Healthcare Culture Is Hell

— Can it be fixed?

by
Robert Allan Bear, MD



April 4, 2023

A strong organizational culture is considered the secret sauce of successful organizations. But the Latin term abyssus abyssum invocat (one hell calls forth another), explains perfectly why it is increasingly difficult to maintain optimal organizational cultures in healthcare.

Hell #1: Pre-pandemic, health systems and their workers in both Canada and the U.S. were highly stressed. The reasons were different; the end consequences the same. And then, as predicted, this first hell summoned Hell #2: A pandemic-induced erosion of corporate cultures in too many healthcare systems and hospitals.

The causes of this are easy to discern. Administrators, staff, and physicians had long endured ceaseless and stressful change as their organizations struggled to provide high-quality health services to their populations. The pandemic then made urgent and massive additional demands on these fragile healthcare systems, precipitating in many healthcare workers a dangerous emotional cocktail comprising fatigue, frustration, anger, and despair.

Predictably, this birthed additional problems: staff retiring or leaving for other jobs, high numbers of nurses calling in sick, burned out and demoralized physicians, internecine arguments amongst professional groups, and unseemly professional behavior, at times involving the public. Many organizations began to see the shores of healthcare professionalism being undermined and at times washed away by raging emotional torrents.

Hospital work environments will remain stressed until significant system reforms are undertaken. This is a given. Meanwhile, it is imperative that the corporate cultures of healthcare organizations be salvaged. This will never occur organically; leaders must act, and the path forward is exemplified by strong leaders (formal and informal), whose inspiring behaviors (not words) trickle down, drop by precious drop, through all the levels of the organizations they serve.

I recently read an article describing the actions political leaders should take to preserve democracy in the U.S. As I did, I realized that highly effective healthcare leaders employ the same set of actions — differently framed — as they attempt to rescue, as required, the faltering cultures of their organizations. They are:

Command attention. To change an organizational culture, successful leaders command attention. As John Kotter described in his book Leading Change, they create a “burning platform, a clear case for urgent action. They bring the troops together. Look them in the eye. Say something like: ‘Enough is enough. This place is a mess. We’re going to fix it. And we’re going to fix it by working as a team, and I’ll be on it. We’re starting today and will not stop until we’re in a much better place. If you are not interested in this journey, there’s the door.'” Something like that. Not exactly. But similar.

Make meaning. Successful healthcare leaders present principles for the journey and explain why it is worthwhile, even noble. At some level, everyone already understands what these principles are. It’s their framing that’s important around matters such as professional purpose, working as a team, ensuring patients are at the top of the healthcare pyramid, serving the community, building trust, being a shining example.

Meet people where they are. Great healthcare leaders meet people where they are, literally and figuratively. Literally? By being present, leading while walking around, talking to managers, staff, physicians, and patients, better understand their challenges and frustrations. Figuratively? Acknowledging the sometimes strong opinions of physicians and staff and attempting to understand their origins, even if many of these opinions are not fully accepted. The listening is important, even more important than the dialogue.

Pick fights. The sorts of things people in healthcare organizations fight over never cease to amaze. Examples of useless fights that accomplish only the further destruction of the organization’s culture abound. Healthcare organizations are complex entities. Disagreements over management approaches are bound to arise. Successful leaders take the tenth-man approach and welcome them. At the same time, they demonstrate that there are some fights worth having, and that they will fight relentlessly for these. For example fighting for patient- and family-centered approaches to care, for insisting on team-based care models, or for requiring professional and courteous behavior.

Provide a home. Workers like to find a home in the place in which they work and to speak of it as such. Such workers feel their work environments are places in which they are listened to, sense that the organization cares about them, and feel safe. When an organization’s leader, through their actions, constructs such an environment, it will prove a powerful contributor to a strong corporate culture.

Tell a better story. A leader is someone people choose to follow. There are varied reasons for this. One is when the organization’s leader understands the power of storytelling and works to harness that power. Such leaders can frame the past and future of their organization as a story, a strong narrative that inspires and motivates.

As stated, an organization with a weak corporate culture can’t be fully successful. This is particularly true of healthcare organizations in this turbulent time. With this in mind, all healthcare leaders should ask themselves such questions. Have I drawn everyone together to let them know clearly and unequivocally what we are going to do as a team, what our vision is and why? Am I present daily in the organization, meeting people where they work, and listening to what they have to say? Do I ensure timely solutions are found for frustrations? Do I pick my fights carefully and frame them with higher purpose? Is there a positive narrative for the organization, a story about its future built on its past, that is shared by everyone? Every day, do I do my best to talk about the importance of hope and what everyone must do to ensure that hope becomes reality?

Robert Allan Bear, MD, is a physician and healthcare consultant.

This post appeared on KevinMD.