This article is in response to “The Hard Work of Culture” by John Mitchell CEO from Modern Healthcare Online.
The underlying message of John Mitchell’s article (one of the most requested) is both correct and refreshing. Its content signals to me that a CEO in a leadership mindset needs first to realize the importance of organizational culture and its many subcultures that contribute to the success of an entity. Organizational culture reflects the beliefs and behaviors in which, overtime, a body develops, learns and acts out each day. Its objective is the status quo [survival], and today in many healthcare organizations, survival is the only mindset.
Very few CEOs perceive the importance of their role and that of senior leaders plays in leading and championing desired culture change to ensure its survival and competitiveness. Mr. Mitchell does.
The vast majority of CEOs do not understand how the power of their organizational culture correlates to their legacy or tenure success. Most CEOs focus on pleasing their board chair and feel partially accountable for the behaviors and beliefs demonstrated every day in their organization, about which they cannot change as they focus on the bottom line. I say “partial” accountability for their organization’s culture because full accountability is with the board of directors. I can safely say many board members do not understand this responsibility as one of their primary duties as many have revealed, “I was never told.”
In reality, physician clinical integration and alignment in most cases requires an organization to transform their culture to the new behavior
The culture of healthcare organizations continuous to be in a vicious cycle of self-perpetuation in an organizational climate of mistrust, miscommunications, finger pointing, discrediting and hoarding of control.
Dysfunctional behaviors are condoned and rewarded every day by performance reviews not given, salary increases, budget appropriations and contract approvals. Healthcare culture appear to be in a survival state of defensiveness, physical slowness and mental dullness.
Why is it so hard to see and feel the confidence and courage in the board of trustees, hospital management and medical staff leadership who everyday, whether they realize it or not, by their daily actions, create or reinforce the culture within their organization?
The board of trustees must step up and become accountable for setting in motion a process for renewing their organizational current culture by re-aligning key stakeholders’ roles, expectations and behaviors for themselves, hospital management and medical staff leadership.
Most boards do not know they are accountable for their organization’s culture, they rely on their CEO for recommendations and continue operating in a traditional hospital governance model – which in most cases is the status quo.
Board members, CEO, Senior Leaders and Medical Staff Providers need to examine together real experiences that constitutes their current attitudes and behaviors when they interact with each other. Determining functional relationships is about being in sync and aligned with clear roles and agreed on expectations.
The board of trustees are responsible for discussing the following:
First and foremost the board of trustees must require accountability of itself, hospital senior management and medical staff leadership. In doing so, working together as business partners modeling direct, honest and open communications, establishes the beginning of new rules of engagement, which starts with individual accountability, which shifts the organization to the desired culture.
Reality check – If health care organizations are going to succeed in their current environment it will require board members and their CEOs to reassess their understanding of the board’s accountability to its community; its governance model; its strategic plan; its responsibilities for clinical quality; patient safety, finances, patient, physician and employee satisfaction and its ability to assess the recommendations and performance of executive management.
Never before has there been more of an emphasis placed on Trustees leadership skills, business acumen, risk management, collaboration, diplomacy and the ability to think and act proactively.
Health care organizations are staggering from regulations to reimbursement, medical treatment advances to an aging population.
How should boards approach their responsibilities today with the relentless fast moving stream of changes?
How do you find out if their board and its members are being held accountable for their role responsibilities?
Best practice strongly suggests annually conducting an Individual Board Member Performance Self-Assessment.
It is essential for the board to take a timeout each year to think about and rate their own performance. This self assessment is not about the performance of the CEO or the management team. The purpose is to evaluate the board’s satisfaction with aspects of its performance and to be candid on the areas needing improvement.
The objectives are twofold:
Self Assessment questions range from 15 – 20 questions with a rating scale #1 Disagree, #5 agree #10 strongly agree. Each question includes, “How can we improve?”
Each trustee independently and anonymously rates the board’s performance on the set of questions, i.e., “Our board has developed trustee performance expectations that are shared with new candidates and used annually as part of the ongoing performance assessment and reappointment.”
Effective boards take the time and expend the effort to ensure each trustee has a clear understanding of their role and responsibilities and understands the performance expectation the board has of them. Having informed, engaged trustees committed to continuous learning and performance improvement is essential to the board’s effectiveness.
Board members must be responsible for making a contribution and for their own behavior – being on time, coming prepared, asking good questions and engaging in constructive discussions and decision making. It only takes a single director’s dysfunctional behavior to undermine the entire board’s ability to work together and do good work.