Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Culture Change Helps Health System's Hospitalists Become One Team (Part 2 of 2)

2/9/2016 10:12:02 AM | 0 comments

In my previous post, I described how the hospitalists of the Adventist Health – Central Valley Network (CVN) came together to effect system-wide change. Hospitalist medical directors from the network's three hospitals started collaborating after joining CEP America. However, it wasn't until the culture really clicked that the initiatives they designed took off. (More on that "click" in just a moment.)
 
So what are the cultural prerequisites for "meaningful" integration? And as leaders, what can we do to ensure these take root in our hospitals and health systems? In today's post, I'll share my thoughts, plus some real-life examples from the CVN.
 

Why Culture Matters

 
Simply put, culture is a constellation of shared beliefs and values that influences behavior.
 
A strong, positive culture imbues everyone in the organization with a sense of shared mission and camaraderie. When culture is weak or negative, self-interest reigns, and the workplace tends to fragment into fiefdoms ruled by competing interests.
 
Integration is all about breaking down these fiefdoms (or their healthcare equivalents, siloes). It requires retooling all parts of an incredibly complex system. For example, CEP America has committed to aligning its providers with CVN's goals. In practice, this means getting nine independent practices in six facilities spanning four specialties and led by seven medical directors and two lead PA/NPs on the same page.
 
So where does one start?
 

What Do We Really Believe?

 
First, it's important to remember that every organization will (and must) approach culture in a unique way. For example, at CEP America, we embrace something called "the culture of caring." It's based on the belief that patients should be at the center of every decision we make.
 

I think one of the things that makes CEP America stand out is that it’s led by inherently caring people. They really believe—we really believe—that the best business strategy is always the one that’s best for patients.
- Jon Brummond, PA-C


The "culture of caring" isn't essential to integration. There are plenty of integrated providers that don't follow this belief (or hold opposing beliefs). But we embrace it because it's how we really think healthcare should be delivered.
 
Trying to engineer the perfect culture and impose it from the top down doesn't really work. Culture is more likely to take root when it's based on sincere, deeply held beliefs and values that resonate across the organization. It's worthwhile taking some time to define these — not just among the leadership but with input from the workforce as well.
 

Critical Success Factors

 
Strong culture is unique to your organization and rooted in sincerity.
 
That being said, when it comes to integration, there are certain values and beliefs that tend to promote success. So by all means, nurture them within your organization, weave them into your expectations and bear them in mind as you make hiring and contracting decisions:
 
Openness to change. Clinical integration requires massive effort and adaptation. Upheaval on this scale tends to foster tension — if not outright resistance — among providers, nurses and staff.
 
But it's possible to build a culture where change has the opposite effect. People who are principle-driven tend to be galvanized by challenge. Whether their goal is to help patients, improve their practice or make healthcare more sustainable, their conviction gives them the courage to risk and innovate.
 
Engagement. As a leader, you have the ultimate control over how things get done. But as a general rule, the best ideas come from the people on the front lines — the ones who will actually execute the process or initiative.
 
Frontline providers have a better handle than anyone on workflows, resources and human assets. Do what you can to foster grassroots leadership and encourage initiative building from the bottom up.
           
When it comes to engagement, entrepreneurial spirit makes a difference. It's generally easier to foster leadership and innovation among physician partners than among physician employees, because the partners have skin in the game. They know that their own success is directly tied to their clients' success and channel their energy and talents in this direction.
 

Patient care is my passion. It’s the reason I got into medicine in the first place. At CEP America, the books are open, so I know that the sweat from my brow will come back to better my practice environment.
- Douglas Brosnan, MD, JD


 
Alignment. To a large degree, physician practices benefit from local autonomy. As noted above, providers tend to engage more when they have control over how their work is done.
 
However, autonomy in a vacuum tends to foster "siloing," which works against integration. It's important that each group understands the hospital/health system's vision and commits to work toward the same goals. Each practice will achieve these in different ways, but if they are successful, the end result will always be the same.
 

Getting Intentional

 
Culture itself is organic. For better or worse, it already exists in the minds and souls of your workforce.
 
But as leaders, it's our job to define that culture and make it explicit. We do this through example, communication and the expectations we set.
 
Some ways we can work to make culture explicit:
 
Provide torchbearers. When CEP America started the CVN hospitalist contracts, we welcomed many new providers onboard. To help them learn about our culture, we appointed experienced medical directors who embodied our values. When the groups were ready, these medical directors passed the torch to a new generation of leaders.
 
Reinforce cultural beliefs with expectations. These will be unique to every organization and leader, but here are a few that have worked for me:
 
  • Create a "no-fault zone" where struggle and failure are accepted as part of innovation.
  • Be realistic about group strengths and shortcomings.
  • Praise those who ask for help.
 
Make it about people. Values and beliefs can't be shared or nurtured in a vacuum. Culture will grow as team members develop relationships. Provide opportunities for them to get to know one another both inside and outside of work. Retreats, parties and celebrations can all play a positive role.
           
Embrace humility. Change leadership takes courage. Be humble and open to learning and listening. Accept that you can't be right all the time, and model this for others.
 

The Click

 
So what was the big moment for me when our CEP America culture clicked at CVN?
 
It was when I realized that the front line providers were coming up with better ideas than either myself (the regional director) or our experts from CEP America headquarters.
 
Once they were aligned, engaged and making decisions based around the patients' best interests, their ideas become more innovative, more workable and more sustainable. And that's when magic started to happen.


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