Culture is a health organisation’s basic personality - getting it right will shape how your people interact with each other and those under their care
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Risk aversion, fear of superiors and even bullying have featured in headlines about Australia’s healthcare culture in recent years, undermining efforts to recruit and retain staff while demands on the health system continue to grow. To add to the mix, clinicians are arguably facing the brunt of the effects from fighting the COVID-19 pandemic as distress, mental illness, and burn-out affect our healthcare workers and threaten efforts to retain them.
True patient satisfaction and person-centred care - the mark of any good health provider - cannot be delivered by an unhappy workforce. Staff who suffer from poor wellbeing or who are feeling the effects of burnout, are more at risk of making mistakes which could lead to adverse events for patients. Strong evidence has found that positive culture forces are directly associated with positive patient outcomes.1 Meaning that culture can be the difference between healing or harming a patient. Shifting cultural situations presents opportunities for better patient care and outcomes that can be achieved through collective effort: From health leaders taking an interest in setting expected behaviours, to health staff who hold themselves and their peers accountable to think and act consistently with their organisation’s culture, and to the general public who can advocate for an even better health system.
Culture is an organisation’s basic personality, the essence of how its people interact and work. The Katzenbach Centre provides a useful and simple definition of organisational culture: Culture is the self-sustaining patterns of behaviour that determines how things are done. When an organisation’s cultural situation and strategic priorities are aligned, organisations are well placed to be able to demonstrate impact that is effective and efficient.
A wake-up call, positive culture forces
While some individuals working in healthcare settings may believe they are very different to other ‘high reliability industries’, such as airlines, they tend to share many similarities. Healthcare can certainly be different in the nature of its service, but its challenges are not unique. Across different industries, if staff feel appreciated and empowered to do their jobs, then their organisation and those they care for will receive the best possible service.
Changing a single individual’s behaviour, perspective, and attitude is not always straightforward. So, the greater challenge is in shifting behaviours across units, wards, or medical departments - a collective group of health workers. There are many health organisations who have, or are, successfully transforming their workplace culture towards their intended direction - and their efforts and resilience should be applauded. Actively managing cultural forces is an ongoing process, which should be revisited every now and then. It is clearly an investment in time and resources, which naturally begs the question, what difference can cultural forces really make?
Positive culture forces can make a difference to patients by...
- Improving a number of important clinical outcomes that matter in providing high-quality patient care. These include reductions in mortality rates, readmission rates, and hospital acquired infections.
- Improving patient satisfaction, patient mood, and patient experience.
Positive culture forces can make a difference to clinicians by…
- Improving the cohesion among clinical teams, therefore affecting the way individuals within teams communicate, collaborate, and over time, build trust.
- Empowering clinicians to build psychological trust and safety. This will encourage problem solving, and accepting mistakes as an opportunity to learn rather than failure.
- Embracing and celebrating cultural diversity for teams to expand their knowledge and ways of thinking, allowing access to different perspectives and experiences.
- Supporting a reduction in clinician burnout and emotional exhaustion, enables clinicians to bring their best selves to work.
- Increasing clinician satisfaction and engagement within an organisation and to then view it as a point of differentiation.
Positive culture forces can make a difference to health organisations by…
- Increasing staff retention, and therefore, reducing expenditure on costs associated with recruitment efforts.
- Making programs and large strategic initiatives easier to implement as employee ‘buy-in’ increases.
- Opening or improving access to valuable ‘voice-of-employee’ opinion that is open and transparent to inform continuous improvement initiatives.
- Promoting favourable public opinion and objective feedback to the health organisation.
Informal leadership matters too
There are fantastic examples of healthcare leaders who continue to maintain a simultaneous focus on the people in their care and their staff. These leaders promote care and compassion and deliver empathic supervision.
Formal leadership plays an important role in a health organisation’s culture. Equally important, are informal leaders who do not hold formal leadership positions, yet wield significant influence over their colleagues. Informal leaders are able to bring a front line perspective in understanding the feelings and emotions at work and have a natural ability to detect the ‘human’ aspects of organisational challenges, create positive emotions, and know how to influence and encourage people to engage in important behaviours.
So what’s next? In formulating a call to action, there are a number of clear priorities that health and care services will need to act upon if they are to effectively collaborate with workforces, and serve their patients. These actions do require an investment, but more so in time and patience and commitment over the longer term rather than traditional dollar funding.
So how can we all make a difference?
Any behavioural and cultural interventions must be bespoke. Attempts to evolve a cultural situation cannot take a one-size-fits-all approach because cultural realities and strategic imperatives will differ between organisations. However, there are some fundamental actions that can be taken to signal and reinforce the behaviours you want to see in your organisation.
Health organisations should consider the five recommendations below:
- Setting behaviours that are aligned with strategic imperatives: Health organisations that seek a shift in their culture, need to identify, share, and follow key behaviours. These behaviours should be consistent with the health organisation’s strategic direction. For example, if an organisation’s strategic imperative is to be patient centred, what are the expected behaviours required to realise this, and how will these behaviours manifest across all layers of the organisation?
- Demonstrating consistent behaviours: The power of leading by example from leadership and management should never be underestimated. When frontline staff observe consistent behaviours, they too will naturally follow. Leadership and management should behave, interact, and work in ways that facilitate a shift in the organisation’s cultural direction, with zero tolerance for behaviour that falls short of your employee’s and your patient’s expectations.
- Recognising and valuing informal leaders: Informal leaders are powerful in influencing genuine behavioural changes, and creating changes in outcomes. Their importance should not be discounted, especially when attempting to shift a cultural situation. Without these individuals - in conjunction with formal leaders - change efforts coming directly from leaders and management can be met with cynicism.
- Checking the pulse of your organisation from time to time: Deploying periodic ‘pulse’ checks and assessments will help health organisations understand areas of improvement to support their staff. This should cover areas of wellbeing (in particular, mental wellbeing) and workplace satisfaction. Three forms of measurement should be considered; the degree in which cultural interventions are progressing, the actual behaviours lived, and the impacts of behavioural shifts on important outcomes such as staff wellbeing, or patient satisfaction.It is important that the organisation shares the results with staff, including areas of improvement. Organisations who are able to persevere and make improvements will gain the confidence and respect of their staff.
- Optimising rostering and leveraging culture as a credible value proposition: Health organisations should focus on both the ‘here and now’ and the ‘future’. The ‘here and now’ looks at managing clinical rosters while accounting for the needs of clinicians, such as; job support, and manageable job demands and workload.2 The ‘future’ is leveraging an organisation’s culture as a strong value proposition to attract and retain talent. Focusing on how organisations can harness culture will be an important element in recruitment, and future workforce planning.
Sources:
1. BMJ Open, Association between organisational and workplace cultures, and patient outcomes: systematic review, 2017.
2. BMC Public Health, A systematic review including meta-analysis of work environment and burnout symptoms, 2017.
3. International Nursing Review, Organizational politics, nurses' stress, burnout levels, turnover intention and job satisfaction, 2017.
4. Yale School of Medicine, Hospital Organization Culture Impacts Patient Care, 2017.
5. Strategy+Business, 10 principles of organizational culture, 2016.
6. Strategy+Business, Why authentic informal leaders are key to an organization’s emotional health, 2020.
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