Hitting the culture reset button for your medical practice

Workplaces with less-than-ideal employee culture are not always easy to identify to those working in them, including the leaders.

As Tracy Spears, founder, Exceptional Leader Labs, Tulsa, Okla., noted in her preconference session, “How to turn around the culture in your practice,” at the MGMA 2017 Annual Conference, being too close to it all can blind some people to the issues.

Not recognizing toxic cultures in the workplace has been damaging to several large organizations in the past year, Spears noted, including:

• Ride-sharing giant Uber, which faced a series of harassment claims leading to the chief executive officer’s resignation
• Google, where a former employee’s internal memos were lambasted for being sexist
• United Airlines, which faced a whirlwind of bad publicity after the dragging of a passenger from a flight earlier this year went viral

Because organizational culture is a very emotional thing, it sometimes requires a practice leader to act like a newcomer when attempting to hit what Spears called the culture reset button.

“Sometimes you don’t realize how toxic an environment is until you leave,” Spears said.

Since practice leaders need to stay on the job to influence organizational culture, Spears said that the transformation process must begin with a phase of discovery, where the practice leader is able to “act like a newcomer,” be objective and approach things with a fresh eye.

Finding trends, not isolated cases

Spears says that anonymous feedback plays a big part in getting to the heart of organizational culture issues. Employees are more likely to provide honest opinions if satisfaction surveys give them a chance to sound off “without drawing a straight line to themselves,” Spears said.

With that information collected, the next crucial step is to put the responses in their proper context and place the proper amount of emphasis on issues and de-prioritizing issues that do not have an organization-wide effect. “What I care about are things that are trending in the organization,” Spears said. “What are the things we can say people have a collective feeling about?

“Too many times, leaders will look at the surveys and pull out the one thing that hits them in the chest and they will focus on that. You cannot do that,” Spears said. “You have to look for the rule of three. … If you see something show up three times or more, you have a problem.”

Practice leaders also should assume that there will be a sense of those issues across the workforce, making it more important to be open about the challenges. “[Employees], they’re feeling and absorbing all of the drama, all of the stress … the more stressful it is, the more transparent you have to be.”

Spears noted that openness about the lingering problems through the organization is a way to build a bond among employees. “When you’re not wondering and worrying about what’s really going on, you can create loyalty throughout the organization.”

Keys to a culture of trust

Spears offered a list for practice leaders to remember in the quest to build “an unshakable culture of trust.” Among those keys:

• Rethinking what being an  “open door” leader means: “I don’t mean that you’re going to have an open-door policy … I mean, you are willing to open the doors to difficult conversations” and confront problems, Spears said.
• Being able to explain decisions: “I don’t want you to explain everything you do,” Spears said, but that “there are some decisions that you need to get out in front.”
• Listening to others, then talking: Spears, echoing her earlier note about achieving a degree of objectivity and seeing things with a fresh perspective, said practice leaders should avoid thinking like they already know the narrative of an issue in the office.
• Being an advocate for others: “Never get caught talking about another employee with another employee,” Spears said, noting that conversations mentioning someone who is not present can be twisted by others. “If you are the person listening to the story, you are an accomplice to the story,” Spears said, making it vital that a leader always consider what would that other person’s side of the story be.
• Assuming good intentions: Spears said it is very easy to assume that someone who does something nice must want something out of it or has some other ulterior motive. Give others a “clean slate” and see them for how things are in the moment, not through the lens of assumptions that are based on the past.

Hitting reset, then maintaining

Spears, who opened her session by outlining the important role that emotion plays in the culture of an organization, said that hitting the metaphorical reset button is all about changing the energy of an office to reframe relationships and put a stop to gossip or other negative talk.

That process begins, Spears said, with a practice leader organizing and building anticipation for a reset meeting where the future vision for the organization is outlined. That buildup is a key feature to helping people “feel energized” about what is to come, which will increase the reset’s chances of success.

“Usually this does not work if a leader just comes in and says, ‘Here’s a mission statement, here’s what I want to do,’ … that does not get a lot of buy-in,” Spears said, noting that many people may have lingering resentment over a long time if they do not understand their part in the change or feel they had a voice in the transformation.

The leader of the reset meeting then should focus on connecting members of the organization — whether they have been there for many years or only a few months — to “a more friendly, happier environment,” Spears said, adding that it helps to emphasis that change is not happening to them but rather for them, the patients and the future of the practice.

Culture reset meetings will look different based on the organizations where they occur, but all of them require “embedding a positive culture” to keep the momentum going for weeks and months ahead, Spears said. Practice leaders should exercise active communication about sustaining the cultural changes sought, including interviews with employees at scheduled times to assess how things are going for them, the highs and lows of their respective jobs and how they view their future and the working relationship with you as a practice leader.

Spears closed her session by stressing just how important the work of building and improving organizational culture is to everyone involved.

“We spend too much time at work to let this not be a priority,” Spears said. “The culture is what affects job performance, how we feel about a job and whether we’re happy or not … you need to do something about it."