Culture Trumps Everything in Healthcare

Several years ago I was on a strategy and operations engagement, working with a hospital about 25 miles away from a state penitentiary and two hours from its system hub in an impoverished and crime-ridden area. I realized four things upon arrival at the facility:

  • The community deserved a hospital, although over 85% of Medicare patients were leaving the community;
  • The hospital was close to going out of business;
  • The new CEO had limited healthcare experience but a passion to keep the care local; and
  • The greatest challenged related to culture.

I was greeted by the recently appointed CEO and an overwhelming urine smell, thinking that a complete turnaround was essentially a Hail Mary. Fortunately, some long shots turn into touchdowns.

The CEO had something that few other people had regarding his new hospital: a belief that anything is possible. Taking cues from his optimism, we went to work on a plan. And knowing that it was going to take significant time and heavy lifting to make progress, we kept it simple: a single sheet that enumerated the opportunities.

Over the course of the next year, we had infrequent contact until he called and invited me for a visit. He was as insistent as I was reluctant, so I obliged. I was a bit apprehensive on my drive to the hospital, but figured that if the new CEO had lasted a year, some things must be better. Still, I wasn’t ready for what I saw.

The physical state of the place had changed completely. The lighting was better, the walls and floors were spotless, and most notably (and thankfully) there wasn’t a single whiff of urine. Staff greeted me cordially and offered to bring coffee; I declined, wanting to see the cafeteria for myself. Again, the facility was completely turned around and staff were making eye contact and demonstrating a level of ownership in their jobs.

Later, I had to go back to my car to grab a file and hesitated as I saw two prisoners on the other side of my Hertz rental. They introduced themselves, told me they were on work release and said that if I needed anything, just ask. The skeptic in me asked if things really had changed that much. But the CEO was able to turn our plan into reality in 12 months by doing some of the hardest work in addressing the biggest problems:

  • He started fresh, eliminating previously held beliefs and norms the biggest challenge;
  • He created equality, stressing the need for all employees to adhere to the same training and protocols;
  • He required accountability, rewarding the right behavior and taking corrective action when people strayed;
  • He literally cleaned the hospital and nursing home from top to bottom, created all single rooms and a new electronic health record, and recruited providers, and soon patients began to return.

Ultimately, he put into action one of my favorite mantras: Culture trumps everything else in health care. In 2016, I had the privilege to work on a culture assignment for a large physician group and a healthcare system. I am a firm believer that culture can change in 12 months.

If you’re looking for a culture assessment and a culture transformation plan, contact me at


Scott Goodspeed is a Director at Stroudwater and an expert in organizational culture.