Changing a Stubborn Hospital Culture

Senior healthcare executives responding to HealthLeaders Media researchers indicate that their biggest stumbling block to an effective patient experience strategy is the difficulty of changing organizational culture.

Why is that so difficult, and what can leaders do to help bring about a culture that embraces patient experience?

Pauline Arnold
Chief Nursing and Quality Officer
Vice President of Clinical Operations
IU Health La Porte (Ind.) Hospital

On mission drift: When you ask people why they are in healthcare, the answer invariably is "I want to help people." In that helping, sometimes we didn't engage people to become part of the helping. The helping became doing it for them.

On engaging the patient: We have to change the way we think about patients and their families and the role they play in their own healthcare. Patients seek out providers to give them answers to their healthcare questions. They want solutions that they can understand and embrace. Often they have researched information on the Internet that may or may not be correct. But there is an inconsistent embracing of their own responsibility for their own healthcare and seeking to partner with the healthcare provide to achieve their own healthcare goals.

Leaders have to commit to changing their own behaviors that then support those core beliefs. Tools aren't enough and educating people isn't enough. It requires a fundamental change in how we think. Then you use the tools to help establish the consistency for the behaviors that you know are required to meet your new beliefs.

On effecting the change: You can implement a change but that doesn't become the culture until it is embedded into the DNA of what we believe in the organization. You know it's in the DNA when it happens every time. It becomes a culture of always. We are on a journey. We are not there yet.

Jeffrey M. Fried, FACHE
President and CEO
Beebe Medical Center
Lewes, DE

The reason why it is so difficult is because changing culture involves changing everything in your organization. It involves looking at every process and opportunity for communication. It looks at performance reviews, how you recognize people, the values that you communicate to the organization. It involves not just communicating but also getting everybody in the organization to embrace it and be engaged in what is happening.

What has worked for us is having a clear message about what we are trying to accomplish, setting high standards, reporting frequently on how we are doing, and letting the frontline staff who interact with the patients come up with the ideas about what we can do to improve patient satisfaction.

We are continuing to improve, and the more we can get people involved, the more creative and innovative can be the ideas they come up with. For example, several years ago our employees came up with the idea of creating a competition among the different units, departments, and floors. We looked at team sports. We have a quarter where we are focused on football and we use football analogies and terms to help promote the idea of competition when we are trying to do a better job. Then we go to basketball and baseball and NASCAR. That idea didn't come from anybody in leadership. It came from frontline staff.

Timothy Putnam, DHA
President
Margaret Mary Health
Batesville, IN

We are realizing that if we are really patient-centered it requires teamwork and you have to convey trust in the skill you are giving to the patient but also in the rest of the team. That takes time. It wasn't how we were trained.

We don't have a shortage of people wanting to do the right things for patients. It's getting them to understand what those right things are: recognizing that we are all caregivers, from direct patient care to all the other departments. Information technology, environmental services, dietary are all caregivers whether we interact with patients directly or not. We have to reinforce that day in and day out.

As we make the transition from volume to value we look at how we add value from the patient perspective and that is the next logical step. It fits right in with patient-centered care. What is the value to the patient? What do they want? What is going to help their health improve? And a lot of what we are finding is that to improve their health it is not additional health services. Sometimes it is social and support services, transportation, and other things that we are going to have to figure out how to engage if we are really delivering patient-centered care.

Gary Muller
CEO
Marquette General Health System
President and CEO
Superior Health Partners

We have to somehow let the patient be the only thing we are thinking of during the day. This is perfect for us because we are looking at the value equation being quality and service over lower costs so the service part is just as important as anything.

There are many components. It's not just how to take care of the patients. It's about hiring the right people. It's retaining the right people. It's supporting the team. It's looking at the patients' needs first. It's coming into your job, whatever it is, and thinking my job is taking care of people. Some people do that naturally. Others just need to have that reinforced all the time, and that is where leadership comes in.

The expectations and accountabilities will be rolled into their job evaluations, rewards, and incentives. We are taking the carrot approach and putting a lot of emphasis on the patient satisfaction scores.

A big part of our culture and at any hospital starts with the physicians. We are putting a lot of emphasis on physician training and using them as part of the culture of change. That is a little more difficult. We employ about half of our physicians. We can influence them a little bit more than the private docs. A big part of it is getting them into the loop for training.