Medical Staff Culture- Part 1

Culture is a key driver of organizational effectiveness and performance because it engenders the attitudes and behaviors within that organization. Over the next few months, William Cors, MD, MMM, FACPE will discuss strategies to understand and use your medical staff culture to empower the ability to shape what is said, believed and accomplished within your medical staff.

Dear medical staff leader:
What is your medical staff culture? The answer is more important than you think.
The true measure of an organization's culture is how people behave within the organization. In some medical staffs, the behavior is generally consistent with the stated mission, vision and value, but in others, it is the complete opposite.
In many medical staffs, questions about what the medical staff's mission or vision stands for draws a blank stare.
Accordingly, culture drives behavior and behavior drives results. To achieve a truly effective medical staff, physician leaders must proactively mold and lead the medical staff culture so it will simultaneously drive the desired results of physician and hospital success.
During our work with medical staffs, we have found that medical staff culture can be best understood as expressing five underlying dynamic tensions, sometimes referred to as polarities.

See how many of these you recognize in your medical staff:

1. Collegiality and excellence. Collegiality is unconditional acceptance. Simply by meeting the standards of membership, your fellow physician should have your unconditional respect as a colleague. This is the "social grease" of physician-to-physician relationship. We all want to work in an environment where excellence and balance is achieved, however, are you or other physicians willing to accept colleagues unconditionally? Do you meet the standards of excellence that are expected?
2. Freedom and commitment. Physicians need to be free to make choices about how to spend their time-on their practice, with their families, on personal pursuits. However, if we want to be relevant to hospital discussions, bring a voice to the table, and have adequate influence we need to do our part. That includes a commitment to attend meetings, help solve problems, and take turns in medical staff leadership.
3. Appropriate independence. This is critical for the practice of good medicine.  But so is mutual accountability of physicians to their peers on the medical staff.  Balancing this tension is a challenge for medical staffs.
4. Appreciation and continuous performance improvement. We have all adopted continuous performance improvement as almost a mantra in healthcare today.  But in doing so, we often fail to appreciate those physicians who are already providing excellent care. Countless physicians already respond to calls at the middle of the night, deal with angry or hateful patients, who threaten to sue them, and then get up the next morning and do it all over again. Who is saying thank-you in your hospital?
5. Stability and change. Medical staff leaders must embrace and implement change to help the hospital and the medical staffs achieve success. For medical staffs today, this includes an array of issues, including: new pressures to adopt evidence-based medicine, address disruptive physician behavior, operate under public accountability for quality measures, reduce costs of patient care, and manage physician-to-physician and physician-to-hospital conflicts of interest. The very survival of hospitals and their medical staffs depends upon their ability to respond to these changes in a timely and effective manner. An organization requires a measure of stability or it risks lurching from one fad to the next. An effective medical staff is one that balances stability and change well.

Next month, in Part 2, we will address how to deal with ineffective medical staff culture. Until then, be the best you can be.

William Cors, MD, MMM, FACPE
The Greeley Company