Wednesday, March 12, 2014

Tip 30: The Culture Curve Ball

The Culture Curve Ball

“I guess the simplest definition of culture is what happens when the manager leaves the room.” — Vala Afshar 

Every so often I hear from leaders sharing stories about their great culture. Unfortunately, a lot of the rest of us feel as our ability to lead and contribute are compromised due cultural challenges beyond our control. One physician executive shared, “I am working hard to help the organization become more integrated, but often feel I’m up against what I can only describe as a crappy culture… it’s one curve ball after the next.”

Q: This statement begs the question: “Is good leadership possible even under less than ideal circumstances… like say in a “crappy” culture?”

A: YES. A quick context check before we huddle around this culture leadership dilemma. Just what is a "crappy" culture? More importantly, what does a good culture look like? Take a look at a few of these items. How strongly do you agree or disagree with these statements:
  • My organization's culture makes patients safer.
  • My organization's culture produces clinical quality. 
  • My organization's culture supports coordination of care.
  • The patient experience is not compromised due to behavior from leadership, physicians and staff.
These statements help us clearly determine if our culture helps or hinders us in context of a variety of organizational imperatives. In cases where cultures become more of a liability rather than an asset, leadership becomes even more important. (By the way, these are just a handful of items from our Patient-Accountable Culture assessment.)

Just to be clear, the objective is not to help you rank at the top of the “best places to work” lists — rather, it’s about focusing on creating a culture based on what matters most to patients.

So what do leaders of a “crappy culture” do? How are leaders supposed to function effectively?

It’s easy to be an effective leader in a culture that values teamwork, makes everyone feel safe, fosters trust, and is full of role model leaders to learn from. But what about the rest of us? Is it impossible to be an effective leader in a rough and tough culture?

NO. Here’s a few things that you’ll want to be intentional about if you find yourself in a culture that is less than optimal:
  1. Establish and maintain standards of performance and behavior that align with patients. Sure, the organization’s culture may have set the bar so low that trust, respect, and teamwork seem optional. This doesn’t mean your standards can’t be higher — much higher. More importantly, hold yourself to these same standards as a role model and leader.  As the Role you play becomes more apparent to others, you’ll lead by example and gain influence. Effective leaders give rise to new context that shifts organizational culture one interaction at a time. In this case, the new context you’re setting is about framing a culture that places less emphasis on our individual Jobs and more on the Role we play as part of a team.
  2. As you set the tone, continually clarify your non-negotiable leadership principles and stick to them. Leaders placed in an unhealthy culture are more likely to compromise their leadership principles and values. Take the time to develop your own list of leadership principles and values. Consider starting with these T.R.U.S.T.E.D. patient driven leadership values. If your leadership practice is based on what matters most to patients, you’ll be a tougher target when the symptoms of a distressed culture surface. Your Role will become your “go-to” tool for managing and developing culture. As Role becomes more important, you’ll be tested by others who are good at their jobs, but lack an understanding of the Role they play on the team.  As the leader, it is up to you to remain non-negotiable on your principles.
Is your culture aligned to what matters most to patients?... 
Click here to take the poll

In The News...

A Patient Dies. A Hospital Heals

By Bill Santamour
H&HN Managing Editor

A fictional account of a tragedy and how a hospital changes for the better.

A patient dies after surgery despite the fact that checklists and other cutting-edge policies are in place to prevent such a tragedy. The clinical staff become defensive. Physicians close ranks to deflect blame. Nurses know that if somebody has to take the fall, it will, no doubt, be one of them. The hospital CEO understands that the fault lies not with individuals or policies, but with a staff too focused on their own task-filled workdays to see the bigger picture and too cynical to believe that things can ever fundamentally change. And the CEO herself is so overwhelmed by putting out everyday fires that she has no time to think about long-term solutions.

That’s the set-up of Heroes Need Not Apply, Brian D. Wong’s fictional account of Angels Hospital and the aftermath of a patient’s death, a death that could and should have been prevented. Wong, an M.D. and founder of The Bedside Trust, paints a familiar picture of today’s hospital staff, in which the sincere goal of putting the patient at the center of everything they do can get lost in the crush of workloads, silos, egos, long-standing hierarchies, skepticism and plain fear. His vivid cast of characters includes a brilliant but intransigent surgeon, a young doctor with conflicting loyalties, an outspoken nurse, a new CEO and the person she brings in to help change the culture.

