Practice Notes

Trying to 'change your culture'? You're already doing it wrong.


Managing Director Jessica Sweeney-Platt travels across the country to share Advisory Board research findings with members at annual meetings and on site at their institutions.

I spoke with a medical group leader not too long ago who said to me: "We have got to start walking the walk on population health, but our culture isn’t helping us. Can you give me guidance on what other groups have done to improve culture?"

My immediate answer was “Sure we can help with that.” But the more I thought about it, I started to wonder if that question was in and of itself one of the problems. You see, "culture" is a monster noun—it means so many different things to people that it ends up meaning nothing at all. And we hear this in our research all the time—everything is attributed to, or conflated with, culture. Which begs the question: how can you change something that encompasses everything?

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To answer that question, we have to answer the question "What is culture?".  And there are a lot of answers to that question. Edgar Schein, the MIT professor that many consider to be the "father" of organizational culture research, defines culture as follows:

"Organizational culture is the pattern of basic assumptions that a given group has invented, discovered, or developed in learning to cope with its problems of external adaptation and internal integration, and that have worked well enough to be considered valid, and therefore to be taught to new members as the correct way to perceive, think, and feel in relation to those problems."

Another way to think about it is that it’s a consistent, observable pattern of behavior in an organization—it’s the way things "get done." But no matter how you define culture, the operative question for so many of our members is "how do I change it?".

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The answer is you can’t—you can’t change culture if you think of it as a singular concept. You have to break it down into more manageable components, and then assess and prioritize those smaller pieces. Which is where our research can be helpful: there are four components to a robust culture, and while they are interrelated, each is something a group can address independent of the others.

1. First and foremost, a medical group needs a clear, robust, cohesive vision for what the group intends to achieve. A good vision is aspirational, easy to remember, and essentially answers the question, "Why is the health care community better off for the existence of this group?"

But a compelling vision is not, in and of itself, enough to ensure a robust culture. To achieve that vision, three things must be aligned to it:

2. Leadership that has its priorities and organizational structures aligned with the vision

3. Talent Management decisions that reinforce the vision at every stage of the employee life cycle

4. Infrastructure investments that support and reinforce those priorities and values


Find opportunities to improve your culture

The Medical Group Culture Intensive is a questionnaire designed to assess a group’s status on each of the dimensions discussed above to help executives and their teams find their most immediate opportunities for improving their group’s culture.

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