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Healthcare Culture: How to Navigate It If You Don’t Have an MD

Several years ago, a mail-order shoe company turned running an organization on its proverbial ear by introducing a new operations model. The company? Zappos. The model? Formalized, organization-wide culture to the benefit of both employees and customers.

Of course, Zappos didn’t invent workplace culture. Every workplace has a culture – even healthcare. But what Zappos did do, however, is give organizational leaders a prototype for being more thoughtful and strategic about creating culture.

In business, culture creation usually comes under the CEO’s umbrella of responsibility. In healthcare, however, that’s not always been the case.

Many healthcare organizations espouse a “culture of engagement,” a “culture of accountability,” or a “culture of service.” But, the truth is, such a culture may or may not exist. Saying you have a culture and actually having it are two entirely different things.

For some in healthcare, there continues to be a “culture of haves and have-nots” with power plays, titles and degrees dividing clinical, support and administrative staff.

There may be opposing points-of-view among multiple leadership contingents. Or there may be a lack of a unifying vision. There may be those who are trying to maintain the status quo within an environment of ever-increasing change.

And there also may be what New York Times contributor Danielle Ofri, MD, calls “abuses of hierarchy,” in which physicians promote or allow widespread disrespect of non-MDs.

In another article, “A Compelling Call to Action to Establish a Culture of Respect,” published on the National Institutes of Health website, Matthew Grissinger, RPh, FASCP writes:

“Bullying, incivility, and other forms of disrespectful behavior are rampant in health care, allowed to exist while we tolerate the behavior, remain silent, or make excuses – ‘That’s just the way he is’ – in an attempt to minimize the profound and far-reaching devastation that disrespectful behavior causes. While a culture of disrespect is harmful on many levels, its effect on patient safety makes it a matter of national urgency, according to Lucian Leape, MD, of the Harvard School of Public Health and his esteemed colleagues, who authored a two-part exploration of disrespectful physician behavior in the journal Academic Medicine. Although disrespectful behavior is not limited to physicians, they often dominate the culture and set the tone.”

This type of culture, says Leslie King, Ph.D., Franklin University’s dean of the College of Health & Public Administration agrees ran rampant until only a few years ago when things began to change.

“Within healthcare, the tradition of the culture has been very hierarchical,” he explains. “Historically, within the industry and the hospital setting, your value was looked at in terms of how many and what degrees you had. There was a pecking order based on your ability to contribute to the patient care process, so MDs and nurses were treated as more important than others.”

“The good news,” says Dr. King, “is that changes in healthcare delivery are also creating changes – positive ones – within healthcare workplace culture. And that bodes well for the non-MD, including and especially those with a doctorate in health administration.”

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“The family experience has become as important as patient care,” he says. “And keep in mind that those who have direct contact with the family are not always the doctors and nurses. The historical physician-first hierarchy is changing. Now the role of administrators and CEOs is evolving so much so that non-MDs and those with an executive doctorate are also responsible for ensuring that the patient and the patient’s family have an experience that goes above and beyond just good medical treatment.”

This approach puts everyone – from physician to administrator to CEO to doctorally trained leader – side-by-side at the table and in collaborative, problem-solving teams.

“This is good thing,” says Dr. King. “With the team approach, the focus becomes holistic toward healing and care, patient safety and family experience.”

While it’s easy to blame physicians, no matter what the cultural problem, the key is to create a healthy organizational culture characterized by:

  • Mutual collegiality
  • Shared focus on excellence and operational efficiency
  • Devotion to patient safety, care and outcomes

As a non-MD leader in your healthcare organization, it is incumbent upon you to help envision, define, develop and nurture a safe, collaborative culture.

Here Dr. King shares top DOs and DON’Ts for how non-MDs can navigate their healthcare organization’s culture.

DO look for opportunities to become part of high-performance, cross-institutional project teams, as well as find ways to grow and learn about the entire hospital, healthcare or organizational system.

DON’T be afraid to get outside of your discipline and learn from others. “So much can be learned about the hospital and the patient and your immediate role when you do this,” says Dr. King.

DO find a mentor, coach or other person outside your area. Dr. King says you’ll get a different perspective on the organization and on how to grow professionally when you seek out someone who has been around the organization longer than you, or someone who holds a higher position than yours.

DON’T pigeonhole yourself into just your service line or silo. “Doctors get to work across the continuum, of course, but so many others within healthcare do not,” says Dr. King. “Stop confining yourself to just your area of the system.”

DO join a professional organization and become an active participant. “Always put your sights on professional growth and look to your future,” says Dr. King. “Becoming part of a professional organization, such as the American Association of Healthcare Administrative Management, will connect you with other professionals and allow for the exchange of best practice ideas.”

DON’T forget to volunteer for work-related community activities. Dr. King says volunteering in this way demonstrates not just an interest in your own advancement, but also shows that you are a holistic person who is committed to giving back.

DO pursue advanced credentialing or a terminal degree such as an applied professional practice degree in health or healthcare administration. “Whatever your next level would be is what you should prepare for,” says Dr. King. “If you want to move higher up, you don’t necessarily need a Ph.D., but you do need to become an expert in healthcare systems operation. A doctorate of healthcare administration or DHA can prepare you to look across an organizational system and apply management theories at a practical level. An executive doctorate also can help you better understand the broader scope and dynamics of holistic care and serving a community, as well as the patient and family.”

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