Wednesday, April 29, 2009

Culture of an organization: a key success factor in these economic times

In numerous articles published recently, we read that over half of the hospitals and health systems in the U.S. are either in or headed toward a financial crisis. Clearly, if turnaround in these institutions is going to occur, everyone working in them must be coalesced around a common vision and utilizing their best performances to reach common improvement plan goals.

In an article published in the April 2009 HealthLeaders magazine entitled, “The Bumpy Road to Change,” author Carrie Vaughn indicated that cultural change is that “unambiguous phrase seemingly at the heart of every hospital turnaround effort or quality improvement program or employee satisfaction initiative.” Vaughn points out that because cultural transformation is so difficult, some efforts fail while some efforts are successful.

Recognizing that I have stated on numerous occasions in previous posts that the successes for CHRISTUS Health in our first decade have resulted from our ability to establish a “CHRISTUS culture,” I have reflected on our reasons for success and have compared them to those articulated in the article.

As previously stated, our culture has as its foundation our mission (to extend the healing ministry of Jesus Christ), vision (to be a leader and advocate in creating exemplary health care services, processes and structures that improve the health of individuals and of local and global communities so all may experience God’s healing presence and love) and values (dignity, integrity, excellence, compassion and stewardship). This is who we are (mission), where we are going (vision) and how we behave (values). With these three guiding understandings clearly and frequently communicated, they have increasingly become living documents by our Associates, physicians and volunteers expressed in their activities of daily living.

In addition, our culture has, both in the U.S. and Mexico, been built around our Journey to Excellence and our commitment to full and real-time transparency.

The HealthLeaders article listed five tips on how to get cultural transformation efforts off to a good start:
1. Prepare leaders. Find out how senior leaders view their involvement and responsibility in the culture change effort.
2. Acknowledge that the process takes time. For example, it takes about three to five years to become officially designated as a patient-centered hospital by an independent advisory council and recognized on quality checks by the Joint Commission, says an article source.
3. Don’t do too much. You must prioritize, look at the most important items and deal with them first.
4. Be inclusive At Griffin Hospital in Derby, Conn., everyone attends their retreats—business office people, engineering folks, housekeepers, security—not just clinical staff. They view every employee as a caregiver.
5. Recognize every culture is unique. Organizations should be sensitive to geographic culture, the culture of the organization and the personality of the organization.

So, to get there, what did we do at CHRISTUS?

We certainly agree that cultural transformation isn’t easy. As one administrator said, “Cultural change is like stretching out a rubber band. You can stretch it out, but it wants to pull back into its old shape and size.” Recognizing this, we have been patient, but always focused on our cultural brand components. We have often said the successes we have had are no accidents. They have resulted from very intentional plans.

We also knew we had to prepare our leaders, so through annual leadership retreats and quarterly meetings with regional and business unit leaders, the Senior Leadership Team has been able to repeat the message frequently, and with time, these leaders communicated it with the same clarity and energy.

In developing some of the components of the culture, we were also as inclusive as possible. All the Associates and physicians were asked to give input into the values of the organization in 1999 when CHRISTUS formed. Clinical staff are always involved in determining the clinical quality outcomes and metrics that we measure on our Journey to Excellence, and the goals for transparency have been developed from a multidisciplinary group of technology-oriented Associates.

After a decade, the CHRISTUS culture is clearly visible, strongly felt and a rallying point to face the challenges exacerbated by these economic times. It has not always been easy, particularly in the early years of our history. We have, on occasion, let the five causes of failure in cultural transformation listed in the article invade our ministry for periods of time. Those are:
1. Lack of a strong accountability system. Culture change efforts often start unraveling during year two when the initial excitement about the effort wears off, says Quint Studer, founder and CEO of the Gulf Breeze, FL-based consulting firm The Studer Group. Then it becomes apparent there’s no system in place that holds leadership accountable for driving the change and leading by example.
2. Trying to do too much, too fast. It’s great to be excited about the effort, but senior executives should be careful not to overwhelm managers. If you implement one change, like having nurse leaders round on patients, you are likely to be successful, says Studer. But if you implement multiple changes all at once, you risk all of the initiatives failing because your team gets so emotionally exhausted.
3. Narrow approach. Transforming culture is a lot broader and more difficult for people to grasp than a customer service program that focuses on making people smile, says an article source. Organizations can’t just focus on programs; they should take a comprehensive approach, as you are essentially talking about a belief system.
4. Morale. Culture undertakings are impacted by group morale, so you can’t do it in isolation, says an article source Organizations should have the true support and consensus of the entire senior leadership team. Top leaders need to go out and sell the change to staff and be role models for it; otherwise, it sets the tone for the organization not to take it seriously. Everyone in the organization needs to be involved in the effort, as well.
5. Underestimating leadership training and development. “The No. 1 issue leaders face is they don’t have enough time,” says Studer. Many leaders have never been trained to run a good meeting or select or fire staff. If you’re asking people to change behavior, they will need to be more efficient.”

However, today, 10-and-a-half years after CHRISTUS was formed, the CHRISTUS culture is alive and well, essential if we are to grow and be successful in the future.

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