Our healthcare clients commonly bring us in to support any number of initiatives– reduce turnover, increase HCAHPS scores, reduce time to fill, or simply hire better performers. Frequently, we end up having a discussion about culture. Culture can be hard to define, but we take the position that your culture is nothing more than the collective behaviors of your workforce. What behaviors do you encourage and reward? What behaviors do you tolerate, or not?
For us, that means, what behavioral competencies should we be looking for as we build an effective selection system? We end up, in this process, learning a lot about an organization’s culture and about culture change, in general.
I posed a few questions to Laurie Wasko, Ph.D., the Director of Consulting Services and leader of our healthcare consulting group. Laurie and her team work with health systems and healthcare companies, large and small – and they all talk a lot about culture.
Here’s what Laurie had to say:
1) What are the signs of a negative organizational culture?
There are a few leading and lagging indicators that we typically see. Overall, a negative culture can impact bottom line performance, so business metrics suffer. We see and hear from staff that too much time is spent resolving seemingly minor disagreements. In a good culture, those disagreements would be pro-actively resolved in a collaborative manner.
Employee engagement/satisfaction scores will suffer in a bad culture. Patient experience data will reflect the culture. Generally, if you have happy, engaged employees, it will be reflected in the environment you are creating for patients. (Studies consistently show a correlation between employee engagement scores and patient satisfaction scores!)
Also – in a “bad culture” we often see little faith in direct supervisors. Staff are less likely to seek out their help and advice. Front line managers, rather than faithfully implementing the strategy established by senior leadership and putting a positive spin on changes, try to gain credibility with their subordinates by being critical of the senior team.
2) If you have a negative culture, what’s the best way to change it?
This is tough, particularly in larger organizations. Negativity spreads quickly and can pull in your best, most engaged employees who get frustrated. It’s hard to turn a big ship. We’ve seen hospitals take years of diligent effort to change their culture. At the other end of the spectrum, we’ve seen rapid changes in a department or office by changing the manager. Some managers have the ability to create a positive work environment and make staff feel valued.
Accordingly, changing leadership/managers is often the quickest way to turn it around. Some managers and staff are just incapable of building a positive culture. Avoid hiring these people with a solid approach to hiring. Make the hard decision to part ways with people who are harming the culture.
We’ve designed the hiring systems for two hospital start-ups recently. Senior leadership took culture very seriously. We built a hiring system that targeted highly collaborative, patient-focused staff. Not surprisingly, both of these hospitals quickly had the best employee engagement and patient satisfaction scores in their respective health systems. Managers should align words and actions with the culture, and hold themselves and others accountable for their decisions and behaviors.
3) What are the negative impacts of a negative culture in the workplace?
A disengaged employee is three times more likely to have a negative impact on others. A highly engaged employee has a positive impact. A negative culture means:
You lose good people.
You’re negatively impacting the patient experience.
The organization’s bottom line performance suffers. We tell people – don’t build a better culture because it’s a fun thing to do – do it because it impacts your business goals.
4) Is hiring and re-filling positions the best way to change culture?
You should make every hiring decision with culture in mind. But hiring good people to a bad culture won’t work either. We’ve had hospitals with bad cultures implement our tools and hire highly collaborative, service-oriented staff who didn’t stay long when they realized that leadership and their immediate managers didn’t value these characteristics. Sometimes a few key changes make all of the difference.
More often it requires a diligent and organized effort to better define WHAT the better culture will be. Once the culture is defined, it’s a matter of establishing and communicating the behaviors that will support this culture and then hiring to these behaviors and evaluating manager and staff performance based on these behaviors. This alignment should start at the VERY top of the organization, and trickle down through all leadership levels, as well.
The ENTIRE organization should be held accountable. Those that don’t display behaviors in line with the culture need to go. Hospitals, more so than other organizations, tend to be slow to remove poor performers. Given what we are trying to accomplish, this has to change. Set the expectations and hold people to them, starting at the top.
5) What’s the impact of organizational culture in healthcare?
There is a direct correlation between employee engagement scores and patient experience scores. Culture impacts staff retention and even the ability to attract good candidates – clinicians quickly pick up on the work culture reputation of the facilities in the area. Culture, and the behaviors that make up that culture, impact the patient experience. They even impact the quality of patient care and patient safety.
Research shows, for instance, that hospital cultures that tolerate lateral violence between staff, poor communication, or poor adherence to patient safety procedures, tend to have lower scores on measures of clinical outcomes and patient safety.
For instance, OR checklists only work when the OR staff embrace them and there is a culture of attention to detail, conscientiousness and the desire to make the extra effort on behalf of the patient. Often leaders can do small things to set the tone.
I’m always impressed when I see surgeons helping OR staff between cases to get the room ready for the next case. It sends the message of a real team environment and whatever metric you are measuring – in this case OR suite turnover, is owned by everyone on the team.
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