Everyone seems to have their own take on it.
After working with over 85 healthcare organizations in the past 8 years to help them create and sustain a culture of safety based on the best practices of high reliability organizations, I have come to believe: Culture is the cumulative effect on the organization of the actions of the people within the organization at daily moments of truth.
The heart of this definition is what people do at the daily moments of truth.
Intrinsically, you know what a moment of truth is - the tens, if not hundreds, of little decision points every healthcare professional encounters in the course of their daily activities.
A decision point is where a choice must be made.
You can do "A" or "B.
" You can do something, or nothing.
You can say something, or say nothing.
You can do it the right way, or use a work-around.
You can do it mindfully, or thoughtlessly.
Many of these decisions are decided almost on the subconscious level, sometimes out of habit - without even being aware of deciding.
So if we want to change culture, then we must influence what happens at the thousands of daily moments of truth in an organization.
There is a simple formula for this.
Remember that "simple" does not always mean "easy.
" This formula is simple to understand and difficult to follow.
The formula for changing culture is this: Thoughts --> Actions --> Habits --> Character = Culture Changing culture begins with changing how folks think at the moment of truth.
If you can change how they think, affect why they do what they do - then you can change how they act at the moment of truth.
If we can change their thinking long enough to affect how they act on a repetitive basis, then we can help them develop habits.
Habits are those actions we take almost without thinking - it's just the way we "do business" on a personal level.
Changing habits changes our character.
Character is what we do, again almost at the subconscious level, especially when we think no one is watching or no one will know.
Ultimately, culture is determined by the collective character of all of the people in the organization.
Their character is determined by their habits.
Their habits are determined by how they repeatedly act at moments of truth.
Their actions at that moment are determined by how their thought processes have been influenced.
So if you want to change culture, you must change character, and if you want to change character you must change habits, and if you want to change habits you must change repetitive actions, and if you want to change actions you must change how people think.
In my experience the most effective way to change how people think is through leadership actions.
These actions include steps like:
- Over-communicating what must be done, how it must be done, and why it must be done;
- Aligning all of the documents that describe how business is done in the organization with the philosophy of how it should be done;
- Public and repetitive acknowledgment and rewarding of the desired actions at the moments of truth;
- Consistent coaching for those needing improvement and willing to improve;
- Imposing negative consequences for those unwilling to change how they think and act.
"Telling" is not training.
Great training that changes actions is experiential, inter-disciplinary, case-study based, allows for practice, and offers real time feedback and reinforcement on performance.
Effective training gives both the individual and the team an opportunity to practice the actions needed in a learning environment so they will skillfully be used at the moment of truth.
To ensure those actions are repeatedly used when needed and therefore made into a habit, hardwired tools are most effective.
Tools like checklists, protocols, communication scripts, standardized communications, and briefing guides help people use the right action at the right moment.
The tools serve as a forcing function; if the tool is used correctly as part of the consistent daily work flow, the individual has no choice but to take the right action repeatedly and thus develops an effective habit.
Little by little, moment by moment, person by person, habits are ingrained and character changes.
As character changes, the culture also changes.
The beauty of the LifeWings methodology is that each of the components necessary to affect thinking, actions, and habits are built in to our process and our expert facilitators and coaches demonstrate and teach the skills to follow the culture changing formula.
Improving the future landscape of our country's healthcare system depends upon creating and sustaining cultures where healthcare professionals are allowed to be capable of all they were created to be.