Modern Healthcare Online: “The hard work of culture” By John Mitchell CEO

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

Perception Speaks Strongly When Expectations Aren’t Clear

In my experience conducting organizational key stakeholders’ relationship assessments, most physicians I have interviewed have the perception they are not the hospital’s #1 customer. They do know they have less influence and control over the hospital environment they work in – whether employed by the hospital or an as Independent Practitioner.

Physicians’ Perceptions

When I asked a family practice physician why he had this perception, he, in turn, asked me if I had seen their physicians’ lounge. He recommended I take the time to see it to understand what he meant.

When I toured the lounge, I saw a poorly lit room with worn furniture – a small cluttered desk with one phone, an outdated desktop computer, and a thermos of coffee with a short stack of Styrofoam cups on an end table.

Another physician related his frustration with the intensive care unit being sporadically opened and closed, noting the situation had been ongoing for a year. If physicians were the medical center’s #1 customer, he would not have lost the needed patient revenue for his practice nor had to inconvenience his patients and their families when he had to transfer them to an ICU at a competing hospital 90 miles away.

When I further inquired about the intensive care unit not being consistently open, I was told a staffing issue had been plaguing the unit. The medical center could not attract or retain critical care nurses and the situation was further exacerbated by staff absenteeism.

Physicians know they are their healthcare organization’s #1 rainmakers, yet many are not made to feel as if they are the most important contributor to the organization revenue stream. Most physicians realize the board and hospital administration have little clue to their needs or expectations nor for the organizational bureaucracy they encounter every day when implementing their clinical patient orders.

Transparent Reality

The attitude among the top-board members and management teams is very transparent and drives the organization’s attitude toward the physicians, which manifests itself in many ways by well-intentioned persons.

Most organizations rely on implicit expectations when dealing with physicians; these are unwritten and unspoken rules, requirements or understandings among people.

Board policies shape the way management and medical staff undertake their work. Boards are accountable for setting policy with directions and behavioral expectations. They must be clear in what they want the organization to do or refrain from doing.

Is your policy clear throughout the organization?

When was the last time your board of directors discussed and approved an explicit policy with expectations on how they wanted the organization to conduct and transact business with their physicians? If the answer is never, why not?

When people have a clear understanding of what is expected of them in providing customer service to physicians and meeting those expectations, trust grows and relationships develop. The opposite occurs when customer service expectations are not clear and not being met; trust diminishes and key stakeholder relationships become strained.

Do you have organizational consensus?

The board may have a policy consensus but that does not guarantee that hospital management and their staff agree.

Going back to the story shared by the physician about the conditions of the physician’s’ lounge – in the corrective action, the board and hospital management established an ad hoc committee of management and doctors to determine and recommend remodeling options.

Within 90 days, the lounge had a complete makeover which included new furniture, a kitchen area with food, coffee machine, etc. The dietary department became accountable for daily replenishment and environmental services was responsible for daily cleanliness.

The efforts by the board, hospital management and the ad hoc committee were well received by the physicians. Within a couple days of the lounge’s reopening, a nursing supervisor and a small band of nurses expressed a subtle resentment at the upgrade done for the doctors and not for the nurses.

Regarding the physician’s story concerning the inconsistency of the intensive care unit’s hours, the board and hospital management approved a physician-led ad hoc committee to determine action plans and recommendations to enhance the credibility of the ICU.

Within 90 days, a well-respected internal medicine physician assessed the ICU to determine both its strengths and areas needing change. He made the following recommendations: (1) become the unit’s medical director for one year, (2) schedule physician education for the unit’s nursing staff and (3) collaborate with nursing management to transfer the unit manager and find her replacement. Interestingly enough, nursing salaries were not a major issue. Hospital management collaborated to make the long-needed changes in the unit’s leadership. A formidable minority of employees perceived the physicians were now running the hospital.

Do you have organizational commitment?

Commitment begins with the board of directors being accountable for setting policy and expectations. People Employees look to their hospital management to take the time to share and clarify such expectations and consequences. Shared accountabilities create ownership and build relationships of trust and support.

Development of a “physician customer service policy” is the responsibility of the board. Its successful implementation is with the hospital management and their staff who must fully understand performance expectations and consequences when interacting daily with physicians.

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