Physicians and Organizational Culture: Addressing the Satisfaction Gaps Around Cultural Fit

Written by on February 28, 2013 in Practice tips - No comments

At a time when physician engagement is critical in effectively addressing the changes impacting healthcare, organizational culture is an important factor that physicians tell us is central to their sense of engagement and overall satisfaction.

As physicians move increasingly to an employed model, organizational culture becomes a more significant issue, especially for those who previously worked in smaller medical groups and in solo practice.  Differences in areas as varied as accountability, autonomy, work environment and communication methods can create gaps between expectations and reality.

Physician Wellness Services and Cejka Search recently completed a nationwide, multi-specialty survey on organizational culture with over 2200 physicians, and a companion survey of administrators.  It identified cultural attributes that were important to physicians’ overall satisfaction, and gaps between attributes that were important to them and their satisfaction with their organizations’ focus on the attributes.  The survey also explored the importance of cultural fit to physicians as they evaluated and made decisions around new practice opportunities versus remaining in their existing practices.

The Importance of Culture

A literature review of organizational cultural survey instruments specific to healthcare led to 14 cultural attributes which, based upon our experience, were most relevant to physicians.  Falling into four major area—work environment, organization, leadership and management, and communication—the cultural attribute questions formed the basis of the survey.

The first notable initial finding—all the cultural attributes were important to physicians.  All but one fell into the upper quartile for importance to physician satisfaction as measured on a 10-point Likert scale—well above the 3.0 to 7.0 mid-range.  The top cultural attributes were:

  • Respectful communication (8.6 average score)
  • Patient-centered care focus and supportive management approach to errors and mistakes (tied at 8.5)
  • Transparent communication (8.4)

Asked to rank their top 3 attributes, results closely tracked with the absolute scores, although patient-centered care focus came first.

Physicians gave lower marks for how well they felt their organizations demonstrated competence around the cultural attributes, with average scores ranging from 5.8 to 7.6 and falling more in the mid-range.  The highest scores—patient-centered care focus and clear mission and values (tied at 7.6), and respectful communication (7.2).  The lowest score was for transparent communication (5.8).

Physicians scored even lower for satisfaction with their organizations’ focus on these cultural attributes, with average scores ranging from 5.7 to 7.0.  Gaps between perceived organization competence and satisfaction ranged from .1 to .8 points—led by clear mission and values, followed by patient-centered care focus and team-focused environment.

Ultimately, the biggest concern was the gap of 3.0 to 4.3 points between the ideal—a 10 score—and their satisfaction scores with their organization, indicating considerable room for improvement.

The companion asked administrators how important they felt the cultural attributes were to their physicians, and how well they felt their organizations demonstrated competence.  With few exceptions, administrators were on track with what was important to physicians.  However, administrators were more positive in assessing their organizations’ competence on cultural attributes, with scores ranging from 6.9 to 9.1, compared to physicians’ average scores ranging from 5.8 to 7.6.  This finding points to more gaps that could lead to issues.

Cultural Fit—and Its Implications

The final set of questions assessed how well  physicians felt they fit within their current organizations, how this impacted their satisfaction, and whether issues around cultural fit had prompted them to leave a practice or job, or accept other opportunities.

Regarding their own cultural fit, physicians scored 7.0 on average—at the high end of the mid-range.  When asked how much cultural fit influenced their job satisfaction, the average score was a more robust 8.4, indicating they clearly felt cultural fit was important.  Administrators gave an average score of 7.2 regarding the cultural fit between their current physician population and the organization.  While tracking very closely with physicians’ self-identified cultural fit, it is far from the ideal score of 10, showing much room to improve cultural fit.

Ultimately, the influence of cultural fit on behavior is key.  When asked if their expectations around cultural fit had been a determining factor in accepting a practice or job opportunity, the average score was 7.7, showing cultural fit was a significant factor in evaluating prospective opportunities.

Asked if lack of cultural fit had prompted them to leave a practice or job, physicians scored 6.5, with 27.1% who scored 10.  Over 50% of respondents felt lack of cultural fit had a greater influence on their decision to leave than not.  This significant finding may be understated, given several comments in the open-ended questions by physicians saying they wanted to leave, but stayed in their present job due to concerns around family and location preference, career stage, or economic concerns.

Administrator responses, when asked what percentage of otherwise qualified candidates were not offered a position because lack of cultural fit was a determining factor, averaged 36%.  Asked how often cultural fit had been cited by voluntarily departing physicians as a primary reason for leaving a practice or job, the average response was 32%.  This points to another noteworthy gap:  administrators may be underestimating the degree to which cultural fit affects retention and recruitment.

How to Close the Gaps

Each organization is unique, and thus, priorities and cultural attributes that are valued may vary.  However, certain steps—involving a collaborative process between physicians and administrators—can be taken that are common to any organization, with tools and resources that can be helpful:

  • Determine what your organizational culture is—and where you want it to be.  Some organizations work for a long time defining their mission and values—and then stop there.   To take this to the next level:
    • Define your current culture.  Determine what cultural attributes are important.  Use a survey to ask for input, letting physicians rate where the organization is strong and weak—and how they feel about it.
    • Prioritize where to begin the process of change, based upon the biggest potential impact, or the biggest gaps between expectation and reality.
    • Make sure physicians are involved—and, potentially, leading—subsequent efforts.
  • Be deliberate in your approach.  Start by pursuing one or two attributes that will have the most impact, following a defined path toward achieving meaningful and positive change.  Set tangible benchmarks and accountabilities, and develop formal action plans.
    • Ensure agreement around the definition of each cultural attribute, identifying the daily and actions supporting it at the individual, workgroup and organizational levels. 
    • Develop a roadmap around what needs to change, communicate it and act on it.
      • Ensure that physicians are involved in decision-making at every step.
      • Discuss the initiative openly, at the individual and group level, including physicians and administration.  Outside facilitators can be helpful in encouraging openness and creating a safe environment to share ideas and concerns.
      • Provide individual coaching and mentoring for those who need more help or are struggling.
      • Measure progress periodically and communicate results, honestly and constructively.
      • Provide training and education in areas supporting the change, e.g., communication skills, civility and behavior coaching, conflict management, coping skills around stress and burnout, developing resilience around change.
      • Provide adequate time to work on change initiatives.
      • When significant progress has been made around the first one or two cultural attributes, start on the next priorities.
  • Institutionalize the cultural attributes.  Organizational culture must be reinforced and nurtured.
    • Recruit for cultural fit.  Develop assessment tools and processes to ensure that physician candidates understand the organizational culture and demonstrate their ability to fit in and support it.
    • Use behavioral interviewing techniques ensure candidates support the desired cultural attributes.
    • Create onboarding programs that tangibly educate new hires and reinforce cultural norms.
    • Choose physician leaders who personify and can model the desired cultural attributes.
    • Develop a mentoring program with specific roles and accountabilities for mentors and mentees.
    • Incentivize the behaviors and attitudes that support the desired culture.
    • Continue to measure progress against the desired cultural attributes.  Work at exceeding expectations.
    • Celebrate your culture as desired changes are achieved.

Ultimately, this is about changing behaviors and attitudes—not just those of physicians, but all stakeholders who work alongside them and support them.  This will benefit the organization by creating a stronger sense of engagement with its physicians while improving satisfaction with their jobs and careers.

By Robert Stark, MD and Daniel J. Whitlock, MD, MBA,
Consulting Physicians, Physician Wellness Services

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