Culture and the Courage to Change - Member Profile - AAMC

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Culture and the Courage to Change“Increasingly, it appears to me that the source ofour discontent is a fundamental imbalance withinour institutions—an imbalance that stems from afailure to put at least as much energy into improvingour culture as we put into advancing our strategy.”These days I find myself thinking about the frequently quoted saying,“Culture eats strategy for lunch every day.” There is a clear implicationfor us in the concept that culture is every bit as important as strategy.You can have a multivolume, exhaustively prepared strategic plan, but ifyou fail to attend to the culture of your organization, you may fail toreach any of your goals.If culture trumps strategy, perhaps we are suffering from how little effortwe explicitly devote to the culture of our own institutions. When we addup all the time we spend on developing strategic plans for our curriculum,clinical enterprise, and research programs, how does it compare to thetime we spend on explicitly assessing and building the right kind ofculture? Is it a brilliant strategic plan that inspires faculty, staff, residents,and students, or is it a culture that makes them feel fulfilled and valued? Ifyou look at our Web sites, you find that virtually every academic medicalcenter has an elegantly detailed strategic plan, but few seem to devote asmuch attention to the culture they have or are trying to attain.Just what is the culture of an organization? Most definitions of culturefocus on the shared values, assumptions, norms, behaviors, and ritualsdeveloped by a group, as well as all the structures used to preserve theseessentials. While culture is an extraordinarily powerful force for a groupor organization, it is so pervasive and interwoven with every activity thatwe may not give it much conscious attention. However, when wedirectly examine our organizational culture, suddenly we can see clearlythe drivers of performance, the reasons for levels of morale, and the rootcauses of many organizational conflicts and tensions. In turn, this4Association of American Medical Colleges
Culture and the Courage to Changeexamination presents the opportunity for us to change the culture ofour organization to improve performance, resolve conflicts, and, mostimportantly, help all of us feel genuinely fulfilled by our work.“While culture is an extraordinarily powerful forcefor a group or organization, it is so pervasive andinterwoven with every activity that we may not giveit much conscious attention.”If culture matters so much, just what is our current culture in academicmedicine? The answer cannot be found simply by reciting our visionand mission statements. To understand culture, we have to think aboutunderlying values, assumptions, norms, and rituals that are lessapparent. In his provocative book, The Culture Code, author ClotaireRapaille describes how a single code word or phrase often can capturethe complex values, assumptions, and behaviors that make up a culture.As I was thinking about this topic, I asked a number of colleagues which“code words” came to mind when they reflected on the culture ofacademic medicine. Think about it yourself, and see if you agree withany of the feedback I received. What word would you choose todescribe our prevailing culture in academic medicine? The descriptors Iheard included words like individualistic, autonomous, scholarly, expertcentered,competitive, focused, high-achieving, and hierarchical.If those are the words that describe us, we could argue that these culturecodes have served us well. There certainly is nothing wrong with generationsof medical students, residents, graduate students, and facultymembers aspiring to become scholarly experts. The competition ofclimbing the hierarchy of promotion and tenure may have helped pushgenerations of faculty members to great achievements. And certainly,the intense dedication of an award-winning lecturer, an internationallyrecognized clinician, or a Nobel-quality scientist is a wonder to behold.5Association of American Medical Colleges
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Culture and the Courage to Change - Member Profile - AAMC

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