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    Robert Jacob LaGesse
    Robert Jacob LaGesse, MSM, FACHE

    Organizational culture is the silent yet potent force that shapes decisions, molds behaviors and sets the stage for innovation. Culture is vital in organizational strategic thinking, serving as the compass and the map that guide an organization toward its future vision, according to Peter Drucker, management and leadership consultant.

    The interplay between culture and strategy is a dance of possibilities. For an organization to reach the pinnacle of its potential, its culture and strategy must align and resonate with a shared purpose. They must be consistent, complementary and mutually reinforced. A strategy that is incompatible with the organization’s culture is akin to a seed planted in barren soil — it may sprout, but it will not flourish. For profound and sustainable success, the complementary relationship of culture and strategy is not merely desirable, it is indispensable.

    Elements to consider for culture design in healthcare organizations

    • Leadership style: The approach leaders take can foster a culture of innovation or compliance.  This sets the tone for the type of culture employees experience.
    • Employee engagement: The level of commitment from members of the organizational team drives a culture of excellence or mediocrity.  The key ingredient is open and transparent communication.
    • Organizational structure and ownership: Hierarchical and flat structures each foster different cultural dynamics, potentially leading to cultures of control or empowerment, respectively. The impact of external factors on organizational culture varies depending on the size and type of the organization — small or large, or corporate or private.
    • Market dynamics: Competitive pressures can shape a culture of agility or resistance.
    • Technological advancements: Accepting or rejecting technological changes can encourage a culture of continuous learning or obsolescence, respectively.
    • Societal trends: Social movements can influence a culture through inclusivity or exclusivity.

    Culture design decisions in organizational strategy

    An organization’s strategic success hinges on leadership’s culture design decisions, which reflect their level of commitment to factors that shape the workplace and employee behavior.

    Staff development and training

    • Commitment: Encourage continuous learning and professional growth.
    • Impact: Equips employees with the skills and knowledge necessary to adapt to changing market demands and foster innovation.

    Teamwork, cooperation and respect

    • Commitment: Create a collaborative atmosphere where teamwork is valued.
    • Impact: Enhances problem-solving capabilities and promotes a supportive work culture that respects diverse perspectives.

    Written and enforced policies and processes

    • Commitment: Establish clear guidelines and expectations through formal documentation of policies and standards.
    • Impact: Ensures consistency and fairness in operations, aiding in compliance and risk management.

    Fair enforcement of standards and expectations

    • Commitment: Apply rules and standards impartially across the organization.
    • Impact: Builds trust and integrity, essential for a positive organizational reputation and team member morale. Teams value consistency in leadership decisions. 

    Clearly defined safety, quality and service standards

    • Commitment: Set high benchmarks for safety, quality and customer service.
    • Impact: Drives excellence and competitive advantage, leading to customer satisfaction and loyalty.

    These culture design decisions are not standalone; they are interdependent and cumulatively contribute to the strategic success of an organization. A strategic approach to culture design can propel an organization toward long-term success and sustained competitiveness.

    The dynamics of organizational culture and its strategic implications

    Organizational culture is the collective embodiment of values, operating standards, norms and practices that permeate every level of a company. It is the lifeblood of the organization, driven by ownership and leadership, and it manifests in both tangible and intangible ways. Culture can evolve organically or be deliberately designed, but it will inevitably shape the organization’s identity.

    The organic development of culture

    • Even in the absence of intentional design, a culture will emerge, influenced by the collective interactions, behaviors and decisions of those in the organization.
    • Leaders play a pivotal role in this evolution, as their actions and attitudes set the tone for the organization’s cultural climate.

    The double-edged sword of subcultures

    • Subcultures and informal groups arise naturally within organizations, often reflecting the diversity of thought and experience among employees.
    • While these subcultures can foster innovation and camaraderie, they may also inadvertently create silos or diverge from the overarching strategic direction.
    • The challenge lies in recognizing the value these subgroups bring while aligning their contributions with the organization’s strategic objectives.

    Strategic alignment and cultural design

    • A well-defined organizational culture serves as a strategic asset, guiding decision-making and ensuring coherence in pursuit of common goals.
    • Without a clear cultural framework, subcultures may exert disproportionate influence, potentially derailing operational success and strategic initiatives.
    • It is therefore crucial for organizations to consciously develop a planned culture that not only reflects their core values but also supports their strategic ambitions.

    Case study: medical group transformation – ECU physicians, 2015 to 2021

    In 2015, new operational leadership was installed for Brody School of Medicine’s ECU Physicians faculty practice plan (FPP). Facing worsening financial conditions, the medical group appointed a new chief operating executive and director of revenue cycle, both seasoned physician executives, as well as respected clinical leaders as chief medical officer and chief nursing officer.

    The new team encountered an organization deeply entrenched in silos, with each clinical department developing its own culture based on specific goals and needs. Clinic team members identified more with their respective departments than with the broader medical group. 

    A few months after settling in, the new operational team established goals focused on integrating the various practices more closely. They set out to establish robust quality, operational and uniform financial standards, complete with monthly reporting metrics. 

    The team recognized they needed to make some immediate changes to stabilize the practice, while also engaging team members and physicians for long-term success. This involved facilitating a culture change and implementing the new operational standards. To encourage team engagement, leadership formed new committees dedicated to the key focus areas: clinical quality, operational leadership and financial revenue cycle. These teams shared members’ input and suggestions for new policies, processes and initiatives.

    Between 2015 and 2021, the practice transformed from a siloed organization into a more integrated medical group. Staff understood the vision, mission and goals, leading to significantly enhanced financial standing, operational efficiency and patient satisfaction.  Additionally, the greater integration helped the practice weather the COVID-19 pandemic successfully and emerge stronger.


    Leadership plays a crucial role in shaping and maintaining an organization’s culture. When leaders overlook the importance of strategic planning and cultural stewardship, they risk creating an environment where achieving organizational goals becomes increasingly challenging. Here’s why:

    • Lack of direction: Without clear planning and communication, employees may lack understanding of the organization’s direction, leading to misaligned efforts and wasted resources.
    • Erosion of engagement: Neglecting culture design can lead to multiple subcultures that disengage team members’ focus on the organization’s goals, reduce productivity and innovation.
    • Inconsistent execution: A poorly maintained culture often leads to inconsistent practices, undermining the organization’s ability to execute strategies effectively.

    For leaders to drive their organizations towards success, they must actively engage in defining, communicating and nurturing the organizational culture, aligning it with strategic objectives to ensure consistent goal achievement.

    Delicately balancing culture and strategy is crucial. Organizations must nurture a culture that mirrors identity and bolsters strategic success, empowering the workforce to achieve future goals. 

    Robert Jacob LaGesse

    Written By

    Robert Jacob LaGesse, MSM, FACHE

    Bob LaGesse is the Chief Operations Executive and also serves as the Interim Executive Director for ECU Physicians. He joined ECU Physicians in July 2015 from his previous position as Senior Vice President and Chief Administrative Officer for Physician Practices at Phoebe Putney Health System in Albany, Ga. Bob has 45 years of experience in healthcare management in a variety of organizations for profit, not-for-profit and academic settings. His experience includes 27 years in physician practice leadership positions in private practice, hospital and corporate-owned practices. He has a master of science degree in management from Troy University, is a Fellow in the American College of Healthcare Executives and is a Certified Medical Practice Executive in the American College of Medical Practice Executives.

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