Covert cultural considerations

The season of health care leadership transition is nearly upon us, at least for the Department of Defense. That means learning new organizations. Before a health care leader can hope to “shape” the culture of an organization he has to “scope” it. The assessment of culture should be made early; before the leader assumes identity with the new organization and before she becomes too comfortable with the way things are. The best time to begin the assessment is after committing to the new position but before assuming it. Ideally it this assessment should be the goal of one of your first trips to the institution before anyone really knows or recognizes you. And it should always be done with your Boss’ permission, visibility and her understanding of your hope for anonymity. After you officially assume your new position the things you check early in your tenure will also help you get a sense of the organizational culture.

Organizations can be thought of as having a mind, heart and body representing its processes, people and “place.” The processes reflect how it “thinks,” the people how it “feels” and the physical plant or place reflects how it ”looks, acts and operates.” Where the three intersect in the center of the Venn diagram is the organization’s culture, its “soul.” How that culture looks and feels to others both in and out of the organization is its climate, its “spirit.” These categories should be taken into account in a cultural assessment. It cannot be completely accomplished in a single visit. But the process must begin somewhere.

When you make your anonymous visit, dress in “civilian clothes. ” Do not dress too formally lest you be mistaken for an industry rep, but not so slovenly that you attract the attention of the security guards. Bring a magazine so you can pretend to be reading.

People

• Sit in lobbies and reception areas throughout the hospital. Listen for laughter.
• Watch receptionists interact with patients and staff.
• Listen to receptionists answer the phone (without violating HIPAA). Listen to greetings.
• Pause in a hallway and seem lost. See whether anyone stops to help you and what they say.
• Make eye contact with ten people in the hallway and see if they greet you.
• Make eye contact with the next ten people, smile, greet them and see what they do.
• Sit in the cafeteria at lunchtime and watch how employees interact.
• Engage the cafeteria staff as you come through the line for lunch and watch their interactions.
• Notice how staff members wear their uniforms, laboratory coats and ID badges.
• Do staff members wear ear buds or Bluetooth phone headsets?
• Are they using their smart phones as they walk in the corridors? (Extended version.)
  

Processes

• During your anonymous observations listen to staff giving instructions to patients and families. Does what you hear make sense? Do the patients seem to understand?
• Every chance you get, listen for uniformity in “two patient identifiers.” Are they consistent with the policy? (Again, no HIPAA violations please.)
• Has the organization dedicated individuals at major corridor intersections to assist with way finding? Are they truly helpful?
• (Additional “process” scrutiny may have to wait until you’re officially working.) (Extended version.)

Place

• Is there trash on the floor? Does anyone pick it up?
• Are the walls nicked and dented? Do you see evidence of dry-wall repair?
• Are there many black scuff marks on the polished floors?
• Are there hand lettered signs or even badly Xeroxed or printed signs taped to doors, walls or counters?
• See where and how often you notice the hospital’s logo. How is it used on signage, literature, on scrubs, laboratory coats, jackets or fleeces?
• Look at printed hospital literature in public areas. Is it current? (Is it present?) Is it reproduced well? Does it reflect well on the hospital’s brand and identity?
• Notice public areas (which sometimes escape staff “ownership”). Are hand sanitizer dispensers filled?
• Stop in visitor restrooms after three o’clock on a Tuesday (or busy hospital day). Is there evidence of a recent housekeeping visit? Are the trash receptacles full? (Extended version.)

The culture of an organization is a direct reflection of its leaders. People pay attention to what the boss checks. An aggressive effort to get to know the organization with humility, without passing either judgment or condemnation sends a powerful message. (Try not to mention your last hospital by name in speech or conversation. No one really wants to hear about it.) Certainly you must have a sense of where the organization is before you can hope to begin to move it to where you think it needs to go. Think through your goals and schedule your transition carefully. There is a lot to learn.

As a leader you begin influencing, shaping and affecting the organization on your very first day.
To better assess the culture, consider making your first day an anonymous one.

Chuck Callahan Henry V 4.3 – Lead from the Front
https://henryv43.wordpress.com/

(Extended version with sample transition time-table.)