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Opinion: ‘Why’ culture improves patient outcomes

Industry Insight

Posted online

Health care providers certainly have had a lot on their plates the past few years.

The Affordable Care Act changed the reimbursement game, which effectively changed the way many doctors must look at their patients. Consolidation of providers has become common, as small practices struggle to stay afloat. Nursing and doctor shortages are impacting both providers and patients. Private medicine is starting to surge into the market bypassing insurance altogether to bring back the doctor-patient relationship.

With these distractions, many health care providers see working on their own organizational culture as a lower priority. However, many of the most successful providers have discovered compelling reasons to put culture at the top of their list of things to work on.

Every health care organization has its own unique culture. This culture is a set of common beliefs, values and assumptions. The most important thing to realize is that an organization’s true culture may not match with their intended culture. I often tell managers that culture is what happens when you aren’t in the room. It’s organizational habits, which can be good or bad.

More and more health care organizations are discovering the value of working to develop a healthy organizational culture. This culture isn’t based on trends, like open-office environments and potluck lunches, but rather employee engagement, relentless focus and natural accountability at all levels. These traits are what we call a high-performance culture. This type of healthy culture makes everything work better at a fundamental level because every person takes responsibility and ownership of their work.

Health care organizations can work to develop a high-performance culture by focusing more on the “why” of what they do rather than the “what.”

People perform better when they are more exposed to both the purpose and the results of their efforts. Humans are hardwired to perform better and become more engaged when they understand why they do what they do.

A 2012 Gallup meta-analysis of multiple studies shows organizations in the top quartile of employee engagement outperform organizations in the bottom quartile in multiple key performance indicators. These high-performance cultures experienced 22 percent improved profitability and 21 percent increased productivity. They also experienced significantly lower turnover, 25-60 percent lower, and 37 percent decreased absenteeism.

Health care providers see an even bigger benefit from implementing a high-performance culture. The same Gallup study shows a 41 percent decrease in patient safety incidents when the organization is successful in fostering employee engagement. These numbers are surprising only until you think about the mechanism of “culture fails.”

Let’s take a simple example. Hand-washing is incredibly important to patient outcomes. Each year, nearly 100,000 deaths are linked directly to infections picked up at a health care site. This is not only well known by providers, but it is also well understood by the general public. Yet recent studies show hand-washing protocols are followed only 40-50 percent of the time. Efforts to educate doctors and nurses on the importance of hand-washing has had very little impact on compliance. However, taking a cultural approach to the problem produces more improvements.

A University of North Carolina study tried a simple “why” approach to the problem by posting signs at hand-washing stations that focused on preventing patient diseases instead of hand-washing itself. The new approach improved handwashing by 33 percent, and this study only utilized a sign.

Health care providers share a common purpose of providing great care to their patients. When these providers focus on processes and lose their focus on patients, they lose their “why” and their organizational culture slips. At the same time, when providers focus on patients, they find that everything works better.

This patient-centered approach can create a high-performance culture when the “why” is repeated from hiring to retirement. It occurs when patient outcomes are shared with nurses who may only see a patient during their shift. It occurs when employees can engage their own challenges and clear barriers that could improve patient outcomes. It occurs when health care supervisors are trained to lead and engage their team rather than oversee processes.

The current health care climate is incredibly challenging, but providers who are focusing on implementing a high-performance culture are thriving. They are attracting and retaining more talent and providing better care for improved patient outcomes.

Don Harkey is the co-founder and chief innovation officer at People Centric Consulting Group in Springfield. He can be reached at


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