When culture gets in the way of change

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The health care system is awash in a laundry list of change imperatives: patient-centred; funding reform; integrated care; stakeholder engagement; clinical and technological innovation; population health, among many others. No matter the cause or outcome, central to the system’s successful metamorphosis is the evolution (arguably, revolution) of its cultural underpinnings.  This notion is made more challenging by the additional dynamics of urgency, risk of failure, overcoming inertia and transparency is an understatement.

We see the cumulative effects of such tectonic clashes every day: conflict; delays; inertia; false starts; silos and turf. When the life cycle for a required change must occur in weeks or months, while its cultural prerequisites can span years, the usual response is to delay timelines to give change readiness the opportunity to catch up.  And, therein lays the fatal flaw: what if the cycle time for system transformation doesn’t allow for years of nurturing a new culture?  What if the dominant culture needs to change synchronously or be so nimble that it accelerates change rather than hinders it?

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What if the fundamental challenge to healthcare is that its dominant culture is no longer serving it well – that we need rapid reset of its cultural roots in order to be successful with challenges now and in the future? How do we make a culture so “change ready” that it anticipates and embraces opportunities rather than prevent any departure from the status quo?

We have heard the catchphrase: culture eats strategies for lunch. Perhaps we have come to the juncture where leaders need to turn that axiom on its head and deploy strategies that eat cultures for lunch.  While cultures have their place, what if the culture IS the problem?  What if the culture that worked in the past is the exact wrong culture for what lies ahead?

Sourced from a multitude of thought leaders: “organizational culture” is an institutionalized pattern of assumptions and behaviours that have worked well enough in the past as to be considered valid and transferrable to new team members as the correct way to react and approach similar or novel problems. Stated another way – when the rules of a game change, previous successes guarantee nothing; and, amidst radical change, experience can be a liability because it filters creativity.

This doesn’t mean that all cultures are broken and that a lifetime of experience is the prequel to disaster. Just recognize that cultures and lenses can both enlighten and blind us to opportunities.  We need the courage to reflect on that possibility when busy people are faced with new challenges, they stick to tried and true only to find that a new round of “whack a mole” was released inadvertently.

As leaders, how do we create and nurture organizational cultures that will thrive on and seek change. If the only constant these days is constant change, how do we make change the currency of a culture rather than its victim? Descriptors of that desired state: nimble, innovative, flexible, adaptable, quick to market, rapid cycle, dynamic, leading edge, proactive, firsts, new and improved, to list but a few.

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My thesis is that we need to develop a new culture in healthcare. We need a culture that prepares ourselves, our leaders and partners for the opportunities these challenges afford.

It starts with system and corporate governance. What is in the best interest of the patient, the system, the organization and/ or the community?  Our economy can neither generate nor allocate sufficient resources to sustain our rate of spending growth – the health care cost curve needs a downward shift in its slope.  That these are facts and not “positions” is a cultural leap for many.  All too often, the issues we face are reduced to sensationalized sound bites designed for political advocacy.  We need 21st century solutions to our 20th century structures and processes.

Leadership is the ability and courage to sponsor change as well as the propensity to act. Developing leaders and leadership skills are often the first casualty of limited resources.  New solutions need new skills and approaches that are not intuitive.  We will need skilled and courageous folks to shepherd the issues and steward the resource changes ahead.

The outputs of the information age are finally generating the information needed to swap anecdotes for fact. That new knowledge is challenging convention, shining light on variation and generating health system evidence – concepts we should embrace, not malign.  The use of new analytics must inform and challenge us to do better.  These prerequisites of a high performance system are long overdue.

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At its core, healthcare is about professionals helping people who need care, want an acceptable quality of life and want to be valued participants in guiding their plan of care. That this happens in an office, home, clinic, hospital, hospice or long term care facility is secondary to the fundamental notion that every stakeholder contributes to the collective performance of the system.

Integration is both a process (verb) and an outcome (noun). That integration includes a shopping list of other descriptors should not be foreign to anyone.  “Seamless”, “centres of excellence”, “critical mass for quality or sustainability”, “economies of scale”, “hubs, spokes and satellites” and a cornucopia of other concepts are not adversarial; they are as germane to any healthcare system design discussion as one would talk about bedrooms in a house, or seats on a plane.  We must put system effectiveness ahead of sovereignty and stop pretending that a blue “H” is a barrier or trump card to any range of conversations we must have.  It cannot take years to make decisions we face – that’s culture at its worst.

Deploying strategies that support corporate cultures which pursue change – that’s my take on a “strategy to eat culture for lunch”.