In the Know

To Build a High-Performance Organization, Start with Culture

09.18.2017 Lee Penrose, COO for Acute Care Delivery

If you want to know how well an organization is doing, look no further than its internal culture.

In the ever-evolving health care field, culture is everything. At St. Joseph Hoag Health, our culture is founded on shared mission and values that inspire us to be a trusted resource for all, respect the dignity of one another, keep us focused on those most in need, and encourage us to pursue excellence.

These core tenets provide long-term direction as well as day-to-day guidelines for all our interactions. They are also the driver of our performance goals we strive for – excellent quality, a positive patient experience, and strong resource management.

But be aware, cultures don’t form by themselves. It takes work, especially from the C-suite, which must be highly intentional in articulating and reinforcing values and mission. In weak cultures, events and interactions become random and unfocused. In strong cultures, there is purpose, engagement and a host of positive outcomes.

As it turns out, a strong and engaged culture drives quality. According to a Gallup study of 200 hospitals, nurse engagement is the number one predictor of mortality variation across hospitals. This finding is not surprising. Good cultures engage and inspire employees to push for better care. Employees cannot be motived by exhortations to merely tick off boxes as quality metrics are met. In a strong culture, staff members know that, at its core, their organization stands for stretching itself towards the best possible care and truly bettering patient lives.

As for patient experience, it follows suit that employees engaged in a values-based culture tend to patient needs. Again, some health care organizations push only for metrics, focusing on boosting HCAHPS scores. But the bigger picture lies in furthering a culture of dignity and respect for both patients and one another. Metrics are ephemeral markers compared to a lasting spirit of community and caring.

Better employee retention is, of course, another benefit of an outstanding culture. A 2012 PWC study of health care providers found that our field’s first-year turnover rate — the number of employees who left within their first year — was 27 percent, higher than the 22.6 percent across all industries. That’s a sign that, despite its importance, we’re still putting culture on the back burner.

Perhaps there are those among us who simply need to hear the financial bottom line. According to a 2007 Gallup study, facilities with more engaged workers had 8 percent higher net revenue per patient than facilities with lower engagement. I’m reasonably certain that within the past decade, that number has increased. Employees who support their organization’s culture act as responsible stewards of its resources.

Alternately, when we make the bottom line as the top priority and manage tightly to it, we can lose sight of the bigger picture of why we are here. The result can be leaders who are singularly focused on costs and revenues while quality and service take a back seat. The impact to culture and employee engagement can be dramatic.

So where do we go from here?

Start with the basics. A culture must be clearly defined. As a combined organization of St. Joseph Health and Hoag, we knew that focusing on culture would be primary to our success. That’s why defining our culture was one of our first endeavors and continues to be at the forefront. We have always stated that mission, vision and values cannot only be words on a wall. Instead, we encourage one another to act according to our culture. We also regularly honor those who are exemplary role models –from the physician who gives of her time to serve the most vulnerable to the lab technician who provides extraordinary service and everyone in between. We show our teams clear examples of what living out our culture means and we celebrate those who set the example.

Additionally, we are diligent about providing employee communications that are timely, transparent and multi-directional. We believe employees must be well informed and, conversely, able to inform management of their opinions. We encourage active participation in a thriving culture where they are heard and where they play a vital role.

Finally, we protect our culture. When making major decisions, we follow an Ethical Decision Making Model, which calls for inclusion and sharing of multiple viewpoints. Our culture, mission, and values provide the conscience for such decisions. We know that our decisions impact many stakeholders, often for years to come and so we carefully consider their voices.

Ultimately, it is the preservation of a strong culture that marks our success. It is what continues to make us a highly effective organization and a trusted resource for all we serve.

(This story originally appeared in Health Leaders Media, March, 2017)