Organizational Culture Trumps Everything Else in Healthcare

The book I am writing1 is the result of an unpredictable journey in healthcare and my complete respect and admiration for the caregivers in healthcare organizations in the United States. I believe every organization has the capacity and potential to create a work environment that is purposeful, fulfilling, constructive, and fun. Yes, fun! It’s not strategy; not finance; not technology. It is organizational culture that trumps everything else in healthcare.

My Diagnosis and the Importance of Culture

On March 16, 2015, I got the diagnosis: malignant melanoma, right anterior distal thigh and left posterior shoulder. Just over 10 days later, I waited nervously on the exam table at the Massachusetts General Melanoma and Pigmented Lesion Center. Hensin Tsao, MD, Ph.D., Director of the Center and world-renowned skin cancer specialist, examined me and confirmed my diagnosis. Genevieve Boland, MD, Ph.D., surgical oncologist, consulted and recommended surgery on April 1. The entire process, from pre-op to discharge, took about four hours. My final pathology report on both sites, dated April 3, 2015, showed great news: no residual atypical melanocytic proliferation.

I tell this story not for sympathy, but to share how positive my experience was from my initial clinic visit through surgery. Having started my career at a large academic medical center, I was expecting the impersonal hustle and bustle that we assume comes with large organizations, as well as the resulting sterile personal experience. Surprisingly, I was overwhelmed with optimistic feelings and knew it was because of my many caregivers, including those in environmental services and food services to board members, managers, nurses, physicians, and many others. On my final visit with Dr. Boland, I shared my positive experience. She responded that this was “our culture and we do these things automatically.”

While my personal experience was positive, not all healthcare organizations share the Constructive culture exemplified by Massachusetts General. However, if culture could drive my positive experience as a patient, could it also drive positive organizational results and a great experience for caregivers?

Let’s talk about organizational culture and how that same positive example could become a reality for others.

Culture Trumps Everything Else

After working in healthcare for over 35 years—25 years in hospitals and 10 years providing advisory services to over 500 hospitals across the United States—I learned that culture trumps everything else in healthcare. This is not a gut feeling—both research and my own professional experience suggest that  Constructive norms and expectations lead to better execution of strategy, better quality and patient satisfaction, improved financial performance, and greater levels of employee engagement.2

Some Early Evidence

I contacted Human Synergistics over 10 years ago, after I had completed strategic plans for 100 healthcare organizations. Ten of these organizations had not made any progress one year after adoption of the strategic plan in a number of essential areas, including employee and provider engagement; financial health; market share; strategy execution; quality; and patient/provider/employee satisfaction. The other 90 organizations made great strides.

What was the difference between the organizations that improved and those that stagnated? Once again, it comes down to culture. The Human Synergistics Circumplex details the three general types of culture we find in all organizations, including those in healthcare:

  1. Constructive: Cultures that promote effective goal-setting and achievement, growth and learning, and teamwork and collaboration.
  2. Passive/Defensive: Cultures that lead to conformity, rigidity, and lack of team member accountability and initiative.
  3. Aggressive/Defensive: Cultures that lead to internal competition, management by exception, and short-term emphasis as opposed to long-term effectiveness.2

When I surveyed the cultural styles of the 10 underperforming healthcare organizations, eight had Passive/Defensive styles and two had Aggressive/Defensive styles. Since then I have learned that, like organizations in other industries, healthcare organizations with Constructive styles generally produce higher quality results, better financial performance, greater patient satisfaction, and higher employee and provider engagement.3

Future Research and the Culture Map

Because culture is directed from the top of an organization, I am now curious about hospital governance and whether the cultural style of a board leads to increased organizational performance. I am presently conducting research related to performance and board cultural style. Specifically, in collaboration with Human Synergistics, I will survey several hospital boards to measure cultural styles and determine their impact on hospital effectiveness. I anticipate that this work will be completed by early 2016. My hope is that the development work and research in this area will resonate with the healthcare workforce and that the resulting culture map will lead to a more Constructive, productive, and happy work environment.

How would you describe your organization’s culture? Does it share a Constructive, optimistic way of operating? Does it have the capacity and potential to become a purposeful, fulfilling, Constructive, and fun work environment?

I look forward to your comments and thoughts on LinkedIn and Twitter. Thank you!


1 This post is excerpted from Scott Goodspeed’s upcoming book, The Culture Map: Why Organizational Culture Trumps Everything Else in Healthcare (working title).

2 Cooke, R. A., & Szumal, J. L. (2000). Using the Organizational Culture Inventory to understand the operating cultures of organizations. In Ashkanasy, N. M., Wilderom, C. P. M., & Peterson, M. F. (Eds.), Handbook of organizational culture and climate. Thousand Oaks, CA: Sage.

3 In addition to the research articles and books listed on Human Synergistics’ web site, many other articles have been published in specialized journals summarizing studies on the importance and impact of Constructive cultures.  Examples related to healthcare and social service organizations include:

Agbenyiga, D.L. (2011). Organizational culture-performance link in the human services setting. Administration in Social Work, 35 532-547.

Gillett, E. & Stenfert-Kroese (2003).  Investigating organizational culture: A comparison of ‘High”- and a ‘Low’- performing residential unit for people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 16 279-284.

Guidet, B. & Gonzalez-Roma, V. (2011). Climate and cultural aspects in intensive care units. Critical Care, 15 312.

Minivielle, E., Aegerter, P., Dervaux, B., et al (2008). Assessing organizational performance in intensive care units: A French experience. Journal of Critical Care, 23 236-244.

Pelieu, I., Djadi-Prat, J., Consoli, S.M., et al (2013). Impact of organizational culture on preventability assessment of selected adverse events in the ICU: Evaluations of morbidity and mortality conferences. Intensive Care Medicine, 39(7) 1214-1220.

About the Author

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Scott Goodspeed

At the Brown University School of Professional Studies, Executive Master of Healthcare Leadership, our mission is to transform healthcare and create a lasting impact in the world by recruiting the best students and faculty committed to advancing academic excellence, collaboration, and innovation. Scott comes to Brown University from Stroudwater Associates, where he consulted with hospitals and healthcare systems across the US. With substantial industry experience, he focuses on health system governance, clarifying strategy, deploying rapid cultural change and enhancing operational and financial outcomes. Previously he was principal and vice president at iVantage Health Analytics, and president and CEO of four hospitals in three states.