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Corporate culture is defined as the beliefs, values, and behaviors that guide how employees within an organization interact with themselves, their vendors, their customers and/or any key stakeholders. Stated another way, corporate culture has been described by many as “what happens in an organization when no one is looking over their shoulder.”

An article in the Harvard Business Review in May 2013 indicated culture can account for 20-30% of an organization’s performance when compared with culturally unremarkable competitors. In today’s healthcare environment, it is rare to find an organization that isn’t talking about changing its corporate culture to remain competitive and relevant in the communities they serve. At the same time, hospitals and health systems are struggling with performance improvement in so many areas: enhancing quality and safety, engaging the employees, increasing patient satisfaction, and last but not least, improving operating margins.

With hospitals and health systems trying to address so many critical issues all at once, many organizations are attempting to drive performance improvement, by developing a “culture of accountability.” If a hospital or health system is going to address quality, safety, employee satisfaction, patient satisfaction, and financial performance all at once, what kind of culture would enable success in all those areas, all at once? On the surface, accountability seems to be that one concept that should enable an organization to address any and all challenges that arise. Everyone in the organization, from the front-line staff to the CEO, needs to be accountable for what they do to be successful.

But creating that culture of accountability is easier said than done. What keeps a hospital or health system from achieving a culture of accountability?

Within every hospital in our country there are clinical staff – physicians, nurses, therapists, and pharmacists – who throughout their training are taught the importance of always doing what’s right. It essentially started with the Hippocratic Oath in medicine, with the concept “first do no harm.” The nursing profession also adopted this standard with the principle of nonmaleficence, to protect the patient’s safety. Along the way, healthcare borrowed from private industry and added the critical standard of zero defects when it comes to performance improvement, emphasizing the importance of accountability to protect the patient. Accountability is something that every clinician understands, and every hospital strives for. Who wouldn’t want to work in a hospital where everyone strives to ensure that a culture of accountability is alive and well?

Unfortunately, many hospitals are not able to achieve their desired goals. It’s likely not the concept of accountability that is the stumbling block. Nor is it a lack of understanding of what’s needed, in terms of concrete steps. Every organization recognizes and understands that you must hire the right people, set clear and measurable goals and expectations, review results, and address variations from the standard. So, what’s missing?

Accountability without gratitude is a failed strategy. It is critical that people feel appreciated and valued for what they do. Not only for themselves, but more importantly so they can pay it forward; so they can show gratitude for others. There’s nothing wrong with striving to create a culture of accountability. But to do so also requires having a culture of gratitude – they need to go hand in hand. Together, they create the kind of culture that everyone can understand and appreciate. A culture of accountability and gratitude can create the kind of environment where everyone is motivated to do their best and willing to be held accountable for what they do.

The practice of gratitude is something that we are seeing and hearing more organizations embrace. At the same time, there is not a great deal of research that has been done on gratitude in the workplace. Steven Fehr at the University of Washington has concluded that making gratitude part of the culture is key, and that organizations must ensure that gratitude is something that happens continuously. It can’t be something that is emphasized once a year, nor can it be viewed as the program of the month.

And of course, if leadership wants to ensure that gratitude becomes part of their culture, they must model behaviors and examples of gratitude for the rest of the organization. It all starts at the top. Leadership must demonstrate gratitude on a daily basis. Whether it’s spending a few moments talking about gratitude at every meeting, making a point of thanking staff during “walk arounds,” or writing personal thank-you notes, there are many opportunities for leadership to show sincere appreciation and gratitude to their employees.

Hospitals and health systems are used to throwing money at problems, but as we all know, that’s usually not a sustainable solution. For example, hospitals have often increased salaries to try and retain staff. Unfortunately, after the competitors do the same to eliminate any differential, the advantage quickly dissipates. Conversely, having a culture where everyone in the organization has a strong bias towards accountability and a feeling of gratitude to be working there, would create a tremendous competitive advantage. That is a culture that would not only energize people to do their best, but would also help to retain staff, and most importantly, ensure their community is being served the way it should.

This article is written by Jeff Fried, Executive Consultant for Gobel Group and former President and CEO of Beebe Healthcare. Click here to read the next article in the series.