Culture Change Part Three

Leaders play a large role in organizational culture and act symbolically; what leaders pay attention to signals what is most important to the organization members. For example, when leaders bestow perks on certain roles and not others, it sends a cultural message. At one hospital the staff holiday meal had been cancelled due to funding cuts but all members of the management team received expensive watches as a holiday gift. This disparity communicated to the entire organization. People pay attention to how things like desirable physical space, flexibility, and work schedules are allocated and read meaning into those arrangements.

The leaders in the org chart matter a great deal but there are also informal leaders, those who may not have an official leadership role but who have great credibility and influence on others. The term “champions” has been used for those who are willing to be early adopters and bring their peers along with full intention.

Informal leaders can be harnessed in service of the desired change. Not just anyone however can function as a champion. To be effective, the champion needs credibility with their peers and the ability to articulate empathy for the way people may feel about the change and the desired result of making the change, expressing the reasons to adopt more palliative care services further upstream for rural community members with serious illness. The champion must model curiosity rather than fear about what may unfold as change occurs. This does not mean the future is depicted as rosy without reservations but it does mean that concerns are voiced with a focus on finding solutions.

One particular challenge in health care teams is culture change among the medical staff. Physicians in particular may be reluctant to accept messages from non-physician messengers. This makes the role of the physician champion particularly important. Medical staff may function as unconscious informal leaders, not always realizing that power and influence they have been granted by others.

In a rural healthcare team where ARNP and PA providers may play leadership roles, it is not always clear if for example, an ARNP champion can have optimal influence on MD and DO peers. It depends on the level of collegial egalitarianism present in that particular medical staff team.
Those who want effective change might carefully assess the candidates for champions and make choices with the greatest possible service to the desired change. Ideally the champion already cares about serious illness care, already knows that “fixing” is not the only kind of care, and has some of the warmth and empathy that serves as the core of palliative care interventions. Even the most passionate champions might also be made more effective by a set of well thought out talking points, clear and cogent, that make the case for the culture change while also expressing empathy for the peer the champion seeks to influence.