By Daniel Whitlock, M.D., MBA, Consulting Physician, Physician Wellness Services, Minneapolis, MN and David Cornett, Senior Executive Vice President, Cejka Search, St. Louis, MO,
At a time when physician engagement is critical in effectively addressing the changes impacting healthcare, organizational culture is an important factor that physicians say is central to their sense of engagement and overall satisfaction. Organizational culture becomes a more significant issue as physicians move to employed models, especially for those who worked in smaller medical groups or in solo practice.
Differences in areas as varied as accountability, autonomy, work environment and communication methods can create gaps between expectations and reality.
Physician Wellness Services and Cejka Search’s nationwide, multi-specialty survey of more than 2,000 physicians on organizational culture identified cultural attributes that were important to their overall satisfaction, and measured gaps between their satisfaction and the organizations’ focus on those attributes. The survey also explored the importance of cultural fit to physicians as they evaluated and made decisions around new practice opportunities versus remaining in their existing practices.
The importance of culture
A review of organizational cultural survey instruments specific to healthcare identified 14 cultural attributes which, based upon our experience, were most relevant to physicians. The cultural attribute questions formed the basis of the survey and were categorized into four major areas: work environment, organization, leadership and management, and communication.
The first notable finding was that all cultural attributes were important to physicians, which all fell into the upper quartile for importance to physician satisfaction as measured on a 10-point Likert scale - well above the 3.0 to 7.0 mid-range. The top cultural attributes were:
- Respectful communication (8.6 average score)
- Patient-centered care focus and supportive management approach to errors and mistakes (tied at 8.5)
- Transparent communication (8.4)
Physicians gave lower marks for how well they felt their organizations demonstrated competence around cultural attributes. Average scores ranged from 5.8 to 7.6, falling more in the mid-range. The highest scores were for patient-centered care focus, clear mission and values (tied at 7.6) and respectful communication (7.2). The lowest score was for transparent communication (5.8). Physicians scored even lower for satisfaction with their organizations’ focus on these cultural attributes, with average scores ranging from 5.7 to 7.0.
A companion survey asked administrators how important they felt cultural attributes were to their physicians, and how well they felt their organizations demonstrated competence. Administrators were largely on track with what was important to physicians; however, administrators were more positive in assessing their organizations’ competence on cultural attributes, with scores ranging from 6.9 to 9.1, compared to physicians’ average scores ranging from 5.8 to 7.6.
Cultural fit and its implications
Regarding their own cultural fit, physicians scored 7.0 on average - at the high end of the mid-range. When asked how much cultural fit influenced their job satisfaction, the average score was a more robust 8.4, indicating cultural fit was clearly important. Administrators’ average score of 7.2 regarding the cultural fit between their current physician population and the organization tracked very closely with physicians’ self-identified cultural fit, but was far from the ideal score of 10.
When asked if their expectations around cultural fit had been a determining factor in accepting a practice or job opportunity, physicians’ average score was 7.7, showing that cultural fit was a significant factor in evaluating prospective opportunities. More than 60 percent of respondents scored 8 or above on a 10-point Likert scale. Yet, when administrators were asked what percentage of otherwise qualified candidates were not offered a position because lack of cultural fit was a determining factor, the average response was 36 percent of the time.
Similarly, when asked if lack of cultural fit had prompted physicians to leave a practice or job, the average score was 6.5, with 27.1 percent who scored 10. More than half of respondents felt lack of cultural fit would influence their decision to leave a practice. This finding may be understated, given several comments in the open-ended questions indicated that some physicians wanted to leave but stayed in their present job due to concerns around family and location preference, career stage or economic concerns. When administrators were asked how often cultural fit had been cited by voluntarily departing physicians as a primary reason for leaving a practice or job, the average response was 32 percent. Administrators may be underestimating the degree to which cultural fit affects retention and recruitment.
How to close the gaps
Each organization is unique, but certain steps—involving a collaborative process between physicians and administrators—can be taken that are common to any organization:
- Determine what your organizational culture is, and where you want it to be.
Some organizations work for a long time defining their mission and values - and then stop there. To take this to the next level:
- Define your current culture. Develop a list and definitions of what cultural attributes are important, then let physicians rate where the organization is strong and weak - and how they feel about the organization’s culture.
- After sharing the results, prioritize attributes based upon the biggest potential impact, or the biggest gaps between expectation and reality.
- Make sure physicians are involved, potentially leading subsequent efforts.
- Pursue one or two attributes that will have the most impact.
Set tangible benchmarks and accountabilities and develop formal action plans.
- Ensure agreement about the definition of each cultural attribute. Identify daily behaviors and actions supporting it at the individual, workgroup and organizational levels.
- Develop a roadmap for change, communicate and act on it by providing tools and resources to support those who are impacted.
- Ensure physicians are involved in decision-making at every step.
- Discuss the initiative openly at the individual and group level. Outside facilitators can be helpful in encouraging openness and creating a safe environment to share ideas and concerns.
- Provide individual coaching and mentoring for those who need more help or who are struggling, and education in areas that support the change, e.g., communication skills, conflict management, developing resilience around change.
- Measure progress periodically and adjust tactics, as needed. Communicate results honestly and constructively.
- Provide adequate time to work on change initiatives. When significant progress has been made, start on the next priorities.
- Institutionalize the cultural attributes.
Organizational culture must be reinforced and nurtured, across the board.
- Recruit for cultural fit. Develop assessment tools and processes. Use behavioral interviewing techniques, to learn more about conflict management, teamwork and communication - making sure they tie clearly into the desired cultural attributes.
- Create onboarding programs that educate new hires and reinforce cultural norms.
- Choose physician leaders who personify the desired cultural attributes and develop a mentoring program, using these physicians as mentors. Make sure to outline specific roles and accountabilities for both mentors and mentees.
- Incentivize behaviors and attitudes that support the desired culture.
- Continue to measure progress against the desired cultural attributes. Work at exceeding expectations.
Ultimately, this is about changing behaviors and attitudes - not just those of physicians, but all stakeholders who work alongside them and support them. This will benefit the organization by creating a stronger sense of engagement with its physicians while improving satisfaction with their jobs and careers.
Organizational Culture Survey, Cejka Search and Physician Wellness Services