Survey Snapshot: Who Should Lead Culture Change?

Insights Report · April 18, 2019

In the wake of Hurricane Maria in 2017, Baystate Health, the largest provider of safety-net services in western Massachusetts, experienced a sudden rush of patients with critical needs such as dialysis and cancer treatments. Thanks to an initiative begun in 2015 that focused on changing organizational culture, clinical leadership felt empowered to respond to the crisis, and did so by organizing extra clinics, opening up slots in physician schedules, and allotting financial resources.

“Clinical leaders worked with the media and community to get the word out that Baystate was available if you had medical problems. Our clinicians saw 800 additional patients by making changes in their daily workflows, exhibiting their commitment to those in need,” says Mark Keroack, MD, MPH, President and CEO of Baystate Health. Springfield, where Baystate Health is headquartered, is home to one of the state’s largest Puerto Rican populations.

Keroack, who spearheads Baystate’s 2020 strategy, is focused on patient experience and employee engagement and says Baystate’s previous culture would never have allowed for such a quick and independent response. “We did not have the culture we needed to be successful, even though we were the lowest-cost health system and lowest-cost physician network in the state,” he says. “We were too focused on tasks, not performance, too rigid, too short term, and too top-down.”

Our recent Leadership survey, Organizational Culture Is the Key to Better Health Care, reveals that while most respondents (59%) believe their organization is changing and headed in the right direction and consider culture change a high to moderate priority (75%), respondents still see too much of a balance between emphasis on the bottom line (45%) and emphasis on patient care (55%). In Keroack’s opinion, success comes when organizations tilt more heavily toward emphasizing patient care. “Focusing on numbers gets in the way of focusing on the human side,” he says.

Health Care Organizational Culture Emphasizes Patient Care Only Slightly More Than the Bottom Line

From the Leadership Insights Report: Organizational Culture Is the Key to Better Health Care. Click To Enlarge.

Changing culture is what attracted Craig Blackmore, MD, MPH, to Virginia Mason Medical Center in Seattle as Director of the Center for Health Improvement Science. “I was at a university doing research on how to change the culture in radiology to provide better care and I’d write papers and send them around, and nothing would change,” Blackmore says.

Virginia Mason had been suffering financially in the early 2000s. After an avoidable mistake led to a patient’s death, the health system realized the need for a cultural transformation and adopted Toyota’s Lean Manufacturing principles. The Virginia Mason Production System is built upon three pillars: respect in the way employees treat each other and patients; an acceptance of continuous improvements; and recognition of a need for change in health care delivery. “We are breaking down barriers, traditions, and hierarchies so that everyone has a voice and they can work together better,” Blackmore says.

While Virginia Mason’s Chairman and CEO Gary Kaplan, a physician, is leading the charge for change, Blackmore doesn’t necessarily agree with the 65% of survey respondents who consider it extremely or very important for a physician to helm such efforts. “Having a physician can help get buy-in, but I don’t think it’s a requirement,” he says.

Culture Change Should Be Led by a Physician

From the Leadership Insights Report: Organizational Culture Is the Key to Better Health Care. Click To Enlarge.

Interestingly, Keroack also doesn’t think culture change has to be led by physicians, despite being one himself. “Leadership behaviors that you need are not restricted to doctors. You’re modeling basic decency and respect; you don’t need the language of technical medicine,” he says.

Blackmore and Keroack agree with 33% of respondents that the CEO is the accountable party when it comes to culture. “The CEO is the steward and guardian of the values of the organization — that’s the very definition of culture,” Keroack says.

John W. Lace, MD, FCCP, Medical Director of Clinical Care and Respiratory Care at Dignity Health’s Sierra Nevada Memorial Hospital in Grass Valley, California, says he prefers a physician CEO “because it might lead to more critical thinking as we evaluate how we work to achieve the mandated metrics,” but doesn’t consider it essential.

Lace labels Sierra Nevada “moderate” in terms of priority for culture change but believes any focus should be on the role of clinical leaders, who he calls “ideally positioned to manage up and down.” Lace, like a third of respondents, says culture change relies on hiring people who support the cultural objectives.

Health Care Organizations Use Top-Down Authority Rather Than Consensus Decisions to Change Culture

From the Leadership Insights Report: Organizational Culture Is the Key to Better Health Care. Click To Enlarge.

He also says more work has to be done on improving staff engagement and experience. “If we can improve provider satisfaction, we will make it easier to improve patient satisfaction,” Lace says.

For Baystate Health, improving staff engagement and experience has meant investing in education. More than 7,000 of the organization’s 12,000 employees have participated in a seminar on techniques to make a connection with strangers, according to Keroack. He hopes to embed the new culture so deep that it will outlast his tenure. “I’ve seen a lot of places where the CEO transitions out and the organization loses its way,” he says, adding that culture change “points to the need for succession planning.”

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