Three Keys to Effective Culture Change

When these considerations are working in unison, culture will begin to self-correct and employees become more willing to innovate and collaborate.

THE CHALLENGE: Culture is a point of pride for most organizations. You’ll read articles or listen to interviews in which CEOs and department heads boast about their company’s “culture of empowerment” or “culture of learning” or “culture of whatever.”

Culture influences everything: productivity, turnover, succession planning, communication, quality of care. The most well-managed organizations in health care aren’t necessarily the most talented or visionary, but they almost certainly have strong cultures.

So how do you build a culture you can boast about on a podcast or at a conference? You promote and reward the behavior you want to see more of. You sanction the behavior you want to see less of. And you do this consistently for years. But there are a few measures you should put into place first:

Define "Undesired Behavior”

You can’t consistently punish bad behavior if you don’t know what bad behavior looks like. For example, if an employee makes an honest mistake while helping a peer, is that undesired? Should you punish her? Do you want him to stop being helpful? Conversely, if a delinquent employee acts recklessly — but somehow accomplishes his goal — do you reward him? Is that the type of behavior you want to condone? It’s a difficult question, and it’s why many organizations are more concerned with the intent of an action, instead of its outcome.

• Honest mistakes are forgiven.

• Risky behavior is discouraged.

• Recklessness is harshly sanctioned.

Select an Impartial Judge

Another thing to think about — who gets to choose the consequences for undesired behavior? Who’s the judge? Who dishes out punishment to transgressors? It probably shouldn’t be you. Chances are, an organization of more than 15 people will need several judges. And they should all meet two criteria:

• Each judge should be totally unaffected by the bad behavior.

• Each judge should be intimately familiar with the transgressor’s work.

Victims shouldn’t judge perpetrators. Similarly, uninformed outsiders shouldn’t judge the behavior of an insider.

Install an Appellate System

People aren’t perfect. Mistakes happen. And that’s true for your judge, too. That’s why you need an appellate system. The transgressor, regardless of behavior, must have an opportunity to share his or her side of the story.

THE BOTTOM LINE: When these three considerations are working in unison — defined behavior, impartial judges and an appellate system — culture actually will begin to self-correct. Employees become more willing to innovate, collaborate and drive the organization forward.

Adapted from “Establish a Just Culture ,” part of the American Association for Physician Leadership’s comprehensive online curriculum. More about our educational offerings and credentials at physicianleaders.org/education.