Five Lessons Learned: 2. Culture Matters

Five Lessons Learned in 10 years of Experience:

  1. Invest in doing it right
  2. Culture matters
  3. Leaders need to lead
  4. Create a culture of psychological safety
  5. Sustain new habits with group coaching from certified coaches with proven experience  

The challenges that Healthcare faces are the same throughout the country: limited resources, increasing regulatory burdens, dysfunctional payment incentives, suboptimal EMRs, healthcare provider shortages, and physician burnout. The solutions, however, differ because the healthcare cultures are quite diverse.

Tolstoy’s Anna Karenina opens, “Happy families are all alike: but every unhappy family is unhappy in its own way”. In other words, trying a cookie-cutter solutionoffered by too many large consulting firmsmight work in the Bay area, but it ain’t gonna work in West Texas.  

A great example of this is a week we spent in two different geographies and cultures. We visited two large integrated healthcare systems in the Bay area and West Texas. When asked for a show of hands as to how many on staff had been there for twenty years plus, almost everyone in West Texas raised their hands. The majority of hands in the Bay area didn’t go up until we asked how many have been there for five years or more. 

In West Texas, they had very strong relationships and no problem challenging each other and debating when having to make decisions. No matter how heated the discussions could be they were often followed by all of them talking it over a beer at the local pub. In the Bay area, there were no long-term relationships had been established, and therefore little or no trust, little debate was heard and yet little buy-in was achieved.

On the other hand, in West Texas, there was a paucity of innovation and a reluctance to adopt new ideas. In the Bay area, new ideas were greeted with excitement.

We have found that in a short on-site visit, we can learn enough about the culture to provide a custom approach. These face-to-face visits also allow us to talk with many physicians and executives within the organization, get their buy-in, and empower them to help us create a curriculum for meaningful change. We can leverage the strengths of each individual culture and concentrate on supporting those areas of need. 

The importance of understanding the culture and getting buy-in from key stakeholders can’t be over-emphasized. This in fact was supported by a recent study in “Health Affairs,” a monthly peer-reviewed healthcare journal.

This recent cross-sectional study cites the correlation between organization-level traits (culture) and the incidence of burnout.

It finds: “Agency at the practice level is important—people having a sense of control over how their job works and how their practice works is important, and I think we see that here,” the study’s lead author, Samuel T. Edwards, assistant professor of medicine at Oregon Health and Science University says.

In larger organizations, he advises trying to push agency as far down the hierarchy as possible. “Allowing individual work units to design their own workflow and have less central control seems like it would be a conclusion from this work,” Edwards said. Promoting a leadership culture dedicated to more collaborative and less-hierarchical working conditions is another potential area for larger organizations to explore as they work on reducing burnout in their ranks, he said.

Further underscoring this conclusion, the research found no correlation between the volume of patients physicians saw and the incidence of burnout. “In a smaller practice with strong relationships and a strong sense of mission, control over practice schedules, they’re choosing to work hard because they care about the work and patients, so they’re not burned out,” 

An organization, with long-term relationships like those in West Texas, was more reluctant to change than the Bay area group, and the buy-in there was more difficult. Once the buy-in was obtained, they were able to move forward much more quickly. As author, educator, and management consultant, Peter Drucker once said, “culture eats strategy for breakfast.”

If you are looking for ways to learn to promote leadership culture in your organization with the committed support of CPL, reach out to us today.