“Culture Eats Strategy for Breakfast” – Does it apply to health care?

February 7th, 2018 / By Steve Delaronde

Business management guru Peter Drucker is credited with saying that “culture eats strategy for breakfast.” The message is that an organization will not adopt any change or effectively pursue any strategy that is not consistent with its culture. How does this apply to health care and what can be done to develop a culture that achieves better outcomes, lower costs and a better patient experience as embodied by the Triple Aim?

The foundation of culture is purpose. While the overriding purpose of most organizations is profit, profit is not sufficient for creating a culture of success. Health care attracts people who are not just interested in making money, but who also want to ease suffering and make a difference in the lives of others. The Triple Aim attempts to define a purpose for healthcare organizations by focusing on better outcomes and a better patient experience, as well as lower costs.

Individuals want to be part of something larger than themselves. They want to be part of a group—an organization, workplace, profession, team, or nation—that is consistent with their values. Promoting health, preventing disease, and providing medically necessary and appropriate treatment should be the overriding purpose of healthcare organizations. Unfortunately, there are many distractions encountered along this path.

Healthcare organizations, like many others, are primarily concerned with their own viability. Viability is achieved with a positive balance sheet, whether an organization is for-profit or not-for-profit. The incentives offered to individuals are usually financial. For example, shared savings is the benefit typically emphasized with healthcare providers that participate in value-based care, rather than better patient outcomes or a better patient experience. Additionally, the fee-for-service system continues to exist alongside value-based care structures. This creates a dilemma for healthcare providers that continue to have an incentive to fill an empty hospital bed rather than forego immediate cashflow for an uncertain return of shared savings in the future.

The quest for revenue and profit margins cannot be the sole foundation for a positive work culture. People want to be part of an organization also known for its excellent customer service, contribution to society, and value to the community. Providing healthcare services that are accessible, timely, and effective is consistent with these non-monetary values.

Commitment to an organization is fostered by not just allowing employees to participate in the financial success of the organization, but also through employee recognition, professional development opportunities, promoting a work-life balance, and allowing employees to positively influence and interact with their work environment. People want to know their efforts matter and that they make a difference.

Culture is not optional. If an organization does not actively create a positive culture that aligns with its vision, then something will emerge on its own that may or may not be consistent with an organization’s purpose. Once a culture is formed, individuals joining that culture will soon adapt to the environment. As health care moves from volume to value, the key organization shifts that need to occur include: 

  1. Define purpose – If the culture we want to create is one that delivers positive outcomes and unparalleled service to the patient, then metrics must be developed and recognition provided for those that contribute most effectively to patient satisfaction and positive patient outcomes, as well as financial success.
  2. Embrace change – Emphasize innovation, provide incentives for new ideas, and create an environment where it is safer to take risks than it is to maintain the status quo. Value-based care is synonymous with risk, which must be rewarded rather than avoided.
  3. Lead by example – Building an organization that allows employees to be part of something bigger than themselves means that leadership needs to create opportunities for collaboration, become transparent in its communication, and acknowledge the contribution of those that form the core of the business.

Ultimately, value-based care will be successful for healthcare systems that can best define their purpose, embrace the inevitable change that results, and have leadership that can pay as much attention to culture as they do to strategy.