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Squaring Success: Unlocking the Powerful Math of Cultural Transformation

Jan 19, 2019 08:49AM ● By MED Editor

By Nathan Harrup

Note: Nathan Harrup serves as Regional Director of Clinical Mission Integration for AdventHealth Shawnee Mission in Merriam, Kansas. Although this facility is outside of MED's core focus area, we felt that the information provided would be helpful and relevant to MED's readership. We welcome your feedback!


In the spring of 2018, a change upended the routines that had defined my professional life.  After years of crisscrossing the gentle rust and green of the upper Missouri countryside in the employ of a hospice organization, I put in my two weeks and signed on to serve “south of the river,” as we say in these parts.  My new assignment? Spearheading a major initiative to transform the outpatient culture of one of our region’s better-known health care providers.

It was a decision that would lay waste to habits and highways as familiar as old friends.  The disruption was both cognitive—requiring an off ramp from well-reinforced neural pathways—and practical.  But that culture shock, it would turn out, perfectly anticipated a larger shock to the system that my new mandate was designed to deliver.

Pushback: A Coefficient of Change

“Are you kidding?” was the knee-jerk response of one of our physicians during an initial meeting.  And he had a point. The mission was a bit audacious—the institutional equivalent of attempting a sixty-yard field goal against a headwind.  Our entire regional platoon of health care providers and their teams, in scores of primary care, urgent care, and specialty care centers, were to be redirected toward a paradigm of care that was both new and old—a more holistic, missional model that reflected the faith-forward DNA of the parent organization, AdventHealth.

“More time tacked on to the intake?” the same doctor groused. “Another tab to worry about in the EMR?  And what’s all this about having a caring ‘someone,’, or a source of joy, or a sense of peace—isn’t there a social worker who can ask these questions?”

Change isn’t always pleasant.  But at least the struggle is predictable.  In fact, pushback is a necessary coefficient:  If there’s nothing to overcome, the so-called change is probably just cosmetic.  

This mathematical “law” of culture change can be useful for helping leaders in any industry usher in the new.  At AdventHealth, I’ve also found a few other laws to be vital to the process of transformation—and beneficial for analyzing the conflicts and differences that make groups tick.

C=VI (Culture = Values Expressed Intentionally)

Educating employees in “what we stand for and how” isn’t always convenient or cheap, but it’s worth every second and every penny.  

AdventHealth made it a goal to put more than 80,000 of its associates through a four-hour course in whole-person care in 2018.  The result? Waves of round table discussions, co-mingling workers from every department for reflection and training. It’s been months since I last led one of these table talks, but even today I remember the candid remarks and often brilliant insights my coworkers shared.

But here’s where the math gets wonky:  While C=VI, remember that C=VU, too. Unintentionally expressed values can exert a powerful, invisible downward drag on any organization.  Ask Starbucks CEO Howard Schultz about this—in May 2018, after two African-American patrons were escorted out of a Starbucks by police for the “crime” of loitering in a coffee shop without buying a drink, Schultz elected to retrain his entire workforce of over 175,000 employees to better recognize unintentional cultural biases.  

There is too much to be lost from letting culture grow haphazardly.  Wildflowers in a garden look interesting enough, but they may also choke out the plant life intended by the gardener. The key to taking control of culture, instead, is in defining, expressing, and reinforcing values at every turn.

Respect and Regard are the Prime Factors of Safety.

“Whatever you do,” a coworker at a different company whispered to me years ago, “Stay off the radar.  The less you’re noticed around here, the better.”

The advice was breathtakingly sad.  Why would any employee feel this way—that being invisible is somehow the key to job security?  What kinds of toxic messaging about the cost of speaking up or standing out would have to have been expressed by leaders for someone to actually become fearful of having a noticeable presence?

Safety is Relationship 101, and it hangs on two non-negotiables of relational health: Respect and regard.  Obviously, as an employee I must know my coworkers and leaders will honor my body and mind by treating me with dignity and courtesy. I must also know that if I am vulnerable and honest, it will not cause others to think less of me.  When either of these conditions is not met, safety is absent. A reasonably wise person will instinctively pull away.

Within an organization, the values of respect and regard are typically expressed bottom-to-top.  But if safe culture is the goal, they must also be expressed top-to-bottom and side-to-side. No one at any level of the hierarchy can be exempt from them.    

What does this have to do with transition?  Change is resisted most intensely in those places where fear is felt most.  Worry less about creating safe spaces. Focus instead on laying a cultural cornerstone of safety by modeling respect and regard, as a leader, in every message, directive, and opinion you have the privilege of conveying.  

The Value of Understanding is Infinite.

My youth pastor growing up—we’ll call him Jim—had a special gift.  No matter one’s backstory, Jim could listen to it with not just interest but genuine fascination.  When a visitor to our youth group would share a thread of personal history, Jim would lean in to hear more, tugging on that thread by raising his eyebrows and exclaiming disbelief— “No way!”—at all the right moments.  One would think, to watch Jim’s reactions, that a teenager’s stories about growing up in the suburbs were the height of narrative tension.

