From the original article, "How Many Cultures Does Your Organization Have," authored by William F. Jessee, MD, FACMPE, Senior Vice President and Senior Advisor with INTEGRATED Healthcare Strategies. Dr. Jessee is most recently the former President of the Medical Group Management Association (MGMA). Dr. Jessee may be contacted at email@example.com or at 612.339.0919.
Not only are hospitals merging or becoming part of larger systems, but the number of medical practices being acquired by hospitals and (usually) merged into the health system is staggering. Not surprisingly, one of the most frequent problems that these organizations encounter can often be traced back to a clash of cultures.
Every organization has its own culture. One definition that encompasses culture well goes like this:
“The shared set of social values and beliefs, both explicit and implicit, that guides actions, decisions, and behavior within the organization.”
When that status is achieved, it is described as a state of “cultural coherence.” But when people come together from different organizations, with different value systems and different ways of doing their work, it is not surprising to find that there may be several sub-cultures---a state that can be termed “cultural divergence.” And when people from those sub-cultures are asked to work together as a unified whole, conflict often results.
A good example can be seen in a case study of two hospitals that merged. Each had exclusive contracts with different physician groups to provide hospital-based services---radiology, anesthesiology, pathology and emergency medicine. But with the merger, the management team decided that the simplest solution would be to simply ask the groups in each specialty to merge. Two years later, only one (radiology) had actually done so, and the warfare between the two anesthesiology groups had become a major problem. Why? Because of the profoundly different cultures---driven by profoundly different values---in the two groups. For example, one group employed several nurse anesthetists, while the other employed none—the latter group honestly believed that allowing a CRNA to administer anesthesia was tantamount to malpractice! The physicians in the two groups not only differed in professional values, they actively disliked one another. A merger between the two was NOT going to happen.
Every organization has an explicit statement of its “values." But how widely are those values really shared by your employees? For that matter, how widely are they shared by your physicians, management team, and board? An organization in which almost everyone truly knows, understands, and believes in those values is an organization with a coherent culture---and an organization in which the work force is usually actively engaged in helping the organization perform well and achieve its strategic goals. But an organization plagued with cultural divergence may have segments of its workforce that are either not supportive of its goals, or even actively working to undermine their achievement - not a formula for success.
How many cultures do you have in your organization---one, or many? How good is the cultural “fit” among physician practices that you own or plan to acquire? How well will new hires fit into your organizational culture? How can you manage cultural conflicts when they occur? These are all questions that your organization needs to be able to answer - and if you can’t, you should find help from experts that can guide you to the answers.