Of the complex issues facing the healthcare industry today, the most challenging may be creating an organizational culture that leads to success. Culture isn’t just a buzz word; it’s shared beliefs and values that influence behavior, and culture should be viewed as a strategy as important as any new program or technological or service innovation. Culture can significantly influence all areas of an organization, from improving outcomes to controlling costs to recruiting and retaining the best employees.
During times of mergers, acquisitions and integration, culture can be hard to define, let alone foster. There are competing forces, personalities, goals and even turf wars. But as we move toward hospitals and healthcare without walls and emphasize a team care approach, building organizational culture becomes a critical task for healthcare leaders.
Benefits of Culture of Innovation
In my 13-plus years as an emergency medicine physician, I’ve seen firsthand the benefits of creating a culture that embraces innovation. As a college athlete and coach of my son’s basketball team, I see parallels between sports and creating a culture of meaningful integration in healthcare.
In football, players are essentially “siloed” with limited skill sets and a specific job to do. The quarterback never punts. After fourth down, the wide receiver doesn’t stick around to play defense. The ball changes hands once a play. After that play is set, there’s relatively little on-field communication.
Many hospitals and health systems operate like football teams. They say they are “integrated,” but actually they are a collection of more-or-less functional silos. The difficult work of breaking down those siloes is never done and the result is staff unable to reach their full potential.
By contrast, a truly integrated health system is more like a basketball team: Players have positions, but these roles are flexible. Everyone plays offense or defense. Everyone dribbles, shoots and passes. Handoffs and communication are fluid and constant throughout the game.
And what a difference this type of play makes to the game, or the patient. The integrated system moves faster. The players constantly work together to plan and execute the next move. From the patient’s point of view, this translates into being cared for by one cohesive team moving between departments, or even hospitals.
Three Hospitals, One Vision
To achieve a meaningful culture, providers within a system must work as one team. This can be seen in the experience of a health system with three hospitals in California.
One challenge facing this organization was that patients were often sent to competing, out-of-system hospitals for certain services or when beds were scarce. The healthcare leadership decided to change the organizational culture so that the players within the system would work as a collaborative team.
It worked. The hospitals’ staffs found that by working together, they could frequently meet patients’ needs within the network. This tactic not only prevented financial losses but also was safer and more expedient for patients and their families.
The approach achieved remarkable results:
- In-network transfers recaptured $1.4 million in revenue
- Average inpatient length of stay (ALOS) dropped for all hospitals (by 25%at one hospital). The current network ALOS is 2.9 days
- Case mix index (CMI) was at an all-time high
- All emergency departments saw a marked drop in turnaround times to admission (TAT-A)
Steps for Success
Success began with leadership committed to changing their game by changing their organizational culture. A strong, positive culture imbues everyone within the organization with a sense of shared mission and camaraderie. Conversely, a weak culture tends to fragment into fiefdoms ruled by competing interests.
But culture isn’t built via cookie cutter programs. Each organization is unique. And trying to impose the perfect culture from the top down doesn’t really work. Culture is more likely to take root when it’s based on sincere, deeply held beliefs and values that resonate across the organization.
Some considerations when creating a meaningful and beneficial culture within your organization are:
- Clearly define and communicate your organizational culture. Give well-delineated examples of what it can and should look like. Leadership sets expectations by living culture daily through example.
- Nurture values that matter. For example, build a team that’s open to change. Clinical integration requires massive effort and adaptation, which is hard. Upheaval on this scale tends to foster tension – if not outright resistance – among providers, nurses and staff. The good news is that it’s possible to build a culture where change is embraced. People who are principle-driven have the courage to risk and innovate.
- Listen to the people on the front lines. Generally, frontline providers have the best ideas and a better handle on workflows, resources and human assets. Foster grassroots leadership and encourage initiative building from the bottom up.
- Encourage autonomy. Physicians and clinical staff often engage more when they have control over how their work is done. It’s important that everyone understands the hospital/health system’s vision and commits to work toward the same goals. Each practice will achieve these goals in different ways, but if they are successful, the end result will always be the same -a culture that puts patients’ needs first.
- Provide “torchbearers” by identifying leaders to help colleagues understand your organization’s culture.
- Reinforce cultural beliefs with expectations. These will be unique to each organization, but consider these:
- Create a “no-fault zone” where struggle and failure are accepted as part of innovation
- Be realistic about group strengths and shortcomings
- Praise those who ask for help
- Make it about people. Values and beliefs can’t be nurtured in a vacuum. Culture will grow as team members develop relationships. Provide opportunities for people to get to know one another both inside and outside of work through retreats, parties and celebrations.
- Embrace humility. Change leadership takes courage. Be humble and open to learning and listening. Accept that you can’t be right all the time, and model this for others.
None of these steps happen overnight.It may take a few years, and you can expect some growing pains, but the results will be well-worth the effort.