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    Christian Green
    Christian Green, MA
    Pamela Ballou-Nelson
    Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

    MGMA Stat - Satisfied with Organization's CultureA strong organizational culture can be a catalyst for employee engagement, and help springboard your organization to success. This is borne out by a new MGMA Stat poll, as more than half of respondents expressed that their organization’s norms, values and mission met their needs.
    In an April 10 poll with 1,389 responses, 52% of those polled said they were satisfied with their organization’s culture, while another 31% said they were somewhat satisfied.
    For many respondents, employee engagement was central to their organization’s healthy culture, which starts with the physician leaders and CEOs. As one respondent noted, “Leadership starts at the top. Our physicians are credited with building a high integrity practice and teamwork.”
    Conversely, 17% said they were not satisfied with their organization’s culture. Respondents most often cited poor leadership or lack of core values and mission. “The organization has not been able to define a mission or elaborate on our values,” said one respondent. While another stated, “[The] Mission statement and vision look great on paper but are poorly executed and lived.”
    Given the poll responses, how does one define organizational culture and establish a framework for creating a healthy organizational culture?
    In Diagnosing and Changing Organizational Culture, co-authors Kim S. Cameron and Robert E. Quinn write that culture is the sum of the collective assumptions, expectations and values that reflect explicit and implicit rules in the practice. Until challenged or violated, most people are not even aware that these assumptions and rules exist, such as how we treat our patients and staff.
    A new staff member learns about the practice culture through socialization processes, interactions under uncertain conditions and by contagion. Much of that learning, however, is not systematic or conscious. As medical group practices move into value-based models of care, it’s important to understand a practice’s organizational culture because it is the single biggest factor that inhibits organizational improvement and change.
    Research shows that a healthy culture enhances clinical and business success, whereas an unhealthy culture inhibits success. A healthy culture can:
    • Reduce collective uncertainties and clear expectations
    • Generate social order
    • Establish continuity of key values and norms across previous and new employees
    • Bind members in common direction
    •  Create a vision and energize forward movement
    However, to improve organizational health, culture must be adequately measured first. In their book Diagnosing and Changing Organizational Culture, Cameron and Quinn found that successful mergers and acquisitions could be accurately predicted 96% of the time based solely on cultural match. In other words, organizational change and improvement is markedly affected by culture.1
    At its root, cultural change is intimately tied to individual change. Unless clinicians, office managers and staff are willing to commit to personal change, the practice culture will remain the same and the move to value-based models will be difficult and possibly unsuccessful.  
    Cameron and Quinn also emphasize the value of the Competing Values Framework, which was developed from empirical research on what makes organizations effective. The framework has been applied to individual and organizational behavior for more than 25 years. It has been employed to help thousands of organizations and tens of thousands of managers improve their performance.
    As organizations strive to bring about change, here are some key points to consider, based on the Competing Values Framework:

    • You need to assess your organization’s culture and consider how a value-based model could affect it. A valuable tool in helping you do so is the Organizational Culture Assessment Instrument (OCAI) based on the Competing Values Framework. The OCAI helps diagnosis the dominant orientation of your organization and identify how you would like your culture to look in the future. 
    • Although subcultures may exist within practice departments, it’s important for them to have the same goals and mission as the organization.
    • There’s not a one-size-fits-all culture type that meets every practice’s needs. If you’re willing to recognize the incongruences within your organization and address them, you can ensure that the culture will be more in line with value-based models of care.

    Learn more:


    1. Cameron KS and Quinn RE. Diagnosing and Changing Organizational Culture: Based on the Competing Values Framework, 3rd Edition, Jossey-Bass, Hoboken, N.J., 2011.


    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message.

    Christian Green
    Pamela Ballou-Nelson

    Written By

    Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

    Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.

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