Case Study: Culture Change

Changing a Healthcare Organization’s Culture

Situation: A new CEO took over the helm at a healthcare system (including a hospital, clinics, and an assisted-living facility). He had a goal of changing the culture to one that was more patient-centered and performance-based. The system had a new state-of-the-art facility with significant potential to better serve its population base. However, the organizational culture had been based more on relationships and cronyism than on patient care or the competence of caretakers. In addition, policies and procedures were either poorly formed or non-existent.

Process: The CEO engaged Myron Beard Executive Consulting (MBEC) to assist in changing the culture of the entire system. In conjunction with hospital management, MBEC began the process of assisting this change through the following:

1. Evaluating the Culture: The initial undertaking was to better understand the culture of the organization by getting to know the existing management and their approach to leadership. The culture of an organization is always a reflection of the management of the organization. In initial interviews and evaluations of existing management, it became evident that a culture existed of high relationship and low accountability. There was an absence of constructive conflict, and departments were allowed to operate independent of one another. Raises and promotions were granted more on the basis of seniority and friendships rather than on performance. There was no clear path for employees to raise issues and, when they did, they were often reprimanded for challenging authority. However, the most glaring issue was that patient care was not being provided in a manner that was acceptable to the community. This was reflected both in patient surveys and in the poor reputation the hospital had in the populations it served.
2. Evaluating the Functions: To understand the culture at the grassroots level, MBEC was charged with facilitating a department-by-department continuous improvement process. This process involved a combination of individual interviews and focus groups to identify existing strengths, areas of concern, and areas needing immediate attention. The process was intended to be transparent. At the end of each department’s evaluation, the themes that emerged were discussed and initiatives were established with owners along with timelines that would make the department function at a higher level. In some cases, departments that interacted with one another met together to discuss overlapping problems.
3. Evaluating the People: To maximize the communication within each department, MBEC evaluated all department employees regarding their preferred thinking and behavioral tendencies. These results were shared both individually and collectively, with the goal of promoting a higher level of communication and providing a common language for groups to discuss their similarities and differences. The change in how individuals communicated and solved problems was immediate and palpable.
4. Deploying Talent: One major outcome of the various analyses was the identification of success profiles for key management positions. By creating a success profile for key positions, individuals with the necessary skill sets were matched for a position. Additional changes were made, including redeploying employees to positions where they were more likely to be successful. In some cases, no current employees matched the profile and the CEO was forced to find the talent from outside the health system. These changes included redeploying some individuals on the CEO’s management team.

The MBEC Difference

MBEC helped the CEO create a performance-based organizational culture with patient care at its core.

5. Hiring for Success: By using the profile of success in the hiring process, candidates for key management positions were interviewed and evaluated against the profile, prior to hiring them. By having the profile of success as a data point in the candidate’s hiring process, the CEO could more confidently hire the best candidate for the position.
6. Consulting for Success: This MBEC project included ongoing consulting with new leaders about how to best manage their departments. MBEC helped new leaders understand management fundamentals, including how to create a department vision, establish and communicate roles and responsibilities, and hold people accountable. MBEC reviewed with department management how best to work with individuals in the department, in order to optimize their skills and increase productivity.

Outcome: Three years after the initiation of a healthcare system-wide culture change, the culture of the organization is vastly different than it had been. The healthcare system has nearly doubled in size during that time and nearly tripled in the number of physicians using the system. With the assistance of MBEC, the CEO has created a performance-based system that has patient care at its core. As a result, the hospital has moved away from hiring and promotions on the basis of seniority and relationships to a meritocracy, where people are promoted on the basis of their performance. In addition, employees have a clear path to air grievances confidentially and without reprisal. Although grievances have been reduced dramatically, the grievances that do surface are dealt with independent of personalities. Most important, patient survey scores have risen dramatically and the hospital’s reputation in the community has become stellar.