In my physician leadership roles, I have observed that the same job practiced in two different locations can be invigorating at one and demoralizing at the other. How is this possible? Culture.
Just like me, I’m sure you have experienced different workplace cultures. Some are inviting and empowering. Some you serving in physician leadership roles just can’t wait to get out of unhealthy environments. Bad culture will always move employees to a less functional state of performance. Good culture can take even poorly trained employees and spur them to excel. Culture is hard to define. But the saying that “you know it when you see it” holds true here. It is palpable when you walk in. The longer you stay, the more obvious it becomes, either good or bad. Changing culture is hard. It takes time. It requires tough choices and it almost always has to start at the top and filter down. A bad manager or director will “poison” everyone who works for them. A good manager will ruffle some feathers, but in the long run culture will slowly improve.
I recently observed this transition in an intensive care unit at a community hospital. The culture had become lackadaisical and there was a resistance to change or new challenges. Physician leadership positions were largely assigned by who had been there the longest, not by demonstrated skills. A new director who had been successful in another unit was assigned to improve the culture. They hired a new unit manager from outside the fold and who had prior experience at institutions with higher performance standards. After a few weeks of observation and exploration, the new manager did what needed to be done. They fired some of the worst performing staff, despite their longevity. Leadership positions were reassigned to staff with demonstrated desire to improve and learn. Of course, “drama” ensued! I listened from afar to the many comments about how this wasn’t fair, how it wouldn’t work, etc, etc. The culture was being reset. Expectations were being re-written and the staff understood it was for real.
Physician leadership sets the culture. It is not always popular, but if you want a culture that supports the mission of your organization and empowers employees to succeed, it is critically important. Assess your situation, then address the cultural deficiencies you observe. You will be glad you did (after the drama subsides!)
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