Complete credit for the following article is given to author Joe Tye. Joe Tye, M.H.A., M.B.A., is the CEO of Values Coach Inc., a health care consulting and training firm in Solon, Iowa. He is also a member of Speakers Express. Cultural Transformation in Health Care Settings was published in the February 21, 2012 issue of Hospitals & Health Networks magazine.
Cultural Transformation in Health Care Settings
By Joe Tye February 21, 2012
Think like a physicist to effect change in your organization.
In The Dancing Wu Li Masters, Gary Zukav writes, "The way that we pose our questions often illusorily limits our responses … . The way we think our thoughts illusorily limits us to a perspective of either/or." My goal in this article is to use the laws of physics to help readers think in new ways about shaping the culture of their hospitals. If it's true that culture eats strategy for lunch, then a cultural plan is more important than a strategic plan. Used as a metaphor, Zukav's Wu Li Masters can help you think in new ways about cultural transformation.
But first, an important point: The laws of physics are morally neutral. The momentum of a speeding garbage truck will cause it to ram into a school bus full of children or a prison bus full of convicted killers with equal certainty. Likewise, corporate culture is morally neutral. Enron had a powerful culture, but it was a culture corrupted by greed.
That said, here are some thoughts on the laws of physics and their implications for corporate culture:
Nature abhors a vacuum. Every organization has a culture. Just as physical nature moves to fill a vacuum, so human nature creates cultural traditions, practices and expectations within organizations. The question is whether this culture is allowed to morph haphazardly, or is guided by principles and a plan that are clearly defined and well communicated.
Inertia is best overcome by engaging informal leaders. A body at rest tends to stay at rest, and absent deliberate management intervention, corporate culture becomes stale and stagnant. In an inertia-bound culture, you hear things like "We tried that and it didn't work" and "We've always done it this way." The larger the organization, the more energy it will take to begin the cultural transformation process, similar to the way it takes more energy to move a bowling ball than it does a pool ball. But, unlike pins passively awaiting the crash of a bowling ball, a hospital's leaders can strategize the most appropriate cultural response to health care reform, whatever form it eventually takes. Resorting to a top-down, command-and-control process (e.g., cutting staff with layoffs) is a Newtonian "organization-as-machine" approach; whereas, training employees on the personal skills of ingenuity, courage and resilience is more consistent with the paradoxical relationships evident in quantum physics.
Friction is inevitable and must be overcome. The first thing you encounter when you seek to overcome inertia is friction. The greater the change required, the greater is the resistance. Knowing that friction is inevitable can help you fortify yourself with the determination to forge ahead in spite of it. And just as a snowball gains mass as it overcomes friction rolling down a hill, once the transformation process begins, you will find that the skeptics of yesterday have become the champions of tomorrow.
Critical mass is essential to sustain change. To spark significant cultural change, you must have a critical mass of people buying into the desired change. Researchers suggest that about 30 percent of a population is sufficient to reach critical mass in launching a movement. So, for example, when a third of us decided we would no longer tolerate being poisoned by other people's cigarettes, the movement to ban public smoking became unstoppable. At Tri Valley Health System in Cambridge, Neb., a group of about 50 people meet every morning for several minutes to collectively recite that day's promise from The Self-Empowerment Pledge. According to CEO Roger Steinkruger, that one simple group action has had a positive impact on the hospital's culture, and it is now spreading to other parts of the community.
Escape velocity is generated by staff commitment. A spaceship headed for orbit must first attain sufficient speed to break free of Earth's gravitational pull; the greater the mass of the spaceship, the greater the speed required. To achieve cultural transformation, you need a sufficient number of people (mass) who are sufficiently galvanized (emotional velocity) to escape the inertia, pessimism, cynicism and toxic emotional negativity of the past. Fillmore County Hospital is a critical access hospital in Geneva, Neb. As part of a hospitalwide values training initiative, its leaders asked every employee to think about his or her personal values, then published a beautiful booklet with the responses. Patient satisfaction scores have improved in 27 of 30 measures, which the leaders attribute to having achieved the "cultural escape velocity" caused by a sufficient number of people making the commitment to act on those values.
Momentum assures ongoing progress. A body in motion tends to stay in motion. One of the things that struck me when researching All Hands on Deck: 8 Essential Lessons for Building a Culture of Ownership is the extent to which cultural momentum carried each of the market-dominating companies featured in the book long after charismatic founders like Walt Disney, Ray Kroc, Mary Kay Ash, Bill Hewlett and Dave Packard had departed. In the strongest organizations, cultural momentum is a powerful form of leadership. Organizational structures like Hamburger U at McDonald's ensure that cultural norms are transmitted to each new generation of future leaders.
