This hospital has won numerous awards, but leadership wanted to create a patient and family–centered culture that matched the stunning new campus and clinical reputation. How do we “operationalize” culture? What does it mean to actually be patient and family-focused, or consistently quality and safety-oriented? How does Human Resources support these efforts?
A Deliberate Approach to Culture Change
The work environment or patient experience didn’t match senior leadership’s vision. Surveys showed that staff didn’t feel the organization was serious enough about patient safety and the patient experience. Staff turnover and time to fill open positions were high and patient satisfaction scores were below average. The hospital undertook a five year, comprehensive cultural intervention.
The hospital recognized that “programs” and long term culture change are two different things. The former promises quick results, the latter is about long term process and behavioral changes that result in a slow and steady shift in thought and practice. This shift is manifested in everyday decisions, including how they look at talent. Organizations that hire a candidate out of desperation to fill an open position, or keep a technically proficient employee who is not patient-focused or adaptable, are making conscious decisions that shape their culture.
Human Resources Plays a Critical Role
First, this hospital made culture change part of their strategic plan. Then it looked to its talent strategies. No department has a greater influence on culture than Human Resources. The staff’s attitude toward safety, change, and the ability to remain steadfastly focused on the patient and family experience starts with the ability to attract, select, train, and retain the right people.
Every hiring or promotion decision has an impact on organizational culture, so the goal is to link selection with the desired cultural improvements. Human Resources worked with department leaders to link all jobs to the mission at the beginning of the recruitment process. This link is then maintained during orientation, on-boarding, performance management, and development. Success also required a more deliberate and objective approach to selection decisions.
The New Selection System
Step 1 was the development of an organization-wide, comprehensive behavioral competency model. In 12 weeks, PSI and the client identified a concise model of the behaviors, at every level of the organization, that supports the cultural vision. These competencies now form the foundation of the selection, performance management, and development of all employees from service workers, to managers, allied health and nursing, to senior leadership.
Step 2 was implementing the Select Interviewing® for Healthcare program where hiring managers take a serious role in building their teams, and use of proven, healthcare-specific online behavioral assessments including ServiceFit® for Healthcare, NurseFit®, and Select Assessment® for Leader Development. These add objectivity to evaluating behavioral skills and identify candidates who will exhibit the behaviors that support the culture.
During this five year period, the hospital achieved Magnet status. Patient satisfaction ranking has improved by 16 percentile points. The hospital is rated in the top 10 in the nation and surveys show substantial improvements in staff attitudes about the organization’s commitment to patient safety and to engaging them in quality, safety, and patient experience improvement initiatives.
The new selection system reduced overall turnover by 59% and one-year turnover by 53% while reducing time to fill by 44%. These HR metrics have an impact on bottom line performance and are reflective of a culture that attracts and retains top talent.
Healthcare organizations often struggle with culture change because they are unclear on what it means and how it links to their overall goals. Culture is not a “program,” but the correct way to perceive, think, and feel in relation to problems. Culture manifests itself in the collective behaviors of the workforce. This sounds simple enough in theory but adhering to this principle in the face of tradition and short term pressures is a challenge. Forward thinking senior leaders understand the impact of culture on outcomes and bottom line performance. The most successful organizations understand that talent strategies play a critical role in success and take a structured, deliberate approach to building the workforce capable of creating the culture they seek.