Organizational culture guides practice performance

The physician leaders of the practice are those with the greatest opportunity to enforce the underlying culture.

"Those who are able to see beyond the shadows and lies of their culture will never be understood, let alone believed, by the masses."

-Plato, 427-327 BC, Greek philosopher

Another cultural trait that is commonly observed is that of communality. The "one for all and all for one" spirit dominates in this type of culture. There is likely to be some element of equality in income division and on call responsibilities. Staff support may be allocated to doctors on a more or less equal basis, ignoring their history of productivity.

Culture affects an organization in a variety of ways. An understanding of underlying culture helps organizational members make decisions. Also, culture conveys a certain identity to an organization that in turn increases the commitment of its members.

Breadth and depth

Culture can be characterized both by its breadth and its depth (Figure 1). The breadth of culture is the spectrum of values on which there is agreement. The depth of a culture is essentially the number of committed members and the strength of their agreement on cultural norms. Depth helps distinguish strong cultures from weak cultures.

Strong cultures are desirable in many situations. A strong culture is a powerful "glue" that provides clear direction for organizational members. However, strong cultures promote "groupthink" and thus may stifle independent action. A strong culture that is poorly aligned with its external environment does not provide an advantage to the organization.

Culture has visible and invisible components. Some of the visible components include ceremonies, symbols, and stories. Ceremonial luncheons that reward employees for providing excellent customer service enforce desired values.

Other components of culture reside below the surface. These elements include beliefs and assumptions. Staff members that have learned that the lead doctor of the group is the sole decision maker (autocratic culture) will develop methods of gaining favor and recognition in the eyes of this individual.

Strengthening the culture

How can a culture be strengthened? This question arises when the existing culture appears to be in harmony with the external environment and is serving the organization well. Several strategies have been established that effectively strengthen the underlying culture.

The physician leaders of the practice are those with the greatest opportunity to enforce the underlying culture. Examples from the top send powerful messages to the remaining members of the organization.

Additionally, the reward structure of the organization can dramatically strengthen the underlying culture. Rewards can take on a variety of forms and can be innovatively selected to achieve the desired results. Promoting an employee to "team leader" can enforce a culture of communality.