Perspectives on the Acute Care Continuum

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This Is What Happens When You Send Managers to Culture School

7/22/2017 5:07:04 PM | 0 comments

cep america culture collaborativeWhen one organization merges with another (as happens at a breakneck pace in the healthcare world), tensions can flare around organizational culture.
 
Case in point: I work for a national physician Partnership. Over the past few years, we've merged with several independent physician groups.
 
As our organization grows, we've looked for ways to nurture our culture — our core values, attitudes, and behaviors — in every CEP America practice. But it can be quite a tall order for a group that spans 250 practice sites in 14 states.
 
As a Medical Director, I'd seen culture change completely transform a struggling, understaffed emergency department (ED). I wondered if it was possible to explicitly teach culture (or at least its practical applications) to our new Medical Directors. After all, we doctors tend to be good students!
 
So together with my CEP colleagues, we piloted a shared learning collaborative around organizational culture. The project lasted a year and taught us some surprising lessons about the dos and donts of organizational "cultural diplomacy."
 

Why Culture Matters

 
For some, the word "culture" conjures up images office slides and kegerators. Culture has become such a buzzword that it's easy to forget how desperately it matters.
 
The stakes around organizational culture are especially high for healthcare. With provider shortages deepening, our workforce has considerable mobility. There's zero need for anyone to linger in a negative, dysfunctional work environment.
 
And turnover hurts. Our internal research suggests that it takes 3–6 months to recruit and credential a provider and another year or two for that provider to reach full productivity.
   
So how does culture play into this? For one, we want to create a climate that encourages providers to stick around. For our Medical Directors, this means providing all team members with a positive onboarding experience, a voice in practice matters, and opportunities for engagement and leadership.
 
Even more importantly, we need to hire people who are a good "fit." In the words of clinical psychologist Dr. Cameron Sepah, "Your company's culture is who you hire, fire, and promote." Not everyone was born to be a CEP shared practice owner, and that's OK. But we need to equip our Medical Directors with the tools to hire the right people.
 

What's a Shared Learning Collaborative?

 
With these goals in mind, we invited four of our newest Medical Directors (three from Kansas and one from Washington D.C.) to participate in our Culture Collaborative pilot.
 
Over the years, CEP has implemented a number of learning collaboratives to test and implement new processes. Our collaboratives have tackled everything from advanced provider satisfaction to ICU quality metrics and ED turnaround times.
   
Our Culture Collaborative had the following components:
 
  • Operational assessments
  • Pre- and post-collaborative surveys to all ED team members
  • Developing site action plans
  • A two-day collective learning event at DeKalb Medical Center in Atlanta, complete with workshops and breakout sessions
  • Biweekly coaching calls with the ED leadership team
 
At the conclusion of the program, we repeated our operational assessments and team surveys. We also asked the Medical Directors for feedback. As we started drilling down into this data, some surprising lessons emerged.
 

Can We Really Teach Culture?

 
Feedback from the participating Medical Directors was extremely insightful. They identified several areas that had been helpful as well as suggestions for improvement. I believe that many of the insights that came out of the experience are useful for all types of organizations.
 
Some key takeaways:
 

Your organizational mission and values must be explicit.

 
Culture is more than a mission statement. But transmitting your culture requires being very clear about who you are (and aren't) as an organization. Your mission and values statements serve as touchstones when you need to hold someone accountable or make a difficult decision.
 

Frame best practices with values.

 
The best way to explain your culture is to show it in action. For example, CEP is a democratic physician group. So we teach medical directors to run meetings using a democratic format that allows all voices to be heard.
 

Make time for social learning.

 
One thing our medical directors wanted more of was time to discuss their challenges with colleagues and mentors. In hindsight, this was a missed opportunity to model our culture while supporting our newest Partners. Cultural learning is mostly social learning.
 

Show how your culture addresses their pain points.

 
When people are new to an organization, it's natural to be wary of the dominant culture. They don't want some big shot marching in and making demands! Leaders can build trust by showing their teams how culture can address their biggest pain points. For example, since some of our medical directors were struggling with staffing issues, we gave them tools to spot and win over "best-fit" job candidates.
 

Make it real.

 
The recruiting session was probably our biggest hit of the collaborative. We used mock interviews to help the medical directors spot candidates who might fare better as employees or independent contractors than CEP shared owners. The participants suggested we add even more role-play next time around (for example, using courageous conversations to counsel providers).
 

Be aspirational.

 
Probably the best decision we made was to hold the two-day face-to-face learning event at DeKalb Medical Center. Remember that ED I mentioned that transformed through culture improvement? Well, that's it.
 
Just a few years ago, DeKalb's ED was struggling with recruiting and provider staffing. We wanted to make it a great place to work, so we spent a year focusing on the culture.
 
One of the keys to this change was improving the quality of our department meetings. Transparency is a key CEP value, and we used it to make our meetings relevant and engaging. We talked openly about challenges and our plans to address them. We shared our progress in the form of metrics and financial data.
 
Providers realized they were being heard. Attendance at the meetings began to rise. More and more team members bought in to our vision.
 
Today, DeKalb's ED has a vibrant culture rooted in our CEP values of ownership, accountability, and servant leadership. We've gone from being understaffed to having a waiting list of providers lined up to work with us!
 
According to our Culture Collaborative participants, the visit to Atlanta was a highlight of the program. They loved spending two days in an environment where CEP culture was "palpable and doable."
 

Putting It All Together

 
The Culture Collaborative reminded me that transmitting culture is like writing a book. You need some "telling," some narration to set the scene and get the action moving. But the richest way to tell the story is to let the reader experience it through characters, events, and occasional twists and turns.
 
As we look at ways to build on the Culture Collaborative, we'll try to balance both ways of learning. In addition to culture workshops and webinars, we hope to build a mentor program for our new medical directors. It's people who really make a culture live and breathe, so who better to learn from than our colleagues?
 

To read more tips on building a strong organizational culture, read this post by David Birdsall, MD.



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