Tag Archives: Culture of excellence theory

Can we become the culture that ‘learns the fastest’?

I recently spent some time in a beach chair (after a busy day on the golf course), reading a bit more about organizational culture. What does it mean? Why is it important?  And why do some organizations seem to drive excellence while others have a ‘that’s how its done around here’ attitude?

According to Glisson (2007) “a number of studies in various types of organizations link culture and climate to service quality, service outcomes, worker morale, staff turnover, the adoption of innovations, and organizational effectiveness (p 739 )”. For example, when we enter a hospital and a banner greets us that reads – the employees and physicians of X welcome you to our institution (FYI – this is a real life example) – we know we’ve likely hit upon a site where culture creates a sense of purpose and a feeling of family….. where people are valued for their expertise, where the stories we tell about colleagues are positive and supportive.  So what do they do differently at a place like X to create the type of culture we all hope to have?

With my own interest in healthcare, I loved the bold statement from James Anderson (retired CEO of Cincinnati Children’s Hospital Medical Center)….. who publicly declared that their organizational aim was to ‘become the organization that can learn the fastest’ and their goal is to ‘be the safest hospital’. Now that’s a leader with a clear vision of what a culture should be. A leader who models the change he wants to see. He and his team have defined excellence in their culture.

Changing corporate culture is difficult. According to Beer & Nohria about 70% of these cultural changes fail – mainly because we immerse ourselves in ‘an alphabetic soup of initiatives’…. I’m sure we all have organizational stories of our ‘flavor of the day’ initiatives where our employees just keep their heads down and wait for the next flavor, OR stories of the plethora of projects we ask our staff to take on at one time – with no additional resources or a firm commitment to stay the course and measure outcomes. BUT change is a topic for another post, so I’ll return to a focus on culture.

The signs and symptoms of an unhealthy culture (according to FCC) include a:

lack of teamwork; poor communication; siloed behaviour; infighting and competition for scarce resources; unclear objectives; overly complex customer interface; and blame, finger-pointing, fear, and mistrust. Organizations may do well on the bottom line in the short-term despite problems with the culture, but in the long-term an unhealthy culture leads to poor performance. (p 3)

Ultimately, the old adage that culture trumps strategy – is true….. the best strategy in isolation will fail every time.  I like the idea that culture isn’t “what we say, it’s what we do without asking”. “Where a healthy culture allows us to produce something with each other not in spite of each other” according to Nilofer Merchant.

What does it say about a culture, when on your first day of orientation, the CEO and Senior Leadership Team meet each new employee and say this is ‘how we do things around here’….. its our culture and the expectation of each of us on the team at FCC. Now that’s a culture that gets recognized and one where people say, I want to work there.

So….. what can WE do in our own organizations to transform our cultures?

There is a lot of great advice out there on leading cultural reform. For me, what resonates is the data specifically related to healthcare transformation. Back at James Anderson, building a culture of reliability includes things like: constantly asking why, a commitment to resilience, front line leaders rounding daily with staff giving 5:1 positive to negative feedback …..these are just a few of the examples you’ll find (on their website) of a transformed culture.

Christine Daley endorses the attitude of Anderson, and identifies that health care organizations often have trouble learning from our failures and using what we learn to make sustainable change. She quotes Senge and his belief that organizations have to strive to become learning organizations (or perhaps better described in my last post as those who practice organizational learning).  As Senge suggests, this process is one “by which individuals continue to expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free and where people are continually learning how to learn together (p 26)”.

What I’ve found, is that we are trying to change our culture of blame….. but so far, we have only created pockets of safety for our staff, it’s not safe everywhere and with everyone – we still have lots of work left to do. We often forget that practitioners are usually devastated by an error, sometimes they never recover. And rather than support them because we know it was the system that failed and not the well-meaning individual; instead we remind them constantly that they were the cause…. BUT, its hard in an industry when errors mean harm to the patients we work so hard to protect. When our errors end up on the front page of the paper and in a court room where the outcome is still to assign blame and cost.

It would be great if jargon like collaboration, innovation, creativity and continual self-transformation and learning could be terms that we take to heart in our healthcare cultures. I paused when I read Daley’s example of ‘knowing less than our individual members’ – where nurses are aware of new research that would enhance patient outcomes but are asked to work according to outdated organizational policies and practices (p 27). These comments were front and centre for me at a meeting this week, where we talked about specific policies that we are working on and the need to stop the ‘continuous tweaking’, that we should be satisfied with what we’ve got and move on to other and more important things. I wanted to say, stop, but, but, but….. there must be a way for us to continuously adapt our culture. We can’t just move on and be satisfied – but, being new to the committee I stayed silent (and thought yep, this IS how we do things around here)….

I  subscribe to Daley’s ideas of how we bring organizational learning theory to patient care:

Perhaps these themes (specifically adapted to our culture) will help us to see that organizations that practices continuous learning are likely also the ones that see cultural transformation.

Conceivably what’s working at FCC, can also be the 7 steps that will lead reform for us in healthcare:

  1. Identifying a need for change
  2. Establishing and articulating the vision
  3. Enlisting the appropriate help
  4. Leading from the top
  5. Communicating to engage all
  6. Sustaining the new culture
  7. Measuring progress

If it was/is possible at FCC, I believe that we all have bright people in our cultures who can also make it possible. When I look at my own culture (with my rose-colored glasses on),  I choose to believe we have: identified the need for change (#1), enlisted the external help that we’ll need (#3) AND I am hopeful that our leadership team holds ourselves as accountable and responsible to lead the change (#4). Now its up to all of us to ‘act our way into it’ as you’ll see next.

When I’m struggling to find a way to innovate or see my way to the end, the IHI (Institute for Healthcare Improvement) is often my guiding compass. This summer, they published an article that told me that creating a culture of excellence is not as difficult as we might think. They recommend that we ‘act’ our way into it…. that new cultures are not planned out on paper, but are acted out over time. They offer that there are a few ‘vital behaviors’ that create desired results – perhaps for front line staff it’s always asking for help or that leaders will visit the front lines every day….. but over time, if we all ‘act’ the same way and our teams see that this is the new normal, we’ll create a new attitude in our workforce. According to IHI, gone will be statements like ‘well those things just happen’ and ‘we’re not like them’ and instead we’ll hear ‘how could we’ and ‘why don’t we’ ( p 69).

It seems like a pretty simple theory…

It makes me think about the famous quote that many people have at the bottom of their e-mails that reads…. ‘be the change you want to see’ (Gandhi). And here I’ve been the one skeptical of those canned quotes…. seems they are effective after all.

SO….. that’s a lot of surmising (from a beach chair), but it has given me a new energy for what’s ahead and a bit of personal CPR for where our organizational culture is going. What about you – are you willing to ‘act your way into’ a new culture where we commit to ‘learning the fastest’?



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