It’s time to instill a positive culture in medicine

This year marks 33 years of administrative positions in academic medicine.  When I first started, I suspect I made many major mistakes.  I learned through the time-tested school of hard knocks.  As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, “Culture eats strategy for breakfast.”

Look at ward attending physicians.  The same attendings have “good teams” every time they attend.  Their teams get the work done and thrive.  The learners learn and progress.  The same internal medicine attendings have a greater percentage of students choose internal medicine as their career.

These attendings create a positive learning culture.  They make work more pleasant because they have enthusiasm and respect for all the team members.  They want everyone to succeed and the take great pride in the team’s success.

Other attendings repeatedly complain about students or interns or residents.  They do not create a learning culture.

How do we create a positive culture?  Why do we have leaders in medical schools, hospitals and practice who create negative cultures?  Why do many of those leaders spend so much time on complex strategic planning, and so little on creating culture?

Culture derives from a clear understanding of core values.  As a sports fan, you wonder why the same coaches have success repeatedly.  My own favorite team, the University of Virginia men’s basketball team, currently is having tremendous success.  When you listen to the coach, Tony Bennett, talk about the team, he constantly talks about his core values.  The players understand the values and echo them.  Yesterday, I listened to the former coach of the University of Connecticut, Jim Calhoun, interview Coach Bennett.  Afterwards, he contrasted his success with a different set of core values.  The core values guide teams and give them a consistent compass.

We do not see this often enough in medicine.  Too many leaders in medicine focus on rules, productivity statements, grant dollars and surveys, but pay little attention to culture.  A positive culture requires hard work and consistency.  Everyone on the team needs to know what the organization’s core values are.  Why are we here?  Who are we serving?

You cannot find these things on a CV.  Developing culture is an acquired skill that only happens if the leader cares.  He/she must walk the walk rather than talk the talk.  The leader must live the culture and embody that culture.  Unfortunately, it does not happen enough.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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