A strong culture is one of the keys to building your brand and achieving long-term financial success
"When hospital execs talk about improving their medical group's financial performance, the discussion usually centers around revenue cycle management. But that's only part of the equation," asserts Dr. Terrence McWilliams, M.D., Chief Clinical Consultant for HSG, in Louisville. "Often overlooked is how culture affects the group's public face– how they interact with patients, referring physicians, suppliers, insurance carriers, local employers and each other."
The quickest way to understand how culture can have a positive or negative impact on financial performance is to consider interactions with referring physicians, says McWilliams. "One bad experience with one specialist in your group can poison a referring physician's perceptions. The rest of your specialists become guilty by association. Long-term that has a negative impact on both your brand and your bottom line."
A strong, pervasive culture also binds individual group members and practices into a cohesive whole and allows the group to function at a higher level. It's key to your network's performance.
Building a desirable culture requires an active process. Ignore it, and you're fostering the status quo or allowing your culture to evolve haphazardly, quite possibly with divisive or counterproductive results. "Scaling that mountain is not an insurmountable task, especially if you divide the climb into this series of consumable steps," McWilliams maintains.
Step 1: Define the term "culture." Many individuals have a hard time describing what their organization's culture is like. So a logical starting point is defining the term – what is meant by "culture." A simple definition is the collective "shared expectations that drive behavioral norms." Using this definition makes it easier for group members to understand the concept and contribute to the process.
Step 2: Define the group vision – what the group will ideally look, act and feel like. Yes, a vision statement is important to defining the group's strategic objectives, but it also establishes the framework for the group's culture.
Step 3: Prompt the discussion. Group members probably haven't thought much about what desired group culture elements might be. It helps to ask specific questions to prompt individual thought and group discussion, such as:
• What attributes of a group make you proud to be a part of it? This question is at the heart of the vision development interview process. It starts to make abstract concepts more concrete and often focuses attention on group culture elements to consider.
• What does it mean to be a member of the group? The answers to this question directly reflect individual perceptions of the group's collective culture – either the current state or the desired future state. This is another question that individual group members do not routinely think about.
• What behavioral norms are essential to drive the group's culture? Nothing like getting to the heart of the matter – ask the question directly to get a targeted response.
• How will we address group members who are non-compliant? To be effective, members of the group must be held accountable for their behavior. "Enforcing" compliance isn't easy. The best approach: discuss and collaboratively develop collegial methods to promote adherence to group norms. For egregious violations and blatant refusal to comply, the group must also develop acceptable consequences.
• What skill set (including knowledge base) must physician leaders possess to guide this effort and how do they gain those skills? Leadership characteristics and behaviors are often overlooked during culture discussions. Yet leadership has a huge impact on the group's culture. Address this directly by defining leadership expectations.
Step 4: Put it all together. Create a draft document, using the findings from the previous three steps. Then, vet it with the group.
Step 5: Educate the group. Explain that the final document will be used as a roadmap to develop the desired culture within the group by:
• Defining acceptable behaviors and activities for all members;
• Guiding recruitment and hiring efforts to predict a "good fit;"
• Becoming part of the onboarding process; and
• Forming the basis for corrective actions or disciplinary interventions.
Step 6: Review the statement regularly and revise as necessary. The group culture will evolve over time, as will the perception of its members. Much like the narrative vision statement, it must live at the forefront of group business operations to retain its relevance.
Dr. Terrence R. McWilliams, MD, MSJ, FAAFP has been with HSG since November 2013. He joined our group after devoting a decade as the Vice President of Medical Affairs and Chief Medical Officer at Newport Hospital, an acute care community hospital within a larger Rhode Island academic health system. Terry joined Newport Hospital when he retired from the US Navy after more than 20 years as a family physician and clinical administrator in a variety of practice environments, including leading multi-specialty clinical operations and physician-hospital alignment.
Terry received his medical degree from the University of Pittsburgh School of Medicine and a Master of Science in Jurisprudence (MSJ) in Hospital and Health Law from Seton Hall University School of Law. He has since obtained additional expertise in NCQA PCMH and PCSP content and Population Health Management.
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