According to a recent article in the Wall Street Journal (Jobs in 2029: Health Care Booms, Employers Want More, Jan. 8, 2021), employment in healthcare occupations is expected to grow by 15% in the next decade, far outpacing the 3.7% expected overall jobs growth. (This projection does not attempt to account for the pandemic and related economic downturn.)

This presents a huge challenge to healthcare organizations (and thus patients), as competition to recruit, hire and retain a significantly larger number of professionals becomes even more fierce than it is now. Of course, it’s not just a matter of hiring bodies; organizations want to attract professionals with top-notch skills and a drive for excellence. The article projects that hiring of nurse practitioners will grow by more than 50%, and physician-assistant jobs will grow by more than 30%. Given these circumstances, it seems that those being recruited will likely be able to be very selective in terms of where they work. The healthcare systems and other similar enterprises will need to demonstrate that their culture is one in which employees thrive, and are valued.

Culture Makes or Breaks Excellence

We all know the phrase, “culture eats strategy for lunch.” Perhaps a more useful way to think of the impact of culture in an organization is, “If you don’t manage your culture, your culture will manage you.” There’s a lot packed into this, beginning with the fact that culture can be managed. Yes, it takes time and dedicated effort to change a culture, but it most certainly can be changed. So, some initial questions are:

  • What kind of culture attracts and retains the best employees?
  • How do you describe your culture as it is today?
  • Is there a gap between the culture you need and where you are?
  • How can you close that gap?
  • How will you know if you’re closing that gap?

“Culture” is not a purely subjective concept. As the Shingo Institute and workshops teach, culture is clearly observable in the behaviors of people. What do you see and hear in the workplace that indicate what type of culture exists? For example -- How do people talk with each other, peer to peer as well as through vertical levels? Do people freely call out problems and work together to seek solutions, or is there silence and fear of reprisal or shaming for asking questions or pointing out problems? Do leaders (at all levels) seek out honest input from subject matter experts at the frontline and throughout the organization, or are leaders unwilling to show such vulnerability and thus issue top-down mandates? Do people use the handrails when taking the stairs, or do people move on the stairs in a way that causes harm or risk of harm? Do you see a nurse struggling to position a patient in bed, or does the nurse wait until he can get another nurse or aide to help?

Behaviors are Rooted in Safety…

The behaviors examples above are rooted in what Value Capture calls “psychological safety” and “physical safety.” “Psychological safety” means that people feel safe to call out problems and raise issues with managers and leaders without concern that there will be some type of shaming, embarrassing rejection or actual reprisal. “Physical safety” means the absence of physical harm (injury), danger or risk that can be experienced by any person.

…Therefore, Culture is Rooted in Safety

Bringing us back to our starting point, our recommendation is to carefully consider and define the culture you need to attract and retain employees (caregivers, leaders, administrative and all support team members) through the lens of safety. (You may be thinking, “Shouldn’t we start with quality?” We would respond by asking, “Is there true and lasting quality without safety?”) Consider what you observe throughout your organization, from the basement to the top floor. How do people talk with each other, what body language do you see, what are the tone and volume of speech? If you spot a safety hazard, such as an overflowing sharps receptacle, is it emptied or is it still overflowing when you circle back in 30 minutes? And consider this question – Are you likely to really know and understand the scope of safety problems without everyone in the organization truly being psychologically safe?

These observations of behaviors (and artifacts of behavior like the sharps receptacle) will allow you to begin to understand the true state of your organization’s culture. If behaviors don’t demonstrate the culture you thought existed, and if the culture isn’t one that will help you attract and retain the people you need to meet ever-growing and more complex patient needs, then you have an evidence-based starting point to manage the culture.

We’ll have more posts coming to explore this vital key to becoming a habitually excellent organization, excellent every day at everything you do. We welcome your comments and questions.

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