Surgical and Medical Department Culture Change Drives Success – Practical Lessons

(This post is a summary of a presentation we did for the Academic Orthopaedic Consortium as part of their recent mid-winter symposium on a number of topics about optimizing Department Performance.  Special thanks the Department Chairs who shared their unique experiences during the discussion!)

Culture – A Top Concern

In a recent survey (summarized in the AOC 2020, Academic Faculty Compensation and Clinical Productivity Report), Orthopaedic Department Chairs rated “Department Culture” as the MOST important leadership initiative.

This is not a surprise. It’s consistent with our experience working with physician leaders and we’ve integrated the concept of culture into our four-part model for Department Success:

  • Strategic Planning and Tools
  • Supporting Physician Success
  • Effective Leadership
  • Culture
Alan Friedman, M.A.

While culture is a dynamic concept, a solid, productive culture is usually reflected by the following: 

  • Clinical and Administrative leadership understand and share a common vision
  • Clearly defined behavioral expectations – people understand the types of specific behaviors that support the culture, and those that are not accepted or tolerated.
  • There is a high level of trust, psychological safety, effective communication, and collaborative relationships – among physicians, administrative staff and other disciplines
  • Effective meetings and communication that support the Strategic Plan

See: Are you including “culture” as part of your strategic plan?

The Challenge – What IS Culture and How do You Change It?

Often, people can describe what a good or bad organizational culture looks and feels like, but they can’t nail down what makes it so.

So – let’s start with a definition. We like this one:

“[A] pattern of shared basic assumptions that the group learned as it solved its problems . . . which [is then] taught to new members as the correct way to perceive, think, and feel in relation to those problems.

            Schein, Organizational Culture and Leadership, 4th ed.

Or let’s summarize it, this way:

Culture is NOT a program…….It IS about what your organization stands for; and

Culture IS established, and reflected by, a collection of individual behaviors by people within a Department.

Once the behaviors start to change at the individual level, and between people. . . culture change will follow

A few key concepts about building the culture, that you’ve defined:

  • Those who don’t embrace the culture can’t be part of the team
  • Those who remain, reinforce the expectations and behaviors because they accept that these support success, and this becomes the way the team functions
  • You change culture by integrating training on the desired behaviors INTO the work. . . . (NOT through “culture” training)
  • People learn while doing the work, and constantly evaluating and improving behaviors IN THE MOMENT

(Great sports team rarely TALK about culture, but they are constantly WORKING on it!)

See a Case Study of how to integrate strategy, operations, and culture:

The Individual Psychology of Culture – People WANT to Succeed.

Here is a concept that we don’t leverage enough in healthcare:

People, generally, WANT to be part of a team, of something larger than themselves – to feel connected.  Although healthcare has long valued professional expertise and autonomy, this concept is true across all settings, and all professions.

The challenge, sometimes, is getting people to REALIZE that they want this and that they will be happier, more fulfilled and able to achieve their goals, as part of a group where they are valued and where they value others.

You cannot simply TELL people to function more like a team or be more collaborative.  You need  to define the specific individual and team attributes that contribute to a cohesive culture and help a “group” of people become a “team.”  A team is able of accomplishing the agreed-upon goals, because they have “goal congruence.”  

This only happens when leaders commit to helping their people to develop these skills.

See: Sometimes the best way to change culture, is by focusing on “the work.”

Effective Teams Display Common Characteristics:

  • Clarity of purpose and shared notion of what’s important
  • Role clarity
  • Confidence in the future
  • Trust and Psychological Safety

Each of these needs to be deliberately fostered, and modeled by, the Departmental leaders.

An Example – the Navy Seals

The Navy Seals are renowned as an elite force, built on both individual excellence and outstanding teamwork.  How do elite fighting forces like the Seals they accomplish the latter?

Their entire training program is thoughtfully and carefully designed to create a certain culture.  Even in an environment that pushes people to the limits of individual achievement, they value the teammate they can trust, over the one with the outstanding individual scores/talent.

In order to Build trust, you must Build relationships

Build faith in the vision….

            this is the job of a leader!

Building and Sustaining a Culture

Great coaches don’t teach technique and strategy on the practice field and then teach “culture” and behaviors, in the classroom!!!

In our work, we’ve developed a practical approach that has positively impacted the organizations we work with:

  1. IDENTIFY THE ASPIRATION OF THE FUTURE STATE – and articulate it powerfully.
  2. Co-CREATE a STRUCTURE that emphasizes and leverages collaboration
  3. DEFINE the BEHAVIORS that are valued by the Department/team because they will support collaboration and success
  4. CONNECT these BEHAVIORS to WHAT PEOPLE INDIVIDUALLY VALUE – so they are motivated to learn, grow and change their behaviors as appropriate, (this does not mean they have to change who they are). 
  5. BUILD the CAPACITY of YOUR PEOPLE by teaching them these behaviors. Provide insight, support and tools. 
  6. INTEGRATE these efforts into the work, itself.

This last point is critical and often over-looked.  Consider a sports analogy:

  • Great coaches don’t teach technique and strategy on the practice field and then teach “culture” and behaviors, in the classroom!!!
  • Constant attention goes into structuring practice and interactions with players – what’s said, not said, in the moment feedback, etc. – leaders are ALWAYS creating a culture, whether it’s intentional or not.
    • Every meeting, discussion, email, and decision establishes your culture.

Finally – Always Consider the value of Competence, Autonomy, and Connection.

None of this works, if you don’t provide people, under the theory that a sense of “self-determination” motivates people and keeps them engaged. 

Find ways, within the context of the overall plan, to give people:

  • A sense of leadership and cultural COMPETENCE;
    • A sense of AUTONOMY to find/implement solutions; and
    • A sense of CONNECTEDNESS – start with their team, then the Department, and ultimately, the organization (this is harder these days).

These concepts keep people engaged and motivated – both as individuals and as part of the team.

See a recent blog expanding on the concept of “Self-Determination Theory” as it relates to physician leadership and engagement:

Alan Friedman, M.A., is the CEO and Founder of J3P Healthcare Solutions. To learn more about J3Ps solutions, visit