Top 7 Ways to Sustain Cultural Transformation in Healthcare

By Shirley Ruch, Med, RN, C-LNC, Consultant at Creative Healthcare Management

As I partner with organizations that have been on their Relationship-Based Care (RBC) journey for several years, invariably at some point the big question becomes, “How does my team maintain the exuberance and creativity to continue to deepen and also sustain our cultural transformation?”

How Do You Keep the Inspiration and Energy for Change from Fading?

Reflecting on this challenge, I realized that my career has been filled with experiences such as attending inspiring conferences or educational sessions, becoming re-engaged with my professional purpose and joy in my work, and returning to my workplace full of vim and vigor and passion for change. I begin to implement changes, and then... life happens, and I fall back into old patterns of behavior and practice.

So what is the solution? Is there even an answer to this issue of sustainability?  From my experience there appears to be no magic fairy dust that can be sprinkled uniformly for all organizations. At the same time there are some practices that are consistently successful in assisting organizations to deepen their results and to stay the course: 

1. Make sure your mission, vision, and values reflect the principles that guide you every day and keep them visible in everything you do.  Allow these carefully chosen words to provide a true transformational model that is reflected in the entire organizational infrastructure. 
2. Executive champions and other key members of senior leadership must remain visibly engaged in supporting and modeling the new culture. Front line staff are waiting and watching to assess whether this RBC initiative is just another "project du jour" that will wither and die on the vine after something new grabs the attention of senior leadership. 
3. Educate, promote, and retain middle managers with competencies consistent with the mission, vision, and values of the organization. 
4. Include every person in every discipline in taking an active role in bringing the mission and vision of the organization to life. Many initiatives, if done as “nursing only” can have a positive effect. However, sustainability is increased dramatically when all disciplines are included.   
5. Use simple tools such as Commitment to My Co-Workers cards to spread an ethical, high-trust code of conduct throughout the organization and system. How we treat or don't treat our co-workers with respect, trust, and dignity has a profound direct and indirect impact on the quality of care and services experienced by our communities. The Commitment to My Co-Workers card includes commitments such as, “I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every member of this team.” 
6. Devote time to reflective practice implementing tools such as story-telling, peer circle, professional salons, huddles, and journal/book clubs to keep a thoughtful dialogue going that helps people to remember the meaning and purpose of their work. 
7. Develop a Patient/Community advisory committee to meet with senior leadership on a consistent basis to celebrate and affirm successes and also to learn from the opportunities for improvement. I have heard stories of organizations that have expanded the patient/family panel discussion centered around what caring really looks like, smells like, feels like, and sounds like. This is not for the defensive or the faint of heart; it is for those organizations that live their mission strategically, operationally, and tactically. 

Another Suggestion for Your Success

I would be remiss if I didn’t also mention a tool that I’ve found extremely valuable in sustaining changes in organizations. The change management formula found in the book I2E2: Leading Lasting Change does more than I’ve seen in almost 50 years in health care to help keep organizations focused and unified around a common vision. This practical methodology, starting with the development of a collective vision and working the steps of Inspiration, Infrastructure, Education, and Evidence, is key to sustainment. Inspiration unifies and inspires. Infrastructure is of critical importance so that alignment with the vision for care occurs with systems and processes, staffing models, policies and procedures, the care delivery model, job descriptions, performance appraisals and the hardwiring of Unit/Department Practice Councils and a Results Council. Education about the vision for the new culture helps get teams focused. Evidence that the change is working continues to Inspire, which begins the continuous cycle of I2E2 again. If you follow the I2E2 formula, don’t skip any steps, don’t rush through the experience, and understand that it is an ongoing journey you’re on (not a sprint to a defined finish line), you will be on track to sustain your changes.

These are just a sampling of tried and true sustainment strategies, and I invite others to share their ideas and successes. 

As a consultant at Creative Health Care Management, Shirley guides health care organizations through major events such as redesigning roles and processes, remodeling care delivery systems, focusing on collaborative practice, improving teamwork, and driving cultural change. Shirley has more than 45 years of experience in health care. She has held staff, leadership, consultant, educator, facilitator, public health, and research roles in both inpatient and outpatient settings, in roles as diverse as AVP, CNO, CQIO, ADON, director, and house supervisor.