itself, being clear on the most important commitment will give people direction.

The last piece to really having a shift happen is a leader who is willing to stand behind their commitments and not be stuck on how their commitments will be delivered. Having leaders and teams be in absolute agreement about the outcome, committed to the hard to have conversations, and flexible in the delivery will create an environment where leaders and organizations can grow.

[Tony]

I really like both answers to this topic. Mike, your point about structure influencing culture is a good one. As you eluded to, no matter how the structure is set up, there will always be a need for the leadership (how ever things are divvied up) to collaborate & communicate. And Denny, your point about culture being dependent on individual experiences is right on as well. And I really like how you've defined culture in a way that anyone can grasp easily (since it is sort of an elusive term). A few more thoughts on my end:

1. I've often heard it said that there are as many cultures in an organization as there are bosses. Each boss, in some sense, creates his/her own culture. And these bosses take their queue, in large part, from their bosses, and on and on up. So it really starts w/ the senior-most leadership

2. Incentives are a big part of shaping the culture, and part of that is monetary incentives. What is rewarded in your culture? Usually, it is the lack of error.

2a. I don't think you can really "incentivize" (I hate that word) a culture of compassion. Compassion, by its very nature, in order for it to be sincere, has to be driven by a truly unselfish, generous concern for the fellow man. We hospitals should not set up a system to regularly reward compassion (i.e. don't give bonuses based on the number of appreciation letters written by patients), but hospitals should appreciate and recognize those great spontaneous moments of compassion that happen all the time.

[Michael Vela]

Quick thoughts.
Attitude Reflects Leadership - employee attitude, team attitude reflects their leaders actions.
Regarding both Mike's thoughts about Magnet status hospitals: I believe that Denny has hit on this, Magnet Status or Studer or LEAN or some higher goal helps focus staff, focus their commitment and helps transform organizational culture.
I think that regardless of the initiative du-jour, a key factor in success is total commitment on the part of leadership. Walk the walk and talk it, 100%. Staff and associates will quickly smell any lack of commitment and no momentum will be gained.
Momentum implies changes and any momentum gained can easily be lost. Continuous small (incremental) positive changes seem to work the best in maintaining momentum.
Finally, frequent communication. In one of my best experiences, it was in a systems I worked at in the Chicago area. Not only did I know about the successes within my own hospital, but I knew about the success across the system. Helped keep my focused.

[Kristin Baird]

I have found that there are five common denominators among organizations that have succeeded at transforming organizational culture. They are:
* Setting and communicating clear priorities
* Hiring and developing the best people
* Establishing efficient and effective processes to support their people in achieving priorities
* Helping each individual find and nurture a sense of purpose that is linked to the organization's values and vision
* Then finally, leading with passion. Passion is the catalyst that propels the first four forward with greater momentum.

[Lim Khoon Min]

"It's the culture that determines whether important new initiatives are embraced or ignored."

I like this. It's the battle that I'm fighting now.

[Cindy Fallsen]

Great topic. In the Medical insurance industry, we need to be asking the same questions. Often people think of hospitals as Temporary medical care places and do not bother with creating a positive culture. I recently read an article that has these questions to ask about your culture.

* Which aspects of our current culture are we happy / unhappy with?
* Do we even know what it is?
* What preferred behaviours do we need to create the culture we want?
* What behaviours actually get rewarded round here?
* Which unacceptable behaviours are actually tolerated here?
* How do our company processes promote / hinder our preferred behaviours?
* How do our leaders measure up against each of our preferred behaviours?