Remember the Old Adage: Culture eats strategy for lunch!

Is Your Leadership Culture Getting Results?

Is Every Initiative On Time and Under-budget?

Through the last two decades I have started every major healthcare initiative (with a new organization) by first assessing the culture of the management team through a three-part methodology.  Major Health IT initiatives, for example, typically don't fail due to technology but rather due to other issues:  leadership, managing change, governance, project planning and/or execution.  Over the years I have seen both high project success rates as well as high physician adoption of new technologies as a result of doing these assessments first.  Having now utilized this methodology at over 40 hospitals, I have found that assessing and addressing leadership culture at the start of major initiatives yields better outcomes; not only for the present initiatives, but for future efforts as well. I have also found that even within large health systems, leadership culture is a local phenomenon that is independent of the health system culture. 

There are six common myths about leadership culture:

  • "It takes about year or two to change culture."
  • "Assessing leadership culture is very expensive and time consuming."
  • "We shouldn't expose our leadership team to an outsider."
  • "Our team gets results, so our culture is fine."
  • "We just need to communicate more."
  • "I'm worried that the consultant will just want to get rid of all of us."

Here are the realities of what I have found through assessing dozens of healthcare leadership/management teams over the past 17 years:

  • The typical assessment occurs in less than 60 days and produces change in 90 days.
  • The return on investment of a culture assessment is typically 10-20 times the cost, and takes only a few defined events within a 90-day engagement.
  • We all carry biases about our own organization and the people we work with day to day. An experienced, outside consultant is the best person to independently assess your culture and guide you to optimization.
  • Leadership teams with high performance do assess as strong.  So if you are consistently achieving high results, you probably are in fact doing well. So maybe this is not a myth.  However, often organizations embellish their results and really are not as "fine" as they say they are. 
  • Communication is often an issue, but typically not the core issue.  A typical plan following an assessment does include specific messages as part of the game plan.  
  • It is rare that an assessment reviles any unknown personnel issues, though I must admit that 1/20 do put a spotlight on a specific leader that is not properly aligned to the vision/values of the organization.  However, I have seen it serve as an important wake up call for those individuals, who typically already know that they are not a good fit in their role.

Ultimately a leadership culture assessment allows an independent look at the organization using three different perspectives as discussed below:

Observation of Leadership

Observation of Leadership

Direct Observation of Leadership in Action

Hospitals typically have multiple types of leadership meetings each month, with various participants and formats.  By observing a variety of meetings with a fresh eye, the consultant can ascertain the style, content, procedures and process that leaders portray to their directors and managers as well as the management teams's empowerment and participation in the process.

Executive Interviews

Executive Interviews

One-on-one Interviews with Executives and Key Stakeholders

The consultant conducts individual interviews with each member of the executive team and additional key leaders relevant to the latest initiative of organizational focus.  These interviews are confidential and used to identify key themes of the culture as well as assess the background of the participants.  The questions are typically relevant to role of the interviewee and offer some unique perspectives into the organizational culture.

Denison Survey of org. culture

Denison Survey of org. culture

The Denison Survey of Organizational Culture

Denison Consulting offers a unique Survey of Organizational Culture which as been validated across multiple industries including many Fortune 500 companies and governmental organizations like NASA.  According to Denison, Dr. Smith has the most experience in utilizing this independent tool in assessing healthcare organizations. This tool is used along with the other two methods to both validate findings and clearly communicate the key strengths and opportunities for each organization.


Leadership culture can be successful assessed and improved to accelerate results and improve outcomes.  A healthy leadership culture produces greater results, saving time, money and effort for those organizations that are willing to dig deeper.  While myths exist, they can be overcome with a process that has already gotten results for others.