Culture change is one of the core messages of a book I’m working on, so I was interested to see an article about “cultural transformation” in Modern Healthcare by John Mitchell, CEO of Harbor Community Hospital in WA. He notes that there is frequently a disconnect between a hospital leader’s stated goal of wanting to create a great culture and their actions: Retaining a central command and control structure does not empower people, and forcing solutions onto hospital staff who feel uninspired to excel will not produce sustainable improvements. Rather cultural changes leading to improved quality and reduced costs requires the leader to inspire the staff to perform while also empowering them to achieve shared goals.
He lays out four components for creating cultural transformation, and my interpretation of those components are:
- Get help – A leader can’t do something this fundamental alone
- Be ready to change – Create internal teams that fosters champions and an inclusive process
- Budget – Culture change is an investment in the core competencies of the organization
- Hold everyone accountable – Voluntary compliance without accountability will not produce changes
John Mitchell reports that changes in his hospital have turned a $1M/month deficit into a $1M/month profit, and greatly improved their quality scores, employee and patient satisfaction levels, and on-site reviews by JCAHO and others.
One difference between John Mitchell’s observations and my prescriptions are their scope: He focuses on hospitals, and my work encompasses all types of healthcare organizations and stakeholder groups. Specifically, Part Four of my book looks at how to use social and economic forces to solve cultural problems by fostering champions, creating inclusive process and targeting economic incentives. The goal of these actions is to create healthcare cultures within organizations and systems so that the behaviors and actions of individuals and organizations are directed toward outcomes related to system-wide value as opposed to only benefiting the individual or the single organization. Creating such a culture – along with making synergistic structural changes – can produce healthcare systems that provides higher quality care at lower costs, and are prepared to efficiently continue to improve and adopt value-producing innovations.
While John Mitchell talks about his success in turning around the economics for his hospital, I am always curious to learn more details: Did they improve their finances by reducing costs? Improving efficiency? Increasing revenue with better/more accurate billing, or from increasing patient volumes? And what have been the effects on the region’s healtcare system? Are other hospitals in the area losing patients to Harbor Community Hospital, and are they now running deficits?
It reminds me of the story about the person who says that because of a hospital’s poor reputation they, “wouldn’t be caught dead in that hospital.” While a reputation like that certainly doesn’t help increase the hospital’s revenues, if the hospital actually has sub-par quality and only fixes their reputation and not their underlying problems, their finances could improve while overall healthcare costs would go up, and quality of care might actually go down.
Any thoughts or insights into culture problems or changes at healthcare organizations and how it relates to improving quality or reducing costs?