Cultural Transformation: A Top-down Approach

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The culture of an organization is the by-product of every single employee’s daily routine. Research states that to develop a culture, whether it be positive or negative, takes at least five years. Becker’s Hospital Review stated in 2013 that, “the average hospital CEO tenure is under 3.5 years.”
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The American College of Healthcare Executives performed a study on over 4,500 hospital CEOs that showed 2013 had the highest percentage of turnover in the C-Suite (20 percent) in over 15 years.
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Today, it seems that the market goes through administrators even more quickly, especially in the for-profit sector, due to the high stresses on financial stability and fiscal responsibility, surgery numbers, turn-around times, quality scores, HCAHPS, and the list goes on. So how do organizations that churn through administrators every three to five years create a high performing organization that is patient-centered, produces good EBITDA with a sustainable growth rate, and has employees who exceed their job descriptions, and create a place where patients and their families feel safe and comfortable seeking care while producing good outcomes?

In many of the for-profit organizations the roles of the C-Suite members have evolved. The CEOs have been transformed into the physician liaison, contract manager, community liaison, and day-to-day operator of the organization. The executives in between the CEO and the director staff, such as Chief Operating Officers, Assistant CEOs, and Vice Presidents, are being reduced at the organizations with 250 or less beds and placing those roles back onto the CEO. Good or bad, more responsibility is being put onto the CEOs with less resources at the local level causing the more tenured administrators to retire or leave the industry, like we have been seeing with tenured healthcare providers. Becker’s goes on to state that, “most new hospital CEO candidates come from a venture capital/private equity industry background (42 percent) …”
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Therefore when putting more responsibility of the day-to-day operations on the CEO, it seems to be concerning when most new CEOs are no longer coming directly from the healthcare field. At the same time, the CFOs have been given more responsibility and daily tasks than ever before. Developing budgets, and meeting weekly, monthly, and yearly goals, while handling case management, HIM, patient access, and revenue cycles, creates significant demands. In today’s for-profit environment, it is no longer the CEO who is making the final decision, but rather the CFO who makes the decision on what to spend, how to spend it, and what to cut in order to make budget.

So, what can be done in order to create a culture of progression and sincerity throughout our organizations? It starts from the top-down. An organization with a suite full of administrators who staff and employees have never seen does not create a culture of dual accountability. A CEO who talks about how the trash outside in the parking lot is for everyone to pick up, but the administrator keeps walking past it each day, does not show a sincere culture. “What you are doing speaks so loudly that I cannot hear what you are saying,” is a quote I was brought up on. If we as administrators cannot do what we ask of others, then we should not expect a strong culture. “The buck stops with me.” Regardless of our daily tasks and routines, however tedious and time consuming they may be, we must be better connected to our team and people. The following are three things that every administrator can consider to stay in-tune with their organization, no matter how small or large:

Round on five patients a week, calling them by their name – Mr./Mrs. Smith. Talk to the patient and the family member(s), asking how you can be of service to them. Ask if you can recognize anyone on our team for their service towards them.

Round on one department a week – talking with each employee. Ask for suggestions on what you can do as an administrator to help them succeed in their job. Ask how you can be of service to them.

Rotate among administrators to round on the night shift one day each week. Just because they work past 5:00 p.m. does not mean they should go by the wayside. Ask how you can be of service to them that night or in the future to help them succeed in their job.

With those three things, the culture will start to change from the top-down. You cannot simply change a culture by “telling” but by “doing.” A smile, a handshake, a hug, just being of service, will move you forward. You can implement Studer principles and LEAN techniques (which are great to use), each and every day, but without the culture, you will not progress forward.

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http://www.beckershospitalreview.com/hospital-management-administration/10-statistics-on-ceo-tumover-recruitment.html

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https://www.ache.org/pubs/research/ceoturnover.cfm

Justin Harris, MSHA, MBA, CHFM, ACHE Healthcare Consultant (502) 566-1018 jharris@ddafhealthcare.com