The Culture Argument

No one is making the culture argument.

Fundamental, sustainable and meaningful change in the health care system isn’t going to be achieved by new policy or operational initiatives.  No, the more important changes that need to occur involve a transformation of how all involved think about their role in the system.  All stakeholders (patients, providers and insurers) need to reassess and redefine their values and norms.  This is the culture argument and it has been absent in most, if not all, discussion regarding health care reform.

The absence of cultural transformation in the health care debate is understandable in that it is a concept that is difficult to define and/or measure and even more difficult to create and/or change.  But the importance of culture to the success of an organization, or in this case an entire industry, has been well documented.  Peter Drucker, a legendary management consultant, is credited with the saying: “Culture eats strategy for lunch”.

Why is culture so important?  It provides clarity and focus.  It allows for efforts to be aligned and directed to a common goal.  In addition, the values and norms of a group’s culture lead to the actions and behaviors of the group.  People are empowered to act in accordance with the culture.  There is less policy driven micromanagement.  It allows an organization to be less “top-heavy”.

A management professional once said: “You can get a sense of an organization’s culture based on what people are talking about”.   If this is true then there is a lot of work to do in health care.  While there has been a significant amount of discussion about quality and value in health care from outside the industry the talk inside is still for the most part focused on the same old nonsense.  The discussions are still focused on generating as much output as possible at the greatest level of efficiency.  This culture of utilization at the greatest possible efficiency (i.e. the corporate model of medicine) has been one of the main reasons that we now have a crisis.

For those interested in creating the successful health care organization of the future developing a culture of quality and value is imperative.  While this may seem a less tangible goal then optimizing a balance sheet it is absolutely crucial to success.  Everyone in the organization must understand that quality and value take precedent over all other issues and everyone in the organization must be empowered to act and innovate toward quality and value.

Once all energies are focused on a culture of quality and value then the next challenge is to have the culture generate strategies and operations that result in a functional health care system.   For the few who do currently talk quality and value this has also been a challenge.  Admittedly it is easy to talk about a culture of quality and value but to create the working model is more difficult but an absolute necessity.

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