Online descriptors of high-performing healthcare providers abound. Successful ones are described as having a positive culture, aligned goals and consistent leadership. Adjectives like agile, forward-thinking and patient-centric are also attributed to them.

How does an organization become more agile or aligned? How can other organizations put this knowledge to use to improve their own?

“Thirty years of research shows that the best companies are ones where employees trust people they work for, have pride in what they do and enjoy the people they work with,” said Kim Peters, executive vice president of lists and strategic partnerships at San Francisco Bay Area-based Great Place to Work. “People are happy and content because they feel they can be themselves.”

The importance of culture


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The Society for Human Resource Management (SHRM) released a paper in 2019 outlining the costs of a toxic workplace culture. Almost 50% of the people surveyed had considered leaving their job. About 20% of respondents left a job because of a poor culture and, of those who did, 58% said it was the people that prompted their departure.

Although three-quarters said managers set the culture for an organization, 25% did not feel comfortable discussing work-related issues on the job with an employer. Another 40% said their manager did not have honest conversations about work topics. SHRM estimates the cost of turnover due to workforce issues has been $233 billion over the past 5 years.

Satisfied staff want to stay with an employer, however, and 85% who say they have a strong workplace culture talk positively about their job to friends and family, according to the report.

Peters’ group – which measures and certifies workplaces – focuses on employees’ feedback on the levels of trust they experience in order to assess the workplace culture. Their analysis has shown that employers who rank highly in that respect have staff that is more productive, innovative, agile, and likely to want to stay.

“In this kind of workplace, employees trust leadership to make the right decisions, there is lots of transparency and they [the workforce] feel that they are playing a role in the outcome of the organization,” Peters said. “That really is a place people want to be.”

Assessing the intangibles

An organization’s culture can be a difficult thing to grasp, but there are plentiful quizzes and surveys online that can be used as assessments.

In a 2019 article in Forbes, consultant and author Kathy Miller Perkins offered up 5 questions any company can ask to tease its culture in a 2019 article in Forbes. She recommends considering the stories and anecdotes people tell about the organization. They can offer insight into a business’ culture. Next, understand how employees view the company’s leadership. This might best be done on an anonymous basis or through a consultant. Third, look more closely at employees’ behaviors (for example, how do they act in meetings or when something goes wrong?). Finally, ask employees to relate their understanding of the company’s values to see if they align with the leadership’s.

Peters said they have a Trust Index Employee Survey. It helps gauge how employees feel about an organization and how its employee experience compares with that of other companies.

Their survey can help providers understand the level of trust among different groups. Sometimes certain positions, such as those in part-time jobs, are not having as positive an experience as full-time staffers.

“I would encourage people to take the temperature of their organization,” Peters said. “They can’t improve until they understand where they are. It takes a combination of data and listening and caring to build a culture of trust.”

What good cultures look like

According to the SHRM document, good culture produces 3 outcomes: people know how management wants them to respond in any situation, employees believe their response is the right one, and they will be rewarded for demonstrating the company’s values.

Culture starts at the top and employees clearly expect management to lead the way. Effective leaders tend to be humble, have good communication and listening skills, are caring and supportive of the whole team, and place the company’s interests in from of their own, Peters said.

“All of those characteristics are ones that are going to lead an organization to become a great place to work for everyone,” she said. “But in practical terms, that doesn’t happen very often. In fact, according to a survey we did in late 2018, only 49% of U.S. employees experience their workplace as a consistently great workplace.”

A healthcare organization that ranks number 9 on Fortune’s Best Places to Work list (the highest of any health system) has a range of reasons why its employees love their work. The Arlington, Texas-based Texas Health Resources uses a communication approach known as Question and Resolve. All employees can ask clarifying questions of any colleague until both come to an understanding.

“You can just keep questioning until you see what they’re seeing or they see what you’re saying,” Camille Torralba, a nursing supervisor at the organization, said in a 2019 Innovations in Health Care: Case Studies report by Great Place to Work.

Signs of a poor culture

It makes sense that an organization with a poor culture is going to be the inverse of a good workplace. Signs of an unhealthy culture include poor communication and plenty of politicking.

Leaders in a place with poor culture, Peters said, are not interested in individual staff members. People tend not to be comfortable offering opinions or just being themselves. In a toxic environment, everyone leaves at quitting time instead of giving extra to get the job done. When people are not comfortable around managers – or do not trust them – they tend to become alienated from the workplace.

Poor culture can also manifest itself in more serious ways. The SHRM paper said sexual harassment, even if it is not reported, can be a result of poor or misguided leadership. Discrimination in the form of sexism or ageism may arise when leaders do not explicitly warn that this is unwelcome.

Setting and maintaining a good culture is important for keeping employees happy, and in turn, providing good patient care. It should be measured, created, and maintained over time. The number of mergers and acquisitions in healthcare can cause leadership and staff changes, making it easy for culture to break down. Surveying employees annually takes the pulse of an organization and ensures it is trending in the right direction.

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