Organizational culture is a little bit like air, we all know it is there but it can be difficult to actually see. Here is one definition:
Organizational culture is defined as the underlying beliefs, assumptions, values and ways of interacting that contribute to the unique social and psychological environment of an organization.
Culture is less visible to employees who have worked in a place for a long time and it is most visible to those new. Some say culture shows when observing the evidence of what the organization values through symbolic acts, like who gets what space or resources, who is able to participate in decisions, how much freedom people have to influence their own work and who receives benefits. Leaders may try to make intentional statements about organizational values but these are only taken seriously when aligned with what people observe in action.
There are “industry” wide cultures, for example, the NFL has one kind culture that differs from the culture of Starbucks or other coffee outlets. Healthcare has its own culture and there are also professional subcultures. So there is a layering of rural culture, the culture of a community, healthcare culture, the culture of physicians or nurses or other professions and then a very particular organization embedded in those layers. Retention is heavily influenced by organizational culture because most simply, some cultures make people feel trusted and valued and others fall short of that.
So, if we consider palliative care to be a shift in culture that moves from a dedication to “finding and fixing health problems “ to witnessing and facilitating the patient’s goals for the best quality of life, how does one help the culture make that shift?
The first step is perhaps obvious but not easy to make happen, define desired values and behaviors. The second part of the statement is critical, can you describe what behaviors will demonstrate the value shift?
If we are trying to facilitate a cultural shift to integrate palliative care, imagine what some of those behaviors might be; regular goals of care conversations, attention to quality of life as primary goal, visible demonstration that curative treatments are not the only form of care.
In the next part in the series, a discussion of other steps one can take to facilitate culture change.