Is your hospital’s culture ready, willing and able to tackle today’s colossal healthcare reforms, or is it massively unprepared and in dire need of change? Either way, you would do well to read Andrea Simon’s article on the subject, “Adapt hospital culture to changing times,” recently published by Fierce Healthcare.
Twice serving as interim senior vice president of marketing and branding at Hurley Medical Center in Flint, Michigan, Dr. Simon spearheaded a major culture change process that successfully brought about greater collaboration, teamwork, empowerment, creativity and innovation for the hospital and its staff. Below are details outlining how she initiated and then managed the change process:
“With all the changes taking place in healthcare, now is a good time to look at your hospital’s culture. I wrote a series of blog posts on my work with Hurley Medical Center in Flint, Michigan, where I twice served as interim senior vice president of marketing and branding, most recently from 2010-2011.
During that time, one of the biggest challenges the medical center faced was how to change its culture. Healthcare reform, we all knew, altered the delivery of care and the revenue streams. Younger doctors, nurses and staff who entered the system brought with them new values, beliefs and work styles. And yet the hospital, and perhaps yours as well, operated with exactly the same culture―values, beliefs and behaviors―as it had done for many years.
The CEO, Patrick Wardell, wanted to begin a culture change process. But what was the culture, anyway? What should it change to? And how do you change culture? It’s a tricky business, because old habits and cultures are well ingrained, reinforced by the people with whom you share them.
It didn’t take us long to realize how controlling and hierarchical the hospital had become. On far too many occasions, staff and physicians came up with interesting ideas for improving care delivery. But when we asked my colleagues at Hurley how to turn these ideas into actions, they told me to ask the CEO.
Another ingrained cultural element was the lack of staff empowerment to do things in an ad hoc way. A highly unionized organization, the staff was most comfortable letting decisions travel up the line for someone senior to make, then waiting for the answers to trickle back down to them. Plus, physicians and nurses had less than collaborative relationships―not an ideal situation and one that seemed ripe for culture change.
Our challenge quickly became apparent. How could we get 2,500-plus physicians and employees to first, understand their existing culture, and second, agree upon how it should be in the future?
As a cultural and corporate anthropologist, I work with organizations that need or want to change their cultures. The approach I use, as I did with Hurley, is grounded in the research and methods developed by Kim Cameron and Robert E. Quinn at the University of Michigan. For more than a decade, they researched the many different types of cultural styles at play in companies and organizations. They then grouped these styles into four quadrants, differing by the degree to which companies were internally or externally focused, and flexible or controlling.
The four types are described as follows:
Based on the Competing Values Framework developed by Robert E. Quinn, they developed a short but very powerful questionnaire to help companies assess their culture as they experience it today and as they prefer it in the future. This tool is called the Organizational Culture Assessment Instrument (OCAI).
OCAI creates a graph for each person, expands it to each department and then the entire organization. At Hurley, almost 65 percent of the hospital, including physicians and the board, completed the OCAI. The results looked a lot like this―this is a sample and not the actual for the medical center.
For Hurley, the hospital’s culture was highly ‘red’ (controlling, hierarchical) and ‘blue’ (results-driven). What was missing, across almost all departments and even among the trustees, was a desire from the staff for more collaboration, teamwork, empowerment, creativity or innovation.
This did not mean they would sidestep regulations or fail to deliver patient care effectively. But ‘doing it as it’s always been done’ needed some serious rethinking.
There are always deep tensions at the heart of a culture change process. People may not like ‘the way it’s always been done’ yet they hold on tight to what they know. Habits are hard to break and the brain hates to change. Therefore, the process to undertake culture change must be highly collaborative and very much like a theatrical performance. Even if people don’t want to perform the play anymore, everyone knows their roles. Culture change is very much like learning a new role in a new performance.
Once the journey begins and a new script is learned, it is harder to go back to the old (which wasn’t getting you to the future anyway). So what will make ‘a new way of doing things’ stick? Strong leadership, lots of small wins and constant encouragement.”
To read Andrea Simon’s article in its entirety in Fierce Healthcare, click here.
Andrea J. Simon, Ph.D., is a former marketing, branding and culture change senior vice president at Hurley Medical Center in Flint, Michigan. A corporate anthropologist, she also is president and CEO of Simon Associates Management Consultants.