Every organization has a culture–as a patient or an employee, we know that culture by its look and feel, by the ways people talk to each other, by what is supported and not inside the organization. In today’s world of accelerating rates of change, we embark on many changes, sometimes haphazardly, assuming their implementation will positively impact our organization’s culture. But this is not always the case.

Change management is a relatively young science. While the ancient Greek philosopher Heraclitus is credited with teaching, “change is the only constant in life”, it wasn’t until about 25 years ago when we began to consider that we might manage how change occurs. Concepts about successful change date to the pre-1990s, but not until 2000 did processes begin to be formalized and jobs designed specifically to produce successful changes in organizations. In healthcare, we began to adopt Quality Circles and LEAN principles, among others, as examples of those processes. Today, we are entering a new era in which change management is becoming more organic, using prototypes, rapid tests of change, and design principles, with a belief that those closest to the situation requiring change often understand it best. We begin to see this in healthcare when we examine highly reliable organizations, those who adopt a coaching culture, and those supporting staff empowerment. This new period allows us to be purposeful about change and to have the process of change align with our cultural values. For instance, if my lived culture supports innovative thinking and engagement, my organization will support a change process that encourages trial and error and repeated tests of change. If my culture is driven solely by the bottom line, every accepted change will be dictated by a conformity with that cultural belief, even at the expense of quality, safety, and the patient experience.

The plethora of books exploring change management including Good to Great; Built to Last; Smarter, Faster, Better; and Diffusion of Innovations examine companies and situations that help us derive clues that make changes successful. Beyond this, we can all recount times when we’ve seen changes work and when they haven’t. I have witnessed leaders who successfully learned skills to incorporate changes in their own practices that supported an espoused culture while others did not. Same teaching, same competencies, same organizational roles.

What makes successful change highly likely for some and seemingly impossible for others?

Making change that works requires a supportive culture, a culture aligned top to bottom, one that not only permits fruitful change but encourages and supports that change. Such a culture nurtures its leaders so that they in turn cultivate their employees. This kind of organization is one in which the processes have not overtaken the reason people use those processes–we remember the human connection; we recall our calling; we act from a sense of mission.

Three factors serve us well as we endeavor to grow our cultures using positive change processes.

Learning to make organizational change well requires the whole organization, not just a few specialists or those with job titles indicating their support of a change process.
Understanding not simply what the change is but why it is important and how it will occur must become embedded in the fabric of the organization. This requires a presence and voice at the top and an aligned support by all leaders. When this occurs, change spreads beyond the innovators and early adopters and begins to permeate the early majority. Granting the freedom and responsibility for innovation to those whose hands are in the work and then supporting their efforts makes sense.
Incorporating methods for measuring permeation and depth of practice (that is, assessing competence) makes effective change possible and practical for organizational adoption.
We’ve come to a crossroads in the evolution of the healthcare experience. Every indication is that the pace of healthcare change is accelerating. We can either choose to manage these changes effectively or allow them, tsunami-like, to cascade over us. Assuming we choose to manage the changes to support our desired culture, creating a strategy that begins with what we want our cultures to be—to look like, feel like, be expressed as—will determine the outcome of every small change effort in the organization.

Here are some questions to ask yourself today. Do you have an effective mechanism for aligning, reconciling, and communicating goals across the organization? Does every person understand how he or she contributes, really? Is the spoken culture the same as the unspoken one, that is, do we do things the way we tell our interview candidates we do them? Do we support our leaders and employees in their right and responsibility to think through best practices and innovate new solutions? Do we assume good intentions on the part of those who give of their lives to support our organization? Do we follow through consistently with our praise, our coaching, our feedback?

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Culture