More Than Just Staffing: Why Organizational Culture Matters in Healthcare

For part of my career, I worked as a consultant, visiting hospitals around the country to help improve nurse staffing. The night before a consultation, I would make it a point to stop by the hospital to familiarize myself with where I needed to go in the morning. While I started this practice to orient myself, I rapidly realized that it was a great way to learn about an organization’s culture.

As I walked the hospital’s public areas, how employees greeted each other. Was it with a smile? Was it with a bit of banter? Were they passing each other without even nodding hello? Inevitably, I would encounter a bulletin board, usually outside the cafeteria. The tone of messages either conveyed respect for employees as professionals or one that indicated treatment of employees as “needing to be managed.” Without ever stepping into a patient care area or talking with a single nurse, I have already learned a lot. Not surprisingly, the next day, as I did my work focusing on staffing, organizational culture profoundly influenced everything from how staffing was managed to the outcomes—vacancy rates, turnover, overtime utilization, and nurse satisfaction.

It’s clear that the past two years have profoundly transformed our organizational cultures. In many organizations, employees feel unsupported, not necessarily due to the actions of leaders inside the facility but because of numerous societal forces that have not respected their professional expertise. Peer-to-peer support has been disrupted by the increase in turnover, the use of agency staff, and the fact that many leaders worked from home for extended periods. The past two years have not been anything remotely like normal, and our organizational cultures and relationships have been affected.

As leaders, we can begin rebuilding our culture by focusing on those little-noticed things. Greeting the receptionist as we walk in the door. Smiling, nodding, and saying hello as we walk through the hallways. Being intentional with the things we post—on bulletin boards and online—ensures that we treat team members as the professionals they are.

We can tell stories about where we went wrong, what we learned, and how we are going to apply these lessons to do better. We can celebrate all of the great care that has happened during the most complex of times. We can begin to ask, what are the messages that you heard from me over the past year that made you feel supported or not? As we rebuild our teams, we can ask how do we create a culture where you feel supported, where all of us are supported?

We can build an organizational culture that acts as a solution to burnout and attrition. How? First, by treating nurses as the professionals that they are, and not just as cogs in the wheel of delivering patient care. We can recognize that nurses themselves have the insights and intellect to create a professional practice environment that fosters excellence in care, including wise utilization of nursing expertise. We can rebuild our professional governance structures around things that matter to nurses, enabling them to address the challenges of ensuring competence, developing policies and practices, and designing the infrastructure to support excellence in care in a world that is dramatically different than a few years ago.

The future of healthcare and the future of our organizations have been profoundly changed by all that we have been through. We shouldn’t waste this opportunity to thoughtfully and intentionally apply all of the lessons that we learned and design a healthcare system that is more resilient, respectful, and robust. We should initiate conversations with our teams and by our teams about how we can cultivate a work environment that enables us to be the nurses that we always wanted to be and know that we can be.