Cultures form around the values and beliefs of their leaders having to do with success and how it is achieved. That’s why you hear leaders talking about the need for a “culture of accountability” or a “service culture” as both reflect beliefs about how success is achieved. All cultures are the result of a system of shared values and beliefs that govern the thinking and behavior of its members. It’s this system that leaders are trying to change when they speak to the need for increased accountability and service, and it’s this system that a leader leads.

In this light, leaders ought to understand culture and the culture building process with the same depth that they have of the other tools of enterprise leadership, such as strategy and financial management. You can see the power of culture in the visible stories of corporate success and failure. Thus, “It’s the culture” is a common explanation for successful enterprises such as Apple, Ruth’s Chris Steak House, and Starbucks. But it’s also a common explanation for failed companies such as Enron, Atari, and Sports Authority. Culture matters.


Culture starts with knowledge

My company has worked in several industries during the 30+ years of its life. A lot of this work has been in the hospitality industry with restaurant and hotel companies. That’s the area of expertise that often interests healthcare leaders when they call asking, “How can we incorporate more hospitality in…?” It turns out that what they usually mean is more hospitality toward patients—and in ways that add up to steadfast patient loyalty and referrals.

We start off by telling them that there is no such thing as a hospitable patient experience without a hospitable employee experience. Regardless the mission or service, from fine dining to a local diner to urgent care or dentistry, building intentional experiences for employees that drive quality service and care is essential to achieving a great patient experience. In this sense, clear leader intentions are part of the “how to” of culture.

In addition, we make it clear that even when you have both, they will work only if they are aligned with your enterprise’s culture. While that comment can sometimes set leaders back for a moment, the next point we make is that their culture is not a mystery. With a little work, it can be understood, measured, and managed with the same kind of precision often seen in the measurement of clinical outcomes, or business results.

The first step is to recognize that the single largest point of leverage for culture building is a leadership team that is on the same page with respect to the language, values, and habits of the culture it intends to create. In healthcare or any industry, this means defining the core values that underlie your patient or customer experience. This could include anything from quality and affordability to compassion and respect. Anything less than a solid foundation will depress the vitality, relevance, and resonance of the enterprise’s culture and, thereby, its results.


Finding your way

When we engage with a leadership team determined to get “the culture right,” the first thing we try to understand is how the team thinks about enterprise success in terms of its company reputation and measured results. Once they are on the same page, we work with the team to “map” the existing and the intended culture. In the best of all scenarios, the mapping process reveals that the existing culture is very much like the intended culture. Leadership teams get that they have to be on the same page in order to set clear direction. Sounds like a “duh” insight, but we have found time and time again that that being on the same right page is the cornerstone of success.

But as Socrates made clear more than 2,300 years ago “the definition of terms is the beginning of wisdom.” This insight applies with particular relevance to the creation of a vital, relevant, and resonant culture. As a step in that direction, we introduce the three parts of a culture:

Figure 1. Three Parts of Culture
Figure 1. Three Parts of Culture

We go through each of the “boxes” in the picture of culture-parts to illustrate the importance of being on the same page prior to any efforts by a leadership team to work with its enterprise’s culture. It’s this consensus that helps the team to understand the map of its current culture as well as the “what” and “why” of its intended culture and its ability to support enterprise success.

Leadership teams often discover that they are not on the same page. For example, some enterprises call employees something other than “employee” (e.g., Team Member) while other enterprises might use a term that carries a deeper meaning. For example, the Cleveland Clinic calls all employees from physicians to technicians, Caregivers—signifying a shared sense of duty and team in providing care. In the restaurant industry, customers are often called “Guests.” Unfortunately, many restaurant companies do not clarify the meaning of the term and, thereby, fail to take advantage of its power to unite a team.

Because of the role of values in culture building, it’s important for a company’s leaders to answer a central culture question: “Why?” This same question could apply to patients in healthcare. What does patient mean to you and the other leaders in your organization?  Would referring to patients as clients, guests, or customers change expectations for care? How you answer these, and other, questions reveals your values and beliefs and those that you intend your company to embrace. Without an explanation of culture-words, there is no tie back to the culture beliefs and values. I’ve never been to the Cleveland Clinic but it seems apparent that its leaders believe that the path to healing is paved with teamwork. What would be the implications of a healthcare enterprise calling its customers “guests” rather than patients? Who knows; you don’t know what it means until you run it through the filter of your culture’s values and beliefs.

If you work in healthcare, try that name change on your colleagues and ask them what images it conjures up for them. You can also try a little exercise to make the point about clarity and culture fidelity: Ask members of your team to write down their definitions of your enterprise’s results on a piece of paper (and you do the same). After everyone has completed this task (no peaking), say, “On the count of ‘3’, let’s read our definitions together out loud.” If your team is like most, the answer will sound like a foreign language. That’s not a good thing, especially if your team is charged with the responsibility for setting direction for your enterprise.


The bottom line

While the answer to questions such as “How do I make our culture one of accountability, service, hospitality, and so forth” is clear, it is complex in that there is lots of work to do on the “what” and “why” of culture before you get to the “how” of putting your intentions in place. Much of the work of defining a culture has to do with creating clarity among its leaders. Once clarity is achieved, the work of implementation begins. This is a journey of education, integration of values and beliefs into company policies and procedures, and measurement to ensure that you have not been kidding yourself.


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