Culture and leadership: Two sides of the same coin

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One of my physician practice clients asked me to help them improve their patient satisfaction problem. After a series of interviews with staff and physicians, I gave them my diagnosis and treatment plan - if they did not fix their employee satisfaction problem, they would not fix their patient satisfaction problem. And the primary culprit for the former problem: a dysfunctional workplace culture.

What do we mean by “culture” and why is it so important to address? Culture is often hard to describe - but we do know how it makes us feel. On the surface, culture is represented by behaviors, by the way people interact, by how patients are treated, and even by the look and feel of the workplace. What are even more critical to culture are all the things that lie below the surface: attitudes, beliefs, assumptions, and values. Research has found a direct link between work culture, employee engagement, and company success factors (such as productivity, financial metrics, and customer/patient satisfaction).

In his research into organizational culture, Daniel Denison, PhD, found four critical factors that impact workplace performance:

• Clarity of mission and goals: People understand and are committed to the organization’s strategic imperatives.

• Empowerment: People feel that they are part of a high-performing team and are given the training and resources to do their job.

• Agility: The organization is responsive to customer needs and concerns, it adapts to changes in the industry, and changes are managed effectively.

• Consistency: Processes and procedures that bring value to the organization are leveraged, people agree on core values, and there is good coordination and integration among various departments.

If organizations are not intentional about the culture they want to encourage, then the culture will take on a life of its own. Leaders drive culture, so as leaders of your practice, it is important to identify what type of workplace culture you want to promote. Here are some strategies to enhance employee engagement and teamwork, while driving a patient-centric culture.

• Focus on providing positive feedback: Make the feedback genuine, specific, and timely. The more specific the words of appreciation, the more rewarding it feels to people. And everyone can play a role - colleague to colleague; manager to direct reports; physician to staff. Because our brains are hard-wired towards a negativity bias, we tend to notice the negative more, feel it more strongly, and remember it more than positive events. To help mitigate this bias, we need about 8 positives to 1 negative. By “catching each other being and doing good,” everyone plays a role in creating a culture of appreciation, support, and positivity.

• Promote a culture of learning: Mistakes should be used as opportunities to learn versus opportunities to blame or shame. Ask “what and why did this happen?” versus “who did it or who’s to blame?” The more that mistakes are talked about (in a safe and supportive culture), the less medical errors get made. But it requires “psychological safety” where people feel safe to talk about mistakes and errors without fear of retribution. In contrast, except for repetitive errors and/or intentional errors, reporting them should be embraced as opportunities to learn and improve.

• Develop workplace core values: These values, or guiding principles, need to resonate for people. Involve staff in identifying and defining the values they want to encourage and reinforce so that their work environment feels safe, supportive, collaborative, and patient-focused. When people help to author their core values, they are more likely to own them. Establish practices that will reinforce the values and recognize people for exemplifying one or more of them. Examples of values might include: act with integrity; support your colleagues; bring a positive attitude to work; and treat patients as our “guests.”

• Encourage a sense of teamwork: We are wired to quickly form in-groups and out-groups (what is often referred to in the workplace as “cliques” or “silos”), which causes greater affiliation for people we feel connected to and more animosity for those outside our “tribe.” The best way to encourage a sense of team is to help everyone identify with a common purpose (such as providing excellent and compassionate care to patients). It also requires people to work together as a team; rather than thinking about “my” patient versus “your” patient, all patients should be considered to be everyone’s priority. Success is now defined as taking care of all patients that come to the practice, not just taking care of the patients to whom a provider is assigned.