Organizational Culture

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Organizational Culture

• May 25, 2006
• Teleconference
• Michelle Nelson, RN, BSN
• Home Health Clinical Consultant
• Mnelson_at_gmcf.org

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Definition of Organizational Culture

• There is no one single definition
• A personal favorite

The deeper level of basic assumptions and beliefs
that are learned responses to the groups
problems of survival in its external environment
and its problems of internal integration are
shared by members of an organization that
operate unconsciously and that define in a basic
taken-for-granted fashion an organizations
view of itself and its environment (Shein 1988)
http//www.au.af.mil/au/awc/awcgate/ndu/strat-ldr
-dm/pt4ch16.html
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Organizational Culture Characteristics

• Behaviors and Artifacts Things you can see
  (dress codes, employee retention, etc.)
• Values Underlie and determine behaviors
• Assumptions and Beliefs Deep and to the
  organizational core

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Organizational Culture

• Philosophy and values of the organization are
  represented and manifested by the organizational
  culture.

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Organizational Culture

• Think of an organizational culture as a living
  breathing building with a foundation,
  infrastructures, communication systems
  (elevators, stairs, etc.), feedback loops,
  values, beliefs and attitudes.

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Organizational Culture

• Now imagine undertaking a building renovation
  project without having any understanding of the
  current state of the existing structures, such as
  the the blueprint

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Organizational Culture

• The first phase of the construction goes
  rather smoothly. The new office space is almost
  ready for the staff to occupy and suddenly and
  without warning, the floor starts caving in and
  crashing down on the other floors

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Why? There were no major support
systems in place in the area where the renovation
occurred.
Organizational Culture
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Organizational Culture

• Now transfer that vision to any of your
  quality improvement initiatives and ask yourself
  these questions
• Have past quality improvement initiatives
  achieved a measure of success but lost all gains
  over the long run?

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continued . . .

• Are quality improvement initiatives like pulling
  teeth to get implemented?
• Are you able to replicate successes of quality
  improvement initiatives in the same or other
  areas of the organization?
• Is the reaction from staff negative when a new
  quality improvement initiative is presented?

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Organizational Culture

• These may all be signs and symptoms of an
  organizational culture problem in areas such as
• Communication
• Team-work
• Leadership
• Improvement models
• Care coordination
• Patient centered care
• Organizational learning, and/or
• Information management

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Organizational Culture

• Fact
• An organizational culture that is negative
  produces quality improvements that dont achieve
  targeted outcomes, are not sustainable and/or
  cannot be replicated.

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Organizational Culture

• Conclusion
• ACH POA Oral Medication POA other publicly
  reported outcome measures, such as staff
  retention, customer satisfaction, and disease
  management programs and all other QI initiatives
  will not achieve, sustain gains, and/or be
  replicated as long as organizational culture is
  not understood to be the underlying foundation to
  quality improvement efforts.

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Communication The Nervous System of
Organizational Culture

• Can you imagine your brain not being able to
  communicate effectively with your big toe?
• How about if your big toe can not get a message
  through to your brain?

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Communication The Nervous System of
Organizational Culture

• In the first scenario, your brain may not be able
  to tell your big toe to move away from the fire.
• In the second scenario, your toe may not be able
  to tell your brain that there is pain from being
  to close to the fire.
• In either instance, the outcome is disastrous

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An Example of A Diseased Nervous/Communication
System

• Using the same analogy, if leadership is
  unable to communicate effectively Directives
  to the staff member at the lowest level of the
  organization, (or conversely)
• The outcomes can be disastrous

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In Addition
The staff member is not able to communicate
barriers/problems effectively to the
leadership level through the existing
communication structure
The outcomes can also be disastrous!
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Communication

• Because an effective communication structure
  is so essential to organizational culture, gmcf
  is recommending that if your survey reports
  identify communication as needing improvement,
  your organizational POA should address
  communication.

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Elements of Any Effective Change Plan

• Sense of urgency
• Creating a powerful change team
• A clear and concise change vision
• A change communication plan
• Identifying barriers and addressing them
• Planning for and creating short term wins
• Staying the course (not declaring victory too
  soon!)
• Anchoring change into the culture

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The Capability Maturity Model

• Previously used in engineering and software
  development, but adapts well to the home health
  setting
• See page 12 of Creating A Culture of Quality
  Improving Home Health Communication

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The Capability Maturity Model

• This model addresses basic processes of culture
  and presents a developmental approach to creating
  the capacity for sustained quality work.
• Eight areas for creating capabilities were
  selected.

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The Capability Maturity Model

• Quality Improvement Model (OBQI)
• Teamwork
• Communication
• Care coordination
• Leadership
• Patient centered care
• Organizational learning
• Information management

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The Capability Maturity Model

• Each of the areas if further broken down
  into stages, strategies and actions are very
  similar to the ACH Matrix used to develop the
  ACH POA
• The stages are developmental steps in
  achieving improvement. There are four stages
• ? Initial ? Modeled ? Managed ? Optimized

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The Capability Maturity Model

• gmcfs recommendation is that we work together
  as a group in the area of communication in the
  initial stage.
• We understand that many of the agencies may be
  functioning at a higher level, but because
  communication is a foundational area and the
  stages must be developmental (stair step) to be
  effective, starting at ground zero seems
  appropriate.

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Interpreting Survey Results

• Each survey question represents one of
  the eight areas in the Capability Maturity
  Model
• Question 1 represents the improvement
  model (OBQI)
• Question 2 teamwork,
• Question 5 communication

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Interpreting Survey Results

• The easiest method of interpreting the
  survey is to turn to the report that has Mean,
  Std Dev and Frequency at the top of the
  responses.
• Select in the mean column for each question
  and select the questions with the lowest numbers
  as areas that are not as strong as the other
  areas.

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Interpreting Survey Results

• Once again we are strongly encouraging that
  you use question 5 (communication) as the area
  for your POA.
• Teamwork is another area that has tools
  available so that you dont recreate the wheel.
  For that reason both guides and workbooks were
  sent to your agency.

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The Communication Plan of Action (POA)

• Located on the www.gmcf.org Web site

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The Communication Workbook

• www.medqic.org

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The Tools

• www.medqic.org

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References
The Leader's Change Handbook An essential guide
to setting direction taking action. Jay A.
Conger, Gretchen M. Spreitzer, Edward E. Lawler
III, Editors. 1999. Jossey-Bass, San Francisco, CA
 
Managing Transitions Making the most of Change,
2nd, ed. William Bridges. 1991. Da Capo Press,
Cambridge, MA
This material was prepared by gmcf, the
Medicare Quality Improvement Organization for
Georgia, under contract with the Centers for
Medicare Medicaid Services (CMS), an agency of
the U.S. Department of Health and Human Services.
The contents presented do not necessarily reflect
CMS policy. Publication No. 8SOW-GA-HH-06-05
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