Physician engagement is critical to effectively address the changes in health care, and organizational culture is central to physicians’ sense of engagement and overall satisfaction.
For employed physicians—especially those who previously worked in smaller medical groups or solo practices—organizational culture becomes even more significant due to the differences in areas such as accountability, autonomy, work environment, and modes of communication. But organizational culture also plays an important role in group and solo practices, as these physicians evaluate their current situations and possible futures.
Recently, Physician Wellness Services and Cejka Search conducted a nationwide, multispecialty organizational culture survey of more than 2,200 physicians—(82 percent of whom were either in a hospital, group practice, or academic medical center)—and a companion survey of administrators. The survey identified cultural attributes important to physicians’ overall satisfaction and gaps between these attributes and the physicians’ satisfaction with their organizations’ focus on them. It also explored the importance of cultural fit to physicians as they evaluated and made decisions about new practice opportunities.
The importance of culture
The survey focused on 14 cultural attributes in the following four major areas: work environment, organization, leadership and management, and communication (Table 1). A notable initial finding was that all the cultural attributes were important to physicians, with the following cultural attributes in the lead (average scores):
- Respectful communication (8.6)
- Patient-centered care focus and supportive management approach to errors and mistakes (tied at 8.5)
- Transparent communication (8.4)
When physicians were asked to rank their top three attributes, patient-centered care ranked first.
Physicians gave lower marks to their organizations’ demonstrated competence in these areas; average scores ranged from 5.8 to 7.6. The highest scores were for patient-centered care focus and clear mission and values (tied at 7.6) and respectful communication (7.2). The lowest score was for transparent communication (5.8).
Satisfaction scores around organizational focus on the attributes were even lower, averaging 5.7 to 7.0. The greatest gaps between perceived organization competence and satisfaction were in clear mission and values (0.8 gap), patient-centered care focus (0.6 gap), and team-focused environment (0.6 gap). But perhaps the biggest concern is the gap between the ideal and actual scores, indicating considerable room for improvement.
In the companion administrator survey, participants were asked how important the cultural attributes were to physicians and how well their organizations demonstrated competence. Although administrators were pretty much on track with what was important to physicians, they were more positive than physicians in assessing their organizations’ competence on cultural attributes (range: 6.9 to 9.1). This finding points to more gaps that could lead to issues.
The implications of cultural fit
Finally, the survey assessed how well physicians believed they fit within their current organizations, how this affected their satisfaction, and whether issues around cultural fit had prompted them to leave a practice or job or accept other opportunities.
Regarding cultural fit, physicians scored their own fit as 7.0 on average, and administrators assessed the cultural fit between their current physician population and the organization at 7.2—both far from the ideal score of 10. When asked how much cultural fit influenced job satisfaction, physicians’ average score was a more robust 8.4, indicating they clearly felt this factor was important.
The influence of cultural fit on behavior could be seen in questions about employment decisions. More than one fourth of physicians chose the highest score (10) when asked if expectations about cultural fit had been a determining factor in accepting a practice or job opportunity (Fig. 1). Even more physicians responded with a 10 when asked if lack of cultural fit had prompted them to leave a practice or job (Fig. 2). This is a significant finding, and may be understated, given several comments in the open-ended questions indicating that some physicians wanted to leave, but stayed in their present job due to concerns around family and location preference, career stage, or economic concerns relating to the poor economy.
Administrators noted that more than one third (36 percent) of otherwise qualified candidates were not offered a position due to lack of cultural fit, and a similar percentage (32 percent) of voluntarily departing physicians cited a lack of cultural fit as a primary reason for leaving. This points to another noteworthy gap: Administrators may be underestimating the degree to which cultural fit affects retention and recruitment.
Liz Ferron, MSW, LICSW, is the senior consultant and manager of clinical services and Daniel J. Whitlock, MD, MBA, and Robert Stark, MD, are consulting physicians for Physician Wellness Services, Minneapolis.