OK, I can see you rolling your eyes at the term “change the culture.” But by getting inside each individual’s mind and allowing us to listen in on their thoughts and conversations, Wong avoids consultant jargon and preachiness. He presents a true-to-life scenario of personality conflicts common to all hospital staff and the endemic skepticism that often straitjackets any leader’s efforts to foster meaningful change. And he shows how a hospital CEO can overcome those obstacles to, as the book’s subtitle puts it, “build a patient-accountable culture without putting more on your plate.”

The crux of that culture change is eliminating the chain-of-command structure and moving to one in which listening and respect across job titles and individuals can lead to true team care. As someone at Angels Hospital says, “No one person, no matter how smart, was nearly as smart as a roomful of people.”

In his introduction, AHA President and CEO Rich Umbdenstock writes that Wong’s story “brings a human element to the equation and underscores the importance of making patients and their families full partners in the care process."

Heroes Need Not Apply is an excellent resource for you and your physicians, nurses, C-suite and board members. Might even make a good stocking stuffer. For more information, click here.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

H&HN Daily, December 10, 2013

Heroes Need Not Apply... now on eBook

Kindle  iBookstore   Nook
Dr. Brian WongImproved care coordination is essential to gaining the efficiencies required in this healthcare reform era. To move metrics in patient safety, experience, and quality, we must become effective at delivering coordinated team based care.

In his new book, Heroes Need Not Apply, Brian Wong MD, uncovers the reasons why many of us experience spotty improvements in patient safety, episodic service excellence, and insufficient engagement and accountability. To make sustainable improvements, we need to know how to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care.

The purpose of Heroes Need Not Apply is to give healthcare organizations a template for creating a strong foundation for effective coordinated care.  This “how-to” book gives every executive, physician, nurse, and clinical team member the tools to make specific changes at the local level, and uses relatable characters to showcase effective patient-centered skills to improve efficiency, decrease costs, and improve the patient experience. If your hospital is looking to accelerate improvements in care coordination and improve team care,Heroes Need Not Apply is a timely resource designed to equip your organization with the practical skills required for improved care coordination.

The book has already caught the attention of many top physicians, nurses, and executives as an innovative resource to lead our industry into a new era of value based healthcare that is both cost effective and accountable to patients. 
Dr. Wong's Heroes Need Not Apply is receiving praise by noted physician leaders and industry experts throughout the country...
“Heroes Need Not Apply examines the root causes of healthcare’s most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams.”
— Richard J. Umbdenstock, President and CEO of the American Hospital Association

“I believe this book will help save lives, improve quality, and recommit healthcare providers and patients to new levels of trust.”
— Sue Collier, MSN, RN, FABC - Performance Improvement Specialist, Patient-Family Engagement, NC Quality Center/NC Hospital Association

“Dr. Wong’s book “Heroes Need Not Apply” breaks new ground as a field manual for what WE can all do on the front lines to be leaders as opposed to “reactors’ of healthcare transformation.”
— Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University Hospitals
"...[Dr. Wong] speaks the truth of what we must become as leaders in health care."
— Jeff Selberg, EVP and Chief Operating Officer, Institute for Healthcare Improvement.

“Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth.”
— Jack Cochran, MD, Executive Director, The Permanente Federation, LLC

“On the journey to team-based and patient-centric care the evolving healthcare system is indeed a place to which Heroes Need Not Apply."
 Joseph S. Bujak, MD, FACP

“Dr. Wong draws the reader into the world of the hospital and an understanding of the cultural barriers that contribute so much to preventable medical error.”
— Gordon R. Clark, President and CEO of iProtean
On Sale Now!
Kindle  iBookstore   Nook
To order your copy today and/or get quantity discounts for your organization visit:

A portion of the profits from the sale of Heroes Need Not Apply goes to support the Josie King Foundation.
Dr. Brian Wong
To learn more about Heroes Need Not Apply, and/or schedule an author’s interview for your organization please Click here>>
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