by Deb Marshall
Culture is one of those hard-to-get-your-arms-around concepts. We all know it exists and that it encompasses so many elements it’s hard to know just where to start. There is a culture in your hospital, whether you do anything about it or not, so we might as well be intentional about it and get the most out of our efforts. Here is our working definition of culture:
“The shared beliefs, values, customs, and behaviors
of a set of people or an organization as viewed
from both the outside and the inside.”
This gives us something to work with. This article will expound briefly on all of these elements but will also look at the overarching principle of Leadership in relation to Culture—you cannot have one without the other.
In the classic question of “which came first, the chicken or the egg,” the same could be said about leadership and culture. Those who lead an organization certainly shape its culture, but culture is still there even when leaders change. There can be years of history in a hospital with how nurses and physicians relate to each other, how accountability is handled (or avoided), how scheduling or budgeting is done, what behaviors are acceptable and unacceptable, who the opinion leaders are and why, etc. Leaders impact culture, and culture impacts leaders.
How we change it when we know there are things that could be improved is the challenge, of course. All organizations have problems, but the trick is in resolving them so that we are not addressing the same problems year after year. Also, all leaders in an organization impact the culture of the larger organization, as well as the culture in their own areas of responsibility.
We have found that having a “continuous improvement” philosophy helps tremendously in focusing efforts on what can and should be improved in relation to an organization’s culture. Often leaders and employees get defensive about admitting that things could be done differently and more effectively in their areas of responsibility.
This mindset alone is a culture problem and warrants addressing with individual leaders. Leaders must embrace improvement and its positive impact, versus thinking it implies failure or reflects on them negatively. A foundation for improvement can be set up through a Balanced Scorecard (or some similar concept of tracking results on many measures) which can provide the frame of reference, and state of mind, to always be looking for ways to improve.
Many of you are probably familiar with Quint Studer’s Five Pillars (Growth, Finance, Quality, Service, and People) and Nine Principles from his landmark book, Hardwiring Excellence (1). Developing measures that line up under these types of categories gets people focused on the right things and gives you a road map to follow for years into the future.
There are six specific areas to consider when designing your culture:
- Heritage and Traditions
- Language and Symbols
- Shared Values
- Service Theme
- Service Guidelines
- Service Standards
Heritage and Traditions
This is the origination of your culture and should be preserved over time. We often look at websites to see if hospitals have a section on their history—Who were the founders? What are the stories that go along with this? Are they kept alive today? This is especially true in smaller or rural communities where the hospital is often one of the largest employers and is a central institution in town.
If this historical perspective has fallen by the wayside in your organization, consider ways to revive it. If you are being faithful to your heritage, keep it going—it is one of the things most susceptible to loss over time, especially as generations change.
Heritage and traditions keep us grounded and help everyone see where you came from, what has been accomplished, and most importantly, what needs to be preserved for the future. It can be a powerful force in your culture.
Language and Symbols
There are two parts to this—the outward visual appearance of the symbols and language we use to identify our organization (logos, branding phrases, signage, fonts, color schemes, etc.) and the language we actually use in how we talk with each other. The first one is no small task to accomplish in terms of consistency. The second one defines how we relate to each other—both internally and with our patients and customers.
What we say…and what we don’t say…can have a huge impact on the culture in your organization. How we greet people, what words we use to describe a procedure to a patient, how we talk about others in our organization with co-workers, how we recognize people for the positive things they do, how we talk to people about what needs to be improved and why—all of these things are critical to establishing and maintaining culture. We can set standards that help define the kind of behaviors that improve a culture versus those that tear it down.
It is particularly impactful to give leaders training to help them carefully choose the words they use. Using the skills from the training and book "Crucial Conversations: Tools for Talking When Stakes are High" (2) is very helpful in giving managers the information they need to avoid the negative impact that emotion can have on the effectiveness of our communication, and therefore our results.
Shared Values
These are often based on the heritage and traditions established during the course of history. Shared values answer the question “What do you, as an organization, believe to be true?” They are usually found in your mission, vision, and values statements and are the principles upon which your hospital builds its culture.
Usually we don’t see more that five to seven value statements. They should be shared with leaders and staff frequently and, in fact, can be used to start almost all meetings by just asking the question—how does what we are meeting about today impact one or more of our key values?
Value statements are usually developed by boards of directors and executives, then defined by middle management, and then translated into daily activities by employees. They define accountability.
Service Theme
This is often a phrase that exemplifies the “higher calling” that motivates employees to do more than just their job. It puts depth into why they are there and provides a framework for the feeling we want to create. It sets the stage for motivation by evoking emotion and is an action-oriented statement that points to the ideal.
This service theme is used internally in the organization and should not be confused with external branding. A couple of examples will illustrate:
- “Making a Difference by Touching Lives” – a faith-based hospital in the Midwest
- “We Create Happiness” – a famous one from Disney
- “We are ladies and gentlemen, serving ladies and gentlemen”– the Ritz-Carlton
These phrases are inspirational statements that can set the tone for what you are trying to accomplish. Be wary of copying someone else’s service theme—it really should reflect the nature of YOUR organization.
Service Guidelines
There are core behaviors that are expected from everyone in the organization. They are like the “Everything I Need to Know I Learned in Kindergarten” behaviors or the things your mother taught you—parental wisdom and etiquette basics.
These service guidelines translate your values statements into behaviors. They are common sense but unfortunately are often not common practice.
In order to instill them in your organization, define them. What does being friendly look like (i.e., eye contact, how we greet people, helping them find where they are going)? What does a service culture sound like (i.e., scripts for frequent patient contact situations, please and thank you, tone of voice used, use of intercoms/pagers, etc.)?
These are often developed by asking your employees for input through a facilitated process of focus groups and then distilling down to a list of 7 to 10 items. This creates great involvement and buy-in to what you want to accomplish. It also provides leadership with a well-defined accountability tool.
Service Standards
Service standards are prioritized criteria for decision making that everyone uses. There are usually no more than five of these and often include concepts like safety, quality, integrity, courtesy, compassion, effectiveness, efficiency, etc.
This one is probably the most difficult to define but also the most impactful when it comes to making significant decisions regarding your organization’s future. Which standard trumps all others? What really is the most important, what is second and why? Service standards give leaders and employees a thought process to follow and are guiding principles when it comes to making important decisions.
In your organization, where is the greatest pain when it comes to your culture—is it lower than desired patient satisfaction? Turnover? Lackluster employee engagement? Quality or error rates? You have to start somewhere, so focusing on the areas where you can get the most positive results in a relatively short period of time will benefit you in terms of visibility and momentum.
Resource availability is of course important in terms of time, people, and financial support for changes. Create an implementation plan and execute! It’s all about results and accountability, and communication is absolutely key. Consider enlisting the support and input of your marketing department to help with getting the word out on what you are trying to accomplish and to promote consistency in your messages.
(1) Studer, Q. (2003). Hardwiring Excellence. FireStarter Publishing.
(2) Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial Converations: Tools for Talking When Stakes are High. McGraw Hill.
About the Author
Deb Marshall, Wipfli’s HR consulting manager, is a seasoned HR professional with over 25 years of experience helping businesses make the most of their “people” opportunities and challenges. She can be reached at our Eau Claire office at 715.858.6923 or dmarshall@wipfli.com.