Cultural transformation is never an easy undertaking for an organization. It requires an examination of goals, processes, mission, leadership and other essential elements of the organization, and then overhauling them. But as healthcare organizations face new challenges, more find they need to make a cultural transformation to improve performance and meet their goals.

Change Must Start at the Top

Cultural transformation requires an organization-wide commitment to examining beliefs and assumptions, a willingness to disengage from processes, a drive for new values and the energy to follow through with plans to change. While human resources teams can help with the process, they shouldn’t be the originators. Instead, the drive should come from the top, says Shideh Sedgh Bina, a Founding Partner at Insigniam, a consulting firm that focuses on enterprise performance transformation.

“Culture transformation is not an HR accountability,” Bina says. “They’re a facilitator, but it should start in the C-suite. They have to own it and be the drivers. The role of HR is to be catalysts and facilitators.”

“If you look at organizations that provide the highest quality care, which is my definition of high performance, they have very clear cultural expectations of what the coordination of care looks like,” says Leslie Beitsch, Chairwoman of the Department of Behavioral Sciences at the Center for Medicine and Public Health at Florida State University’s College of Medicine. “That doesn’t expressly start with the CEO, but it does start with the leadership of the organization as a whole.”

Once top-level leadership issues a mandate for change, HR departments at healthcare organizations can do their part by, for example, providing baseline measurements of employee engagement and patient satisfaction. As the cultural transformation plan is put into place, HR departments can use those metrics to measure its effectiveness.

What’s At Stake?

The changes in the healthcare industry make it ripe for transformation. “The requirements for integrated care, readmission rates and shorter length of stays are all changing and any healthcare organization is finding its footing among a lot of disruption,” Bina says. “With healthcare enterprises moving from fee-for-service to value-based reimbursements, that’s a completely different culture.”

And as outcome-based performance becomes more of a focus for providers, transforming culture can be key to an organization’s success. “Healthcare organizations need to realize that a stale culture is usually the biggest impediment to delivering top-notch patient care,” says Matthew Stegmeier of Stegmeier Consulting Group. For example, if nurses are thinking about how a physician doesn't respect their level of experience or knowledge, their focus is diverted from patient care.

“Poor healthcare service is oftentimes more of a result of low employee engagement, and not weak hiring practices,” he says. “By focusing on employee engagement and getting to the bottom of what's getting in the way of employees taking pride in their work, healthcare organizations can see a dramatic improvement in performance and patient care.”

Challenges of Cultural Transformation

One of the challenges of cultural transformation is discovering an organization’s perceived culture is different than its actual culture, Bina says. She worked with one healthcare organization that had taken on a commitment to national leadership in its field. “The question was whether the culture would be a match for that ambition.”

“When we did the assessment, we found that while everyone thought they were about the patient, what they were really organized around was making sure they wouldn’t violate the budget,” she says. “That mentality was appropriate for past challenges, but was going to eat their strategy for breakfast,” as legendary management consultant and author Peter Drucker said.

Physicians’ changing roles are another challenge standing in the way of cultural transformation. More of them are now hired as employees instead of simply being granted privileges. “When doctors are viewed not as an important team member, but some sort of god-like royalty, culture change is difficult,” Stegmeier says. “Ultimately, healthcare organizations need to empower all caregivers to make a positive change, but taking that first step in either addressing the problem or asking for help can be a difficult thing to do.”

And, as with any organizational initiative, money and time can pose challenges. “We have a markedly turbulent environment when it comes to change in healthcare,” Beitsch says. “CEOs turn over based on quarterly performance and that’s the antithesis of how you incentivize quality and cultural transformation. Organizations need to commit not to a quarterly outcome, but over the space of a decade.”

If a healthcare organization wants to work on transforming its own culture, Bina recommends bringing in a third party to help do the work and to provide a clearer perspective. “You can’t assess culture from inside the culture. Cultural assessment, done well by a third party, ought to reveal the operative elements of the enterprise’s culture, and the impact of those elements on performance. That becomes the platform for a culture transformation.”