by Tony Chen

Over at the hospital impact social network, there have been a few very insightful comments about hospital culture:

Mike said: "Hospital cultures are very segmented as well. Not only are they segmented by profession i.e. nursing, medicine, ancillary services etc. but also intra-professionally within in each discipline i.e. Nursing - ER, ICU, Med/Surg; Medicine - Surgery, ER, Attendings Residents and the list goes on. Each group has their own expertise they bring to the table and each are jocking for position on many issues depending on the impact. Bottom line hospitals have very dynamic cultures."

Isn't it this type of culture that breeds the "not my job" type of attitude? And when the "not my job" is running point for a patient's care, devastating things happen.

Jane had an interesting solution for this particular problem:

One of my answers is..return the role of "head nurse" to its original purpose. That is, overseeing the care given to all patients on a unit, teaching nurses how to improve their practice, engaging other members of the care team in true care planning, making rounds with physicians and talking with families. Not managing a budget, finding staff, sitting on innumerable committees and spending almost no time actually on the unit.

This comes down to investing in additional resources to the head nurse with the many administrative tasks. While I like this idea, I think there are some administrative/strategic initiatives that only the "head nurse" who knows what's going on could really implement.

Speaking more generically about hospital culture, I saw this very interesting insight from Denny:

"For leaders, the most critical thing they can do to shift a "culture" is find out what the conversations are that their people are having. Not only is it important to know what people are saying to each other, but also what are they saying to themselves about the way things are. When a leader knows what people are saying about "the way it is around here," the leader then has an opportunity to address the issues and make a difference."

I like this explanation because everyone can grasp this. Hospital culture isn't some warm fuzzy thing that only consultants talk about - it is the unwritten norms of behavior and the frank conversations. Of course, this means that the people trust the leader enough to share!

by Nick Jacobs

Giving people permission to care in the health care environment may be one solution to positively changing the manner in which we run our hospitals, nursing homes, clinics and ambulatory centers. If we carefully examine what the current behaviors are and how the stakeholders are punished and rewarded, it’s an eye opener. Having worked in this field for over 20 year, I know that profound caring is just beneath the surface and relatively small changes can begin a process of managing and changing expectations and behaviors.

How is this accomplished? Our first step was to provide enough information and education to every employee, physician and administrative leader so that they had no questions what-so-ever regarding the organization’s goals. We did this by offering open meetings over all shifts to every stakeholder. We then offered classes and workshops in Emotional Quotient (EQ), Disney, Planetree, and general Sensitivity training. We paid for a week-end visit to the Ritz Carlton for the head of housekeeping and maintenance, and sent four employees to Disney University.

By the second year, we had built a comprehensive evaluation matrix for patient satisfaction and patient responsiveness into our employee’s annual appraisals. We then created an opportunity for about 10 percent of the employees (including our senior leadership), to find employment elsewhere. Although this was a difficult time, it was clear that these individuals had no interest in providing the type of compassionate care expected in our organization.

Finally, each and every year for the last nine years, we have continued to enforce our commitment to the philosophy of transparency, patient and peer compassion, and spiritual openness. Integrative health, access to clergy, 24 hour visiting, and a commitment to creating an environment that encourages a nurturing attitude have contributed to making our facility a true center for healing.