Contributors: Carey Gallagher and Tom Bonner
To learn more about Carey and Tom, click here.
Source: Bigstock |
In the last decade we have seen a realization among healthcare leaders that organizational culture is a major factor in achieving short-term and long-term results. The reasons are many, from the fact that culture can dictate communication across teams, impacting the pace of work, to the reality that culture affects reputation, contributing to recruitment of top talent.
We view culture as the set of behaviors that often indicate deeply held beliefs about how people work with one another. The way that people complete tasks, make decisions, and reward performance are components of culture.
Our experience tells us changes in an organization’s circumstances can morph behaviors and expectations. We have seen these shifts generate new energy, but also reveal low-lying fissures and strike new pain points for people who work together. In some cases, critical incidents take leaders by surprise, forcing them to react to the sudden visibility of deep-seated culture issues. We began to wonder, what might be possible if leaders could better anticipate cultural needs?
We recently employed a confidential artificial intelligence tool to do a meta-analysis, taking a systemic lens across both of our project data in our culture work. We wanted to understand what precipitated the decisions to engage us, including if there were no patterns, or if large events had no bearing on culture issues. The analysis helped us isolate two prominent culture change indicators: leadership transitions and rapid growth.
Leadership sets the tone and direction of any organization, and people look to the top to see what they ought to emulate. Even new leaders who establish consistency with their predecessor’s leadership style will represent a culture shift. As people look for signals about what will count as success going forward, it is important for the leader to understand the dynamics at play.
One example of this played out in a clinical department, where a longtime, charismatic leader had recently departed. She had managed people through individual relationships, meaning that people knew where they stood by virtue of how close they were to her. She had also tolerated unprofessional behavior while neglecting to appropriately authorize roles and structure that would establish ways to escalate issues.
The incoming chair first sought to fill his predecessor’s shoes exactly, believing the department needed consistency foremost. However, he was not able to operate in the same way. Faculty and staff became unsure how to manage their responsibilities and some inappropriate behavior intensified, shedding light on deep-seated issues.
The cultural intervention came when a professionalism complaint was filed. Entering the leadership role with indicators of areas to which to pay the most attention could have built early credibility for the chair and avoided some frustration across faculty and staff. A “culture preset” could have provided that lens.
A culture preset is a way to take the temperature of an organization, going beyond employee engagement to understand the kinds of specific working agreements and success factors that have laid the groundwork for the current state. The preset can give leaders data on what kinds of things will be disrupted by the change ahead, and a way to flag focal points as the environment changes for their people. With these insights, leaders can develop an action plan for strengthening trust through the time of uncertainty.
In a culture preset frame, the institution would view the leadership transition as an opportunity to get ahead of needed culture change. Elements of the role ambiguity and disjointed leadership core would have appeared, enabling the new chair to take in what people would need to feel energized and able to do their work. Importantly, the tacit acceptance of unprofessional behavior could have been made explicit, giving the leader a better sense of how to ensure a safe working environment.
Nearly every organization we’ve worked with that has experienced a period of rapid growth has seen cultural fractures. That is no accident. Culture has been defined as the “residue of success,” meaning that the behaviors of people within an organization are calibrated to achieve results they perceive as valuable. However, behaviors that set the stage for growth are often counterproductive as the organization scales.
For instance, a respected surgical program saw turnover shoot up as quality scores dipped. It took a patient death to realize a cultural reset was needed. At its start, the program was a small, fast-moving team where everyone knew one another and people did their jobs almost through muscle memory, pitching in anywhere at any time. Yet as volumes and staffing shot up, so did turnover, and seasoned staff felt unable to teach new staff the ropes while balancing their own responsibilities. The culture had placed a premium on firefighting and speed, resulting in a high-risk lack of knowledge and a corresponding discomfort with asking questions. The approach to work continued to be pitching in with each person taking on more than they could manage — a culture that rewarded heroism at the point of martyrdom and restricted access to learning and planning. The pressures on the program came to a head with the preventable patient death.
Having the ability to understand people’s concerns and enthusiasm about the impact of a larger program on areas like relationships, roles and resources would have accelerated establishment of a constructive work environment. Engaging in a preset mode could have prepared the program for new learning and communication needs and ultimately may have been able to prevent the tragic patient death.
Rapid growth and welcoming new leaders can be seen as “good problems to have” and are big opportunities for any organization to set the stage for success. They change expectations and will lead to culture change. Importantly, both changes are recognizable and usually anticipated in some way, but not always prepared for. These two situations give leaders the opportunity to get ahead of their deepest cultural liabilities, enacting not a “culture reset,” but instead a “culture preset,” speeding time to optimal outcomes for the organization.
Contact Carey at: [email protected]
Contact Tom at: [email protected]
For more information on this topic or related materials, contact CFAR at [email protected] or 215.320.3200 or visit our website at www.cfar.com.