During a recent meeting to discuss the impact of healthcare transformations, I heard a prominent executive in our organization remark, “Culture eats strategy for lunch” when it comes to implementing improvement initiatives. This comment may be related to Peter Drucker’s observation; the amount of time business executives pay to culture and strategy is way out of proportion based on the contribution of each to an organizations success. Healthcare organizations around the world are catching up to other industries in recognizing the crucial importance of culture for organizational success, however, without a strategy of clear goals and plans, accomplishing intended change in organizations fails miserably.
For many healthcare organizations, the CMS value-based purchasing agenda puts an organization’s culture on notice that quality tools and management are required to succeed. If the commitment to self-assessment of accountability for quality is not embedded in an organization’s culture, the chance that change will occur and result in performance improvement is unlikely at best. The disciplines of measurement, data collection, analysis and reporting are cultural attributes that need to exist at all levels. Key elements of culture such as leadership; behavior and attitude change and a clearly articulated purpose are the foundations of patient care value without which the future is vague.
Strategy is not the result of an executive team going on a retreat and having a flash of collective brilliance. It is an iterative process that involves highly engaged employees thinking about how to win the future while still trying to accomplish today’s patient care.
The change that must happen to improve value will not happen at the executive level but at the operations level within the daily processes of care delivery. Staff with their hands upon the levers controlling value processes work in the present, taking care of today’s patients and meeting today’s deadlines.
The executive leadership team is looking toward the future with vision, mission, strategy, policy and all that says, “This is where we are today and this is where we want to be in the future.” To get there things must change. Hospitals today realize that if they don’t initiate change they will not thrive and may not survive. Value-based care is when the patient, payor and provider are satisfied. This occurs at the point of care; the process level. Management changes are a waste of time unless they are driving significant operational changes.
Managers closest to these operational processes are clinical supervisors, program leaders and service line managers who are the bridge between the future vision and those people who will get you there. These individuals will translate and communicate all the good intentions of executive and board leadership into real measurable results at the point of care. This is the key focus of effort in driving change within organizations. These professionals must be prepared and equipped with intelligence and monitoring tools to identify and react to performance variance in real-time.
So rather than focus on culture vs. strategy, focus on how to put solid metrics around your culture. Your employees will likely engage more frequently in order to think up and deliver upon that great strategy that is floating around out there somewhere. It’s not about who eats who’s lunch, but culture deserves more attention than it receives.
