Doing a culture assessment is like holding up a magnifying glass, a mirror and a map on the patient experience. We take a close look at the current reality, hold up the mirror by reporting back what we learn, and then lay out a roadmap for improvement.
In doing the assessments, we often report surprising observations (sometimes even accompanied by photos). But many times, we report disturbing observations that are NOT met with surprise. In other words, the leaders are aware of problems and have done nothing. Doing nothing is acceptance. Acceptance of less-than-desirable behaviors and conditions is lowering the standards and making that the cultural norm.
We recently delivered a culture assessment report where we showed photos of chaotic waiting rooms, filthy bathrooms and accounts of rude staff behavior. In preparing the report, we (consultants) were certain that we’d be delivering news that would evoke prompt action, partly because the patient experience champion had assured us of their high standards for service excellence.
Photo after photo, and story after story from our assessment, the leaders pretty much shrugged and said, “No surprise there.” What? No surprise? If this information is not a surprise, then their values and standards are useless words. They have lowered the bar by developing a tolerance.
I cannot sit back silently in these situations so I poke at the issue by asking for clarification. “So what you are saying is that this behavior (or condition) is okay here?” I may even hold up their standards and compare them to our observations joking that they should reprint with disclaimers in small print claiming “This does not apply in the ER waiting room on weekends.” Or, “These standards do not apply for Mary in Med/Surg because she has been here for 20 years.” When the leaders start to explain that it’s not really okay – we’re in business. It’s at that point that I can begin to show how lapses have become the norm. From there they can start to rally around the standards by recognizing how they’ve slipped from accountability.
Your culture boils down to how things are done around here. Don’t let substandard behaviors and conditions, define your organization.