Want to improve your organization? Start with the culture!

Most of us are not even aware of our practice's culture. Culture represents “just the way things are around here.” Culture is the sum of the collective assumptions, expectations and values that reflect explicit and implicit rules in the practice. Until challenged or violated, most people are not even aware that these assumptions and rules exist — such as how we treat our patients, and staff. As a result, it is very difficult to intelligently discuss culture, not to mention try to change it. A new staff person learns about the practice culture through socialization processes, interactions under uncertain conditions and by contagion.

Much of that learning, however, is not systematic or conscious. As we move into value-based models of care, we realize the need to change, understanding our organizational culture is important. Culture is the single largest factor that inhibits organizational improvement and change. Research is clear that healthy cultures enhance success; whereas unhealthy cultures inhibit success, but in order to take advantage of the power of organizational culture, it must be adequately measured. Research by Cameron and Mora found that 96 percent of the time, successful mergers and acquisitions could be accurately predicted based solely on cultural match. Organizational change and improvement, in other words, is markedly affected by culture. (Cameron, Quinn 2011). 

The one key ingredient that differentiates the extraordinarily successful company from others is less tangible than you might expect, and more powerful than any market factors. That key ingredient is organizational culture!

We must also point out that culture change, at its root, is intimately tied to individual change. Unless clinicians, office managers and staff are willing to commit to personal change, the practice culture will remain unchanged and movement to value-based models will be painful and possibly unsuccessful.  

In the book, “Diagnosing and Changing Organizational Culture,” Cameron and Quinn introduce the Competing Values Framework. The Competing Values Framework (CVF) has been recognized as one of the forty most important models in the history of business. It originally emerged from empirical research on what factors make organizations effective. The framework has since been applied to a variety of topics related to individual and organizational behavior. It has been the focus of empirical studies for more than 25 years, and it has been employed to help thousands of organizations and tens of thousands of managers improve their performance.

Here are some of the key points from the competing values framework as we strive to bring about change in our practices.

Your practice or health system as a whole, needs to come to consensus on your current culture and on your preferred culture needed for change in a value-based model. The organizational culture assessment tool (OCAI), based on the competing values framework, is one source available to assist a health system or practice achieve a viable picture of both current culture and culture as you would like it to be. The OCAI is an instrument that allows you to diagnose the dominant orientation of your practice, or health system, in addition to diagnosing your preferred future culture.

Within any one practice subcultures may exist within departments. This is ok, however, the departments need to share the same goals and mission with the group as a whole-- similar to a hologram where each unique element in the image contains elements typical of the whole in addition to its own unique elements.

There is not one perfect or preferred culture type to meet the changes required in healthcare today, tomorrow the culture may need to change again. The goal is to recognize and articulate your culture today; be willing to look at the incongruences within your system or practice between the culture of today and where you need to be tomorrow for high performance and success in a value-based model.