The Importance of Culture

The importance of culture in medicine, and education (e.g., School Climate) — Speakers at the 2012 AMSA Patient Safety Symposium* acknowledged that when “reforming the system,” the community, such as an organization seeking to become more excellent in the area of patient safety, for instance, must make substantive shifts in a culture, or even create a new culture. That is, how things get done, and how people think on a day to day basis.

It’s so fundamental, that policy and strategy fade under the power of culture.

Culture eats strategy for breakfast. -Tim McDonald of University of Illinois at Chicago

How is this change accomplished?

Create a culture of safety: Educate the young. Regulate the old.- David Mayer of MedStar Health

One way to “educate the young” is through the nurturing and development of leadership at the frontline staff level – the people who really see the issues happening on the ground.

Here is an article about Housestaff Safety Councils, featuring the one I helped start with Chermain Cross and Rafael Hernandez MD at Woodhull Hospital. This began because I had heard about a Housestaff Quality Council started by Peter Fleischut MD at NY Presbyterian, while at AMSA’s Patient Safety and Quality Leadership Institute in 2010. Dr. Fleischut walked us through the first steps. And now, it is really beautiful to see this take off throughout NYC HHC with CIR’s support.

The key thing is incorporating the perspectives of those who see the issues directly, like house staff, e.g. residents, at a hospital so that they have a direct line of communication with senior management. It also gives the committee members multiple opportunities to learn how to communicate with management effectively. Would it not be useful to have committees like this for teachers, for students, for patients, in every health and school system?

Diane Ravitch’s recent post about teacher evaluation system, What If Teacher Evaluation Is Not Broken?, is another manifestation of this tension between individual and systemic failure. It is crucial to provide frontline providers the power and space to provide feedback that effectively advocates for themselves and those they serve, and directly impacts decisions of senior management.

See the sidebar to the right of the article, below, to learn how to start a resident-led Housestaff Safety Council at your institution.

From CIR-SEIU Vitals newsletter, Summer 2012.

*2012 AMSA (American Medical Student Association) Patient Safety Symposium, 9/7/12 to 9/8/12organized with David Nash at Jefferson School of Population Health, and funded by AHRQ.