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I have recently added a new critical access hospital (CAH) to my functions as a physician advisor. The CAH is about 45 minutes away from my present organization. One thing that I have found very interesting is that, even with many similarities and considering the relatively short distance, a different culture exists there.

One should realize that every organization, everywhere, not just in healthcare, has its own culture. In an article from Forbes by Dr. Pragya Agarwal he states that  culture in the workplace is the shared values, belief systems, attitudes and the set of assumptions that people in a workplace share. There is no such thing as the “right” culture because it is shaped by individual upbringing, social and cultural context. But there can be a “good” culture. In the workplace, however, the leadership and the strategic organizational directions and management influence the workplace culture to a huge extent.

I once attended a presentation by a chief executive officer to her employees and she said that culture is not taught, it is learned, and it can take up to six months to learn a new culture. Based on this thinking, for those of you in one setting, you only need to learn or adopt one culture. But for those of us with multiple settings, such as in my new position, we must learn and try to understand and respect the differences among those settings. One must be cautious, however, to not make comparisons as that can lead to disastrous consequences.

Here are a couple of categories or areas to learn about whether you are in an organization and have been there for a long time or you are starting a new position:

  1. What is the geographical location? Is it urban, rural, or other? This can affect the social determinants of health that need to be dealt with. I remember when I worked in a hospital in very rural Mississippi, I had a lot to learn there.
  2. What is the mission statement of the facility? As mentioned above, leadership can affect organizational directions and changes in leadership can have a significant effect. But will the new leadership try to change the culture or embrace the existing culture? I am not here to state which is the better way; it depends on the situation. Certainly, what is commonly referred to as a “toxic” culture would benefit from change.
  3. That last area that I will address is that of change. Will you change to adapt to the present culture as a leader, or will you be an agent of change? The answer should fall somewhere halfway between both. Remember that change can be difficult and challenging.

In summary, whether you are in management or a member of a team, one must respect the culture of where you are. It was there long before you arrived and will be there long after you leave. It may require a paradigm shift in thinking whether it be adapting or changing the culture. What affect will you have?

Programming note: Listen to Dr. John Zelem every Tuesday on Talk Ten Tuesdays at 10 Eastern for his popular segment, “Journaling John MD.”

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