February 11, 2020

9 Steps to Build a Culture for Better Clinical Outcomes (Part 1)

Clinician Leadership | Leadership Development | Team Development

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We have a belief at MEDI Leadership: culture eats strategy for lunch. You may consider this quote from Peter Drecker overused, but most likely you sense some truth in it.

If you’re not sure you agree with Mr. Drecker’s statement, consider the strategies that exist throughout hospitals today. Some of the best minds have created approaches to clinical practices to enable the safest care for the best value.

Yet, we still see large numbers of medical errors. In fact, medical errors are the third leading cause of death behind heart disease and cancer (Modern Medicine Feb 28, 2018). And the amount of monetary waste that exists in the US healthcare system is in the hundreds of billions each year (Shrank, Rogstad, and Parekh; JAMA October 7, 2019).

While effective clinical strategies are important, the fastest way to drive better practice is to focus on culture.

Create a Foundation Culture of Clinical Improvement

I often hear from healthcare leaders, especially those who have been medically trained, that culture is the “soft stuff.” However, time and again, my colleagues and I have worked with healthcare leaders to improve their culture, and they find that the return in engagement and outcomes is significant.

Consider the below formula:

Culture = Shared Values and Beliefs -> impact -> Behaviors -> impact -> Outcomes

Great organizations have an intentional culture, but all organizations have a culture. It’s up to you as the leader if you want to influence and manage it, or if you want to let it morph on its own. I must warn you, though, choosing the latter can result in a culture that is counterproductive to your desired outcomes.

It’s difficult to get ones’ arms around the concept of creating culture, and it’s tough to know where to start. So, a few of my colleagues and I – all who are physicians by trade and executive coaches by choice – have developed nine steps to help. To minimize the risk of this blog becoming a novel, I’m going to break it up into three parts.

In this first blog, I’m going to focus on the people component. Because when it comes to intentional culture, people and relationships must come first.

Determine and Involve ALL stakeholders

When determining your stakeholders to include in the process, you’ll want to go deeper than you may think initially. Consider anyone who touches the process, the flow of the patient, or the clinical decisions. You’ll have a team of clinicians and non-clinicians, sometime from beautiful places in the organization.

I’ve seen teams consisting of physicians, nurses, therapies (PT, OT, RT, mental health), operations, IT (data managers and analysts), IT (EHR infrastructure), and patients who don’t have e medical background.

Once you form the team, make sure everyone is represented at the table when deciding upon recommend care processes. It’s also important to take some time for everyone on the team to get to know each other – beyond just title or role in the organization.  This time is well spent, because it is an important step in building trust which in turn promotes safety in the group to discuss differing opinions openly and constructively.

Train your People

It is essential to get advanced training in clinical quality improvement for your clinical leadership. But beyond that, it is equally important to train the administrative leadership, so they understand the basic principles.

Realize that when your physicians participate in the training and therefor embrace quality improvement, your culture will move. If you’re wondering how many physicians you should train, a general idea might be to target to train the square root of the total number of physicians.

Remember the more people who are trained, the more your culture will embrace quality.

In addition, leadership must demonstrate the culture in their actions, such as placing quality metrics review high in priority on agendas and making decisions around financial allocations that demonstrate to the front line that they walk the talk.

Engage the Board

To really ignite and align the culture of quality clinical outcomes, include your board. Not just on your outcomes, but make sure they’re aware of and approve the most strategic clinical improvement goals.

In addition, provide regular updates to the board on the implementation of processes that support and progress toward the goals.

Finally, work with the board to ensure that achievement of clinical improvement goals is tied to incentive compensation for leadership.

. . .

In our second post, we discuss an organizational structure and process framework to help support more consistent clinical outcomes.

Feel free to contact us for clarification or further guidance on what you’ve read above. We’re happy to discuss how your peers have tackled similar challenges and help you identify next steps.


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About the author

Brent E. Wallace, MD

Brent E. Wallace, M.D. is a seasoned physician leader, having been the Chief Medical Officer of Intermountain Healthcare for 12 years.

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