There are numerous definitions of culture. Everyone seems to have their own take on it. After working with over 85 healthcare organizations in the past 8 years to help them create and sustain a culture of safety based on the best practices of high reliability organizations, I have come to believe:
Culture is the cumulative effect on the organization of the actions of the people within the organization at daily moments of truth.
The heart of this definition is what people do at the daily moments of truth. Intrinsically, you know what a moment of truth is – the tens, if not hundreds, of little decision points every healthcare professional encounters in the course of their daily activities. A decision point is where a choice must be made. You can do “A” or “B.” You can do something, or nothing. You can say something, or say nothing. You can do it the right way, or use a work-around. You can do it mindfully, or thoughtlessly. Many of these decisions are decided almost on the subconscious level, sometimes out of habit – without even being aware of deciding.
So if we want to change culture, then we must influence what happens at the thousands of daily moments of truth in an organization. There is a simple formula for this. Remember that “simple” does not always mean “easy.” This formula is simple to understand and difficult to follow. The formula for changing culture is this:
Thoughts –> Actions –> Habits –> Character = Culture
Changing culture begins with changing how folks think at the moment of truth. If you can change how they think, affect why they do what they do – then you can change how they act at the moment of truth. If we can change their thinking long enough to affect how they act on a repetitive basis, then we can help them develop habits. Habits are those actions we take almost without thinking – it’s just the way we “do business” on a personal level. Changing habits changes our character. Character is what we do, again almost at the subconscious level, especially when we think no one is watching or no one will know.
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