Jim is now a successful medical sales executive.  His formula is transferable to anyone leading a culture transition:  Be authentically curious. The power of curiosity motors our listening tools.  And listening, in turn, drills down to unearth the priceless jewel of understanding.  It’s preached often in business but bears repeating: Help a disgruntled employee feel heard and understood, and you’ll be surprised how quickly the temperature of the gripe seems to fall.

Surveys and online message boards can tell us a lot about how employees feel. Our company went a step further this past year and also held town halls hosted by the CEO, creating a forum for open discussion about a major rebranding that was underway.  No matter how momentous the shift being proposed, giving ear to objections—the “whys” that clue us in to deeper fears worth exploring—will grease the wheels of culture change and improve receptivity 100% of the time.

Reflect.  Repeat. Reassure.  But before responding, seek to understand.

Trust Simplifies Every Equation.

“There’s something you should know about doctors,” a psychologist colleague told me one afternoon.  We had met to unpack the mindset of a physician, and my colleague knew this space well. “They may keep you at arm’s length for months or even years.  But once they know they can count on you, you’ll find them reaching out when you least expect it.” He paused. “That’s why it’s important that you never ignore them when they call.”

How does a cultural vision draw champions out of a pool of candidates who seem to be perpetually too busy, skeptical, or habilitated to the status quo to really consider a new direction?   How does that magical 10%, the “committed minority,” ever find their way to your corner when 99% of the work force would rather just show up and do their jobs than expend valuable energy dreaming?

The answer is trust.  Those you hope to win over need to know you stand not just for a cause, but for them personally.  Build trust by opening yourself to them. Advocate for them. Protect their confidences. When you make a mistake in dealing with them, own it.  Never be afraid to offer help beyond what is required—and follow through when that help is accepted.

Don’t promise a single thing that you are not sure you can deliver—Even if that tweak to the EMR is “just one more click,” don’t understate that single click’s impact on well-practiced routines.  Be truthful and be transparent about what culture change really means in practical terms.

Eventually, critical mass will shift in your favor, if you fight for your cause persistently and intelligently.  In the meantime, avoid shortcuts that risk credibility. Let trust do its work. In time, it will.

Shared Mission is the Greatest Common Denominator of successful teams.

Anthony Ray Hinton served 30 years on death row in Alabama for a murder he did not commit.  Not surprisingly, his first few years were spent drowning in bitterness and escape fantasies.  

But one dark and hopeless night, amid the groans and cries of broken men, Hinton found himself consoling an inmate who was weeping over his mother’s death.  In that moment Hinton, who loved his own mother dearly, discovered a mission. He writes in his memoir, The Sun Does Shine: “I was born with the same gift of God we are all born with—the instinct to reach out and lessen the suffering of another human being.”  

For the next 27 years, Anthony Ray Hinton chose to be a light on death row.  He comforted, taught, mourned with, and encouraged his neighbors at every turn.  Mission became his guiding force, and as he chose to live it, so did those around him, one by one.  Hinton’s eventual exoneration was sweet but almost redundant—he had already found freedom, and made freemen of his fellow inmates.  Mission had given him that gift.

The decision of AdventHealth to convert its outpatient centers from soul care deserts to oases where every patient can be attended to in body, mind, and spirit was not made lightly.  It was openly acknowledged that some providers might leave over the new direction—at great cost to the departments tasked with replacing them.

With that in mind, our initial benchmarks were modest.  30% participation within the first year would have been considered a success.  But something, perhaps, about the mission of whole-person care catalyzed our momentum.  Our leaders from the C-suite to middle management offices across the network coalesced around a key word: wholeness.  Our region’s participation in this initiative reached over 70% within six months and continues to trend up.

Yes, every major organization strives to be mission-driven, and some succeed.  But is it the same mission for each member? Shared mission is the dynamic at the heart of smooth cultural transition.  Share yours, as a leader. Articulate it, with passion and precision, which shouldn’t be difficult if you truly believe in it.  Then sell it. Sell it again and again until your colleagues and employees evidence buy-in by speaking of it as their own.

In the End, Personal Ownership is the Square Root of Cultural Transformation.

In business, as in relationships, focusing on the past and placing blame on others creates a convenient smokescreen behind which to hide our own failures.  Worse yet, blaming shifts responsibility for future outcomes to everyone but ourselves. “You put us in this mess,” the blamer says, “and it’s up to you to get us out of it.”

If an organization is to adapt, change, grow and keep growing, the message of blame must die.  Because in the end, transformation only succeeds when a coalition of employees, representing multiple levels of the org chart, takes full ownership of tomorrow.  And that ownership must be on display every time a leader takes the podium.

The message of personal ownership is one of maturity and pragmatism: “The past is the past.  It matters little who failed. My job is to help us move forward.”

Learn to live out this message, and you won’t be the only one who feels a stake in the process of change.  In fact, the math will be squarely on your side—and on the side of future organizational success.


About the Author:

Nathan Harrup serves as Regional Director of Clinical Mission Integration for AdventHealth Shawnee Mission.  His role includes extending a holistic, missional care model throughout a network of over 150 healthcare providers, and addressing the problem of physician burnout through a matrix of relational and missional initiatives.