In “The Importance of Organizational Culture” (AAOS Now, February 2013), we discussed the results of a survey, conducted by Physician Wellness Services and Cejka Search, that focused on cultural attributes important to physicians’ overall satisfaction. A companion survey of hospital administrators helped to identify the gaps between these attributes and the physicians’ satisfaction with their organization’s focus on them.
In this article, we look at the steps that can be taken to close those gaps, realizing that each organization is unique and therefore priorities and valued cultural attributes may vary.
The first step should be to determine what the organization’s culture is—and what it should be. Some organizations work for a long time defining their mission and values—and then stop. To take this effort to the next level, it’s necessary to define the current culture and determine what cultural attributes are important.
Administrators should develop a list and definitions, ask for input, and then let physicians rate where the organization is strong and weak—and how they feel about it. Once the results are collected, they should be shared and prioritized. Organizations should begin the process of change based upon the biggest potential impact or the biggest gaps between expectation and reality. Physicians should be involved—and, potentially, leading—subsequent efforts.
Plan for change
Organizations must be deliberate in their approach to change. After attributes are prioritized, one or two that will have the most impact should be pursued, with tangible benchmarks, accountabilities, and formal action plans to achieve meaningful and positive change. There should be agreement about the definition of each cultural attribute and the daily actions supporting it at the individual, workgroup, and organizational levels should be identified.
A roadmap on what needs to change is helpful. It should be as tangible as possible, communicated to all, and supported by tools and resources. No exceptions should be allowed. Physicians should be involved in decision making at every step.
The initiative should be discussed openly, at the individual and group level, with both physicians and administrators. Sometimes outside facilitators can be helpful in encouraging openness and creating a safe environment to share ideas and concerns.
Individual coaching and mentoring may be helpful. Holding all accountable is key—particularly those who previously have not been held accountable. Progress should be measured periodically and tactics adjusted as needed. Results should be communicated honestly and constructively. Training and education in communication skills, coping skills for stress and burnout, conflict management, and resilience around change—as well as civility and behavior coaching—may be helpful.
Change initiatives take time; simply adding committee meetings and additional work without placing value (monetary or otherwise) on the time and initiatives developed is counterproductive. Don’t move on to the next priorities until significant progress has been made around the first one or two cultural attributes.
Institutionalize cultural attributes
Organizational culture must be reinforced and nurtured. Recruiting for cultural fit is key. Assessment tools and processes can be used to ensure that physician candidates understand the organizational culture and demonstrate their ability to fit in and support it. Using behavioral interviewing techniques to drill with candidates regarding conflict management, teamwork, and communication will help ensure that they have the desired cultural attributes.
Within the organization, the following steps can help institutionalize cultural attributes:
- on-boarding programs that tangibly educate new hires and reinforce cultural norms
- physician leaders who personify and can model the desired cultural attributes
- a mentoring program with specific roles and accountabilities for mentors and mentees
- incentives for behaviors and attitudes that support the desired culture
- progress measures for the desired cultural attributes
- celebrations as desired changes are achieved
Physicians who are evaluating new practice opportunities should start by asking themselves what is important to them. When speaking to potential employers and coworkers, they should ask specific questions about the organizational culture—what it is, how it has changed, and what is being done to ensure cultural congruency. They should also ask for real-life examples of how culture is manifested and how the organization handles conflicts about cultural fit.
The ultimate shift
Ultimately, this is about changing behaviors and attitudes—among physicians as well as all the stakeholders who work alongside them and support them. This will benefit the organization by creating a stronger sense of engagement with its physicians while improving physician satisfaction with their jobs and careers.
Liz Ferron is the senior consultant and manager of clinical services and Daniel J. Whitlock, MD, and Robert Stark, MD, are consulting physicians for Physician Wellness Services, Minneapolis.