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Shaping Culture

Make sure your organization becomes and stays a quality healthcare institution that patients continue to come back to.

One of the hardest to quantify, yet most important, element of a team or organization is its culture. David Maxfield, vice president of research at VitalSmarts and co-author of New York Times best sellers Influencer and Change Anything describes culture as norms, behaviors and unwritten rules - what he refers to as "below the waterline," rather than what's above. In other words, the culture of a workplace is more subtle than the above-the-waterline influencers of behavior, such as policies, procedures, rules, etc.

Culture is often shaped by years of shared experiences and explicit and implicitly communicated expectations and group norms. The fact that culture develops over a long period of time and is often rooted, at least in part, by subtle organizational factors means that influencing culture can be a daunting task for even the most effective nurse manager.

Shaping the culture of your team can be a long, often frustrating, but ultimately rewarding process - if successful. Of course, there is already a culture that exists among your team members - it just may not be the culture you desire.

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For example, the current culture in your organization may have a lax attitude toward customer service or punctuality. Or maybe your culture is one in which front-line nurses don't feel comfortable sharing their ideas and observations with those higher up the administrative ladder.

Whatever your current situation, changing the culture in your healthcare institution is certainly possible, albeit difficult at times. The tips and strategies discussed below can help you guide your organization in a new cultural direction.

Identify What Needs Changing

"Within the healthcare industry, the culture is overwhelmingly positive," noted Maxfield. "Healthcare professionals come in with excellent motivation, strong values and incredible skills and talent." Therefore, according to Maxfield, the types of changes that often need to be made are small and are adjustments rather than whole-scale cultural replacements.

"You don't want to throw the baby out with the bath water," he said. Maxfield noted examples of the kinds of cultural problems he sees most frequently include fear of speaking up in a very hierarchical industry, poor teamwork or poor initiative. "Most people are doing far and above the minimum requirement, so if there is someone doing the minimum requirement, they really stand out and can be a problem on a team," he said. Maxfield noted it is crucial to run right in the face of these types of behaviors and address them head-on.

Clearly Communicate Goals & Values

Once you have determined what needs changing within your culture, the first step in making those changes is to let your employees know what values and goals they should be striving for. When Ann Martorano, chief marketing and HR officer of Halifax Health, undertook a cultural shift in her organization, one of the first steps was to collectively develop a hierarchy of values within the organization. The Cornerstone program, as the cultural shift was called, focused first and foremost on safety, followed by compassion, image and efficiency.

Spending the time and effort to really drive home exactly what your goals and values are can create a kind of domino effect, where employees begin taking on the task of communicating the culture themselves. "What I thought was so neat about [Cornerstone]," said Martorano, "is that I hear people in meetings now saying, 'Well, you know safety comes first. People are really living those values and they're using them to make their decisions."

Buy-In From the Top

Front-line employees look to their superiors for guidance in so many ways, but perhaps none is so subtle and constant as the way employees take cues regarding workplace culture from those at the top of the organization on down. The same is, of course, true for nurses. Nurses are far more likely to buy in to a cultural shift if they feel like their superiors are behind the changes. This doesn't mean simply paying lip-service to the changes. It means actively and visibly embracing the new order.

"First and foremost they have to have total buy-in from the leadership down through the ranks," said Martorano. "If you don't have that then you might as well not start."

One Bad Apple

It is crucial that the entire organization buys into your cultural change. It isn't truly a culture if only a portion of your workforce adopts it, and even seeing one or a handful of employees disregard elements of your culture can lead to a ripple effect where others also begin reverting back to old habits.

Martorano noted that although her organization's Cornerstone program was primarily directed at the clinical side of the organization, everyone was included in the program, no matter what their role. It is crucial for the entire organization to be committed to your cultural change. "During the month of January, we reoriented every employee in our system," said Martorano. "Over 4,000 of them, in a four-hour session for each person and launched the new culture. And it's worked!"

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Continuous Process

Just as your previous culture has developed over years of collective habits, experiences and incentives, your new culture needs to be continuously reinforced. "It's a never-ending, good challenge to keep it in the forefront," said Martorano, "Keep Cornerstone in people's minds so they remember what we are - our quality standard, our safety, compassion, image and efficiency."

Keeping your cultural shift top of mind is an active process that involves frequent incentives. Employees need to be reminded frequently that their efforts at conforming to the new culture are being both noticed and appreciated. "We try to recognize and reward and do all of those internal things," said Martorano. "It doesn't even have to require money but just recognizing the great work that people are doing . . . just anything we can do to say 'you're doing a great job,' hopefully helps keep people motivated."

Because culture is often difficult to identify and quantify, it can be easy to subordinate improving culture to more tangible goals; however, culture can have a real impact on your bottom line. "For us, the challenge in healthcare is we have to take great care of people, because they have a choice of where they can go, and we want to make sure they're coming to us," said Martorano. The tips discussed here can help you make sure your organization becomes and stays a quality healthcare institution that patients continue to come back to.

Lin Grensing-Pophal is a freelance writer.

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