Randomly intervening variables can foster new solutions. Natural evolution was profoundly altered when an asteroid slammed into Earth some 65 million years ago, leading to the dinosaurs' extinction. In cultural terms, outside factors including the economy, politics, competition and other variables inevitably complicate culture change. But as Margaret Wheatley points out in Leadership and the New Science, "Disequilibrium is the necessary condition for a system's growth." When a group of physicians in Kearney, Neb., announced plans to build their own hospital, leaders at nearby Good Samaritan Hospital feared the doctors would recruit nurses from their hospital. So Good Samaritan evaluated potential sources of employee dissatisfaction and took actions to enhance loyalty. Though the physicians' hospital is not yet completed, Good Samaritan built a stronger and more positive culture as a result of the challenge.
Entropy is the enemy of progress. Culture does not maintain itself; it requires constant attention. When Columbus (Ind.) Regional Hospital was inundated by a flash flood in June 2008, it appeared likely that entropy would set in. Basic services were shut down, the hospital was closed for five months, no revenue was coming in, and the hospital knew its "best places to work" culture and high-performing workforce were at risk. The executive team and board made a decision to keep everyone on the payroll for five months, at a cost in excess of $30 million — money that had been set aside for a new patient tower and emergency department. The hospital reopened with staff intact, continues to be rated as a best place to work, and enjoys a growing reputation for excellence. Its most recent national recognition was for its innovation center — a facility made possible as a result of flood-related rebuilding.
Black holes must be confronted and marginalized. Scientists recently have discovered a black hole estimated to be the mass of 21 billion stars the size of our sun. Black holes literally suck the life out of any objects that come too close. Organizations, unfortunately, have people like that — emotional vampires who suck the life out of people with whom they work and, eventually, out of organizations for whom they work. Marginalizing these human black holes is a fundamental leadership duty. (I shared 14 strategies for doing this in my previous H&HN Daily article, "A Positive Approach to Negative People.")
Quantum leaps are created by inspired leaders. One of the most surreal aspects of quantum theory is the notion that an electron can skip from one orbit to another without ever traversing the space between — the quantum leap. During the mid-1990s, under the leadership of Ken Kizer, M.D., the Veterans Health Administration made a rapid transition from widely being seen as a caregiver of last resort to an organization about which Phillip Longman could write a book credibly titled Best Care Anywhere. Today the VHA is going through a similarly radical cultural transformation to promote Veteran-centered care. Belying the notion that transforming a huge organization is like turning a battleship, the VHA has achieved substantive change at a quantum-like pace.
The problem of measurement requires new thinking. Even more than in management, with its mantra that "what gets measured gets done," physics is a science based on measurement. But there is also an acute awareness of the limitations of measurement. According to the Heisenberg uncertainty principle, the simple act of trying to measure something affects that which is being measured. A manager might believe that he or she is improving patient satisfaction by giving employees a script and a happy face pin, but the way that script is delivered can have a perverse effect. The things that most matter to patient satisfaction are notoriously difficult to measure with traditional metrics. Compassion, enthusiasm, pride and other "soft" qualities cannot be measured, but they certainly can be observed. Like physicists trying to understand the magnificent complexity of the universe, one of our challenges is finding new ways to assess those things that cannot be measured in the traditional manner.
Culture is a force field to be understood and galvanized. In physics, the concept of the force field explains how gravity, electricity and magnetism can cause two entities that are not in physical contact to have a physical effect on each other. Culture is a force field in which attitudes and behaviors in one part of the organization are transmitted across space and time via invisible forces like rumor and gossip; example and expectations; stories and traditions. And like gravity, culture is no less real for being invisible. Mapping out the vectors that transmit culture is a useful way of employing these forces to bring about desired cultural change.
Elegance defines the best work settings. When it evolves according to nature's laws, the universe tends toward elegance: From the Grand Canyon to photographs taken by the Hubble space station, there is beauty in the natural order. The same can be said for organizations that dominate "best places to work" lists: They have beautiful and functional corporate cultures. The Tao of Physics by Fritjof Capra was one of the first books to look at physics from a social sciences vantage point. Capra highlights similarities between modern quantum physics and ancient Eastern philosophical traditions, saying, "The further we penetrate [into modern physics] the more we … see the world as a system of inseparable, interacting, and ever-moving components, with man as an integral part of this system." More recently, in The Elegant Universe, Brian Greene describes how string theory almost makes the universe feel like a gigantic musical instrument. That's a beautiful metaphor for the culture of an organization known for being a best place to work and a best place in which to receive care.
Culture Can Change
There is, of course, another essential difference between the laws of physics and the principles of cultural transformation: The laws of nature are immutable while cultural practices are fluid and malleable. Nevertheless, thinking in terms of physical laws of the universe can provide a useful metaphorical tool for promoting a more positive and productive culture in your organization.
Joe Tye, M.H.A., M.B.A., is the CEO of Values Coach Inc., a health care consulting and training firm in Solon, Iowa. He is also a member of Speakers Express.
The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.
