Guest Commentary: The hard work of culture

Success flows from great workplace environments, but leaders have to embrace creating them

I have worked for more than one boss who publicly stated that people were the organization’s most important asset. Too bad these leaders did not deliver on their lofty sentiment by creating a culture that empowers workers.

Great workplace culture—where employees are engaged and act with a maniacal focus on service—is the single best predictor of organizational success. For hospitals, great culture will launch patient satisfaction scores, assure top quality/safety scores, increase market share and improve margins.

The catch is while it’s easy to talk about such an environment, it’s a really hard goal to achieve.

As a relatively new chief executive officer, I notice little is written in trade publications and journals about the effects of great workplace culture. Ironically, nearly every issue of concern affected by the employment environment—from national patient safety/quality scores to turnover to costs to union relations—is examined in detail.

Yet not nearly enough effort is spent talking about how culture is a driver of everything that gets accomplished in a hospital.

My experience as a department manager, system vice president, chief operating officer and CEO has shown me that staff members will reach the benchmarks important to their administration only if they feel inspired. Fear and intimidation will work in the short run, but results will not be sustained. However, once employees discover great workplace culture, they’re like a cave people running through the night with torches.

Everyone wants to feel inspired at work and patients want to go to hospitals where the staff is happy to be there.

This transformation starts at the top with a leader. Inspiration can’t be delegated. Once the goals and tone are set, the leader then must give up control, because culture cannot simply be driven from the top down. It has to be pushed from the bottom up by staff. It takes a servant-leader to be successful; the leader is the straw that stirs the drink. The traditional “command and control” leadership style is no longer effective in a profession where employees can get a job anywhere they wish to live or travel.

Through our cultural journey at Grays Harbor Community Hospital, I now understand that there are four important staging events in the beginning of a cultural transformation:

• Get help. A leader wouldn’t try to put in a new information technology system without consultants. Why would one expect to instill a new ethos in his or her organization alone? There are several proven and successful “cultural coaches” that can guide an organization as complex as a hospital through its cultural journey.
• Be ready to change. Leaders can expect amazing levels of organizational achievement when the staff successfully manages its own morale. It requires that leaders be visible and consult staff through a very structured network of work teams.
• Budget. Great workplace culture cannot be done on the cheap. The good news is that the return on investment is excellent.
• Hold everyone accountable. A hospital that makes great culture voluntary will, in the end, be worse off. I know because I’ve seen this mistake firsthand. A lack of accountability leads to “program of the month” mentality, which in turn destroys organizational credibility.

Everything from strategic plans to management compensation to performance evaluations must be hardwired to support cultural change.

At my facility, we have seen magnificent results from our cultural journey. We went from a small-town hospital that was losing $1 million a month to a hospital that can now make a $1 million-plus a month. We have moved our quality scores from one of the worst in Washington state to the upper third in a year. Our employee and patient satisfaction scores are significantly higher and continue to improve. We have recruited several new physicians and negotiated two new union contracts. We passed our Joint Commission survey with only three requirements for improvement and a month later received no clinical recommendations from state and CMS verification surveys.

The common denominator in all of these achievements? Our investment in making our hospital a great place to work.

John Mitchell is chief executive officer of Grays Harbor Community Hospital, Aberdeen, Wash.

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