We’ve heard a lot these days, from IHI and others, about how leaders are responsible for the culture of their organizations. Board governance influences leadership and, by extension, culture.
You may wonder, then, where this leaves the rest of the health care workforce — the nurse, physician assistant, or surgical tech, for example — who wants to improve the culture? If they’re told that organizational culture is determined by the board and the CEO, what can they do to effect change?
That question is especially relevant when the leadership is not particularly engaged, and not all leaders are. The bell curve is applicable in a lot of things, and it’s not any different in leadership. Improving culture, patient safety, and quality improvement can be time consuming and messy. And the frustrations of the people on the ground are very real.
Members of the National Steering Committee for Patient Safety — a public-private partnership working to develop a national action plan to prevent harm in health care — have given a lot of thought to the fact that health care workers do their jobs within the culture that exists in their organizations, and they also play a part in nurturing a strong culture. In essence, everyone has a stake in this. While strongly influenced at the top, organizational culture is a shared responsibility of the board, senior leadership, and staff.
Leading from Behind
The first bit of advice for unit managers or staff is to look at what is within your locus of control. What can you do in your unit or department to address the culture?
We know from work that the MHA Keystone Center and others have done that culture is very local. A unit with the highest performing culture can literally be across the hall from a unit with lowest performing culture. You can only control what you can control, but that can be significant to you, your colleagues, and your patients. Some immediate first steps might be to look for ways to improve communication within the team, provide direct and timely feedback to peers and staff, and consistently model civility and inclusion.
Secondly, sharpen your skills at managing up. As you educate yourself about quality and safety, best practices, and how to improve, share information with peers and leaders in your organization. Show how improvements will yield collateral benefits in the form of reduced waste or enhanced workforce safety, which will reflect well on the organization. By taking initiative, you’ll signal to your team and colleagues that you are making an effort to be transparent with them and with those above you in the organizational hierarchy.
Finally, be prepared to show courage. I will always remember a story I heard from a friend who happens to be a surgeon. One day he was getting ready for an operation and he went through the surgical checklist. He thought he was ready to go, then the anesthesia technician spoke up and said, “Excuse me, doctor, but we haven’t introduced ourselves.”
That person demonstrated an awareness of the importance of that surgical checklist, that knowing who was in the room played an important part in their interactions during the operation. Moreover, that person exhibited courage. To look to the point of power in the room and say, “we’re missing an important step,” takes courage. You must be true to that courage to bring forth such issues in order to truly make a difference.
Certainly, when leaders, boards, and staff are all working toward the same goals, showing that courage gets a lot easier. Yet no one should relegate responsibility for culture to someone else. Never doubt that what each of us chooses to do each day makes a difference to patients and colleagues.Sam Watson is Senior Vice President, Field Engagement, at the Michigan Health & Hospital Association, the MHA Keystone Center and a member of the IHI Board of Directors. He is also a member of the National Steering Committee for Patient Safety, an initiative of IHI, a public-private partnership working to develop a national action plan to prevent harm in health care. He co-chairs the subcommittee on culture, leadership, and governance.
You may also be interested in:
Leading a Culture of Safety: A Blueprint for Success
Optimizing a Business Case for Safe Health Care: An Integrated Approach to Safety and Finance