Take off your clothes

Abstract:  This article takes a look at the role of culture as it relates to organizational performance.

It has been a while since I have written for my blog.   I’ve been a little busy on an engagement that has taken a lot of my time.   One of the most challenging aspects of working with organizations in transition is dealing with culture.   I have written a lot about culture in my blog and it continues to be one of the most vexing aspects of leadership and Interim Executive Consulting. The following story is true and it happened almost spontaneously.   I now use this experience to make a point that people will remember about how they allow their cultural limitations to limit their capability.

I was listening to a group of managers debating the hospital’s preparedness for a regulatory survey.   Concern was being expressed about the fact that there were known deviations from standards.   The longer I listened to this, the more frustrated I became.   At the breaking point of my patience, I stood up and said, “OK, that’s enough. Everyone in the room, take off your clothes.”  The shock and awe were palpable.   People sat staring at me as they tried to comprehend what they had just heard.   I said, “I’m serious.   Everyone.  Take off your clothes right now.”  My audience was dumbfounded.   I suspect some of them were wondering if the psychiatrist was in the building.

I said, “Let me ask you folks a question.   If I continue to press this point, my prediction is that at least one of you will take the position that you will not take off your clothes.   You will refuse to do this because you have modesty, morals, ethics, decency and or religious convictions upon which you will base your refusal.”  My question was, “If you have standards that prevent you from taking your clothes off when all that is involved is a simple violation of modesty, how do you rationalize having knowledge of regulatory deficiencies in your areas of responsibility and not having done enough to resolve them when patient safety may be compromised?”  Remember the movie, ‘A Few Good Men?’  Tom Cruise asked, “Can you explain this?”

And so, I had another head-on collision with entrenched dysfunctional culture.   Several years ago, I had the privilege of doing work with Northside Hospital in Atlanta.   Northside’s culture as it relates to regulatory compliance is very simple:  Every department is expected to operate 100% compliant with applicable standards 100% of the time.   As a result, a compliance survey is or should be a non-event at Northside.   This is dramatically different from the culture in other hospitals I have worked in that go through episodes of horror when they are in the survey window and word comes that surveyors have been spotted in the next town.   These hospitals have a culture that says it is OK to have a laissez-fair attitude and approach toward regulatory compliance until they think they might be surveyed.  Then there is a mad rush to get into compliance.

I told the leadership team that the Board of Trustees had decided to commit the hospital to applicable accreditation standards.   Therefore, the question as to whether or not managers are expected to follow regulations is off the table.   Anyone that does not agree with this position of the Board should ‘punch the clock and get over the hill,’ as my dad would say.   I went on to tell the group that in deciding to comply with regulatory standards, the Board had a reasonable right to expect that the standards were being followed on a continuous basis and not just when the hospital was in the survey window.

I told the group that I needed a volunteer, someone that could explain to the Board if the survey turned out as bad as they predicted, how the organization had developed a culture of tolerance of areas of non-compliance with so many standards.   To my chagrin, I did not get a volunteer.   I told the group that this depressed me so much that I was going to go to the store, buy a bottle of wine and drink the whole thing. I was then going to bring the bottle back to the next meeting and use it to play spin the bottle to determine who the spokesman from the group to the Board would be.  I then exited the room.

Over the next couple of weeks, the leadership team of the organization responded admirably.   There was no need to go back to the meeting to play spin the bottle.   Every manager of every department went to work, around the clock in some cases to bring their areas into compliance with regulations.   Sure enough, in less than two weeks, the surveyors showed up.   The hospital had one of the best if not the best survey in its history.

Was this result due to me making a speech?  I don’t think so.   All I did was challenge the hypocrisy of a dysfunctional culture that in some cases could potentially jeopardize patient safety.   What changed was that a group of managers decided independently that they were no longer going to be associated with substandard compliance in their areas of responsibility.   There is a one-liner that states that “You don’t have to move all of the cattle to change the direction of a herd.  All you have to do is to change the direction of the lead steer.”  Peer influence in an organization is extremely powerful.   This is what led me to redefine my own understanding of the word ‘culture.’  Webster defines culture as the beliefs, customs, arts, etc., of a particular society, group, place, or time: a particular society that has its own beliefs, ways of life, art, etc., a way of thinking, behaving, or working that exists in a place or organization.   I define culture as the lowest level of excellence a group will accept as tolerable and normal.   Groups in my experience do a very good job of enforcing the culture of the organization on their peers for better or worse.   When a group decides to hold itself to a higher level of performance or rejects the mediocrity that has held it back, its performance improves measurably.

So, I conclude with questions for you.   To what degree are you being limited by the culture that is surrounding you in your present situation?  What are you doing to change the culture?  Do you have the support you need to get the culture from where it is to where it needs to be?

Remember my challenge to take off your clothes.   Give some thought to where you will draw the line when it comes to the level of mediocrity you will accept and tolerate.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the U.S., I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.

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This is original work.  This material is copyrighted by me with reproduction prohibited without prior permission.  I note and provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com.  I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.


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