Culture trumps Strategy
"Culture eats strategy for breakfast everyday of the week". This is a famous quote from Management Guru and person who is known as one who laid down the principles of Modern Management Theories. He was known for the famous theory of Management by Objectives. In simple terms it defines the mission and objectives of the organization in very clear terms. Then it ensures it communicates the same to every employee. This in turn needs to be monitored and measured by performance. These performances attract rewards and create fresh objectives. This is theory but if this blog was all about theory then I should not be writing it at all.
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In my experience it is very important that fundamentally the leadership defines the objectives of an organization and create a strategy based on the same.
In my experience when I was entrusted with the leadership of a hospital, I was not given a clear statement of objectives, accept a loose statement "Your Health Our Mission". I was told by my trustees "you are heading an old charitable trust hospital which is having huge losses and coupled with a crumbling infrastructure, doomed to failure". So I was given a free hand to turn the hospital around and change the mood from a mere survival to some spark of revival.
A demoralized workforce had among them a few old timers who had seen better and in fact glorious days but were looking up to the leadership to lead. Unfortunately, the hospital was not sure where it was heading with rumours of takeover by a corporate healthcare service provider who would give the money for revival but would also by their mere presence dwarf or literally kill the chances of medical revival.
It is very difficult or impossible to do charity when the coffers are empty and therefore in the face of competition and lack of resources, the most important thing to do is to ensure that the service offered to the patient is such that the patient will have no option but to visit our hospital again. While the focus is on developing infrastructure and obtaining the best of equipment, the onus of using them responsibly, marketing our services and creating a model of appropriate pricing rested with us. This has not happened to the extent required.
Any hospital selling healthcare services tends to create a product and price and expect people to buy the same. Making a product which satisfies all stakeholders makes selling unnecessary. A hospital must design a product that satisfies the Doctors who are caregivers, the Patients who are service users and the employees who deliver services with ease and efficiency. Once all three conditions are satisfied then the hospital revenues rise and sustainability allows the way for charity.
There are multiple reasons for the same, the chief among them is that there are various myths which make us feel that this problem cannot be addressed.
Myth 1: Physicians don't care. This is not true even though we seem to believe the commercial aspects of health care have taken over. However, technology, volume of documentation and explosion of knowledge makes for busy physicians who care but do not seem to have the time to do so.
Myth 2: Doctors do not need to be taught communication skills. Most doctors feel they already know how to communicate but they fail to understand that they have an onerous task of having many difficult conversations which they are ill equipped to perform. A culture of life long learning is needed overcome this hurdle in culture change. Overtime the pressure of keeping up with the latest and multitasking makes the will to communicate better take a back seat.
Myth 3: Empathy cannot be taught. This is not true at all and it is self evident that lack of empathetic listening is the most important reason for malpractice suits all over the world. Our basic nature is empathetic even if we seem to have lost it in our busy lives. Reflection on our styles of communication can help revive this skill. Evidence suggests empathy can be taught and the right choice of words makes a huge difference.
Myth 4: Residents need to be trained more than doctor caregivers. Providing healthcare is more than ever before a team effort and a culture of service creates which work together with the same objective of providing excellent patient care. One weak link breaks the chain and creates a customer who will be satisfied and give a good feedback but will not exhibit loyalty. The physicians who lead by example help the teams to all give the patients a better experience.
Myth 5: Its not about satisfaction scores: The trend to link insurance reimbursement to satisfaction scores is already rampant in USA but not yet there in India, but on the ground we know that chasing satisfaction scores is fool's gold. What is more important is to create loyalty among customers by providing a memorable patient experience which makes sure that loyal customers sing the praises of the organization and attract new customers.
So all the processes and strategies are only as good as the people who use and implement them. So it is imperative to understand that Culture can triumph or eat strategy for breakfast lunch and dinner. Every day in the last few years I have realized that the hardest thing to change is the culture of an organization. We can put the best managers processes and strategies on the job but the most important link is the culture.
This can only happen if leadership takes it upon itself to do this and alignment to goals will help change the culture of an organization. Examples in healthcare like CMC Vellore and Cleveland clinic have created a culture of service and excellence worthy of emulation. Can this plan be put in place in hospitals with average or poor work culture? The answer is a qualified yes. This must be driven by top leadership and backed by a clear definition of the objectives in terms of well thought of vision and mission of the hospital.
Vispi Jokhi
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