When it comes to improving healthcare quality and efficiency, how can organizations most positively change physician behavior? According to research presented in Harvard Business Review, organizational culture is critical.
The HBR article, “Getting Doctors to Make Better Decisions Will Take More than Money and Nudges,” outlines how a stronger focus on culture improves clinicians’ work environments and patient outcomes. As I read the article, I felt many of the takeaways could also be applied to successful analytics implementations and successful organizations as a whole. Let’s take a look.
What’s not so successful in impacting change
The authors of the HBR article, Yusuke Tsugawa and John N. Mafi, examined research on financial incentives, such as pay-for-performance structures that reward clinicians for adhering to certain guidelines or achieving better outcomes. The research indicates that pay-for-performance initiatives can help improve processes of care, but that doesn’t translate to improving overall patient outcomes. In fact, focusing too much on financial incentives can actually lead to negative consequences, such as physicians trying to game the metrics on which they are measured.
Similarly, behavioral economics had mixed results when it came to improving decision-making. This is where organizations make changes to their employees’ environments in order to encourage better choices. For example, one study cited in the article discussed how clinicians reduced overprescribing when they had to justify to peers why they prescribed antibiotics for a viral infection. However, another study showed that when physicians received personalized feedback on their prescribing habits, nothing actually changed.
3 factors that are successful in making improvements
What did help improve results was focusing on organizational culture, which the authors define as “the system of shared assumptions, values, beliefs, and norms within an environment.” The research shows that a positive culture leads to major improvements, including a decline in patient mortality rates.
Factors in particular that promote positive changes to quality and outcomes include:
- Support for clinicians from senior leadership
- Staff empowerment to solve problems
- Establishment of a blame-free environment
It struck me that the same factors contribute to success in any type of organization, and they can also be applied to analytics implementations. In fact, I have noticed this during many meetings I have had with our customers. Organizations that enable their employees to freely explore data, empower them to make decisions and solve problems based on their findings, and welcome questions in a supportive environment have much greater success with analytics than organizations that squelch employees’ questions and explorations.
The secrets of highly successful groups
Author Daniel Coyle provides his perspective on the factors that lead to success in his new book, The Culture Code. Coyle talks about three skills on which high-performing groups are created. These skills are:
- Build safety—how connection generates bonds of belonging and identity
- Share vulnerability—how habits of mutual risk drive trust and cooperation
- Establish purpose—how narratives create shared goals and values
In many ways, these skills are intertwined with the research findings above. Supportive environments in which workers are given the freedom to solve problems (and make mistakes) are naturally built on safety, vulnerability, and purpose.
So the question is, how can organizations improve their culture? It’s certainly a daunting task. Tsugawa and Mafi suggest that healthcare leaders can start by examining resources such as the Institute for Healthcare Improvement or the Taking Action on Overuse Framework.
I’d also suggest examining the cultural factors that lead to improvements and taking a critical look at where your organization is succeeding or failing. Coyle’s book contains some concrete “Ideas for Action” that are good starting points in applying the ideas in your job.
“Culture” is something you’ll be hearing a lot more about in upcoming blog posts. That will include a review of The Culture Code as the latest selection in the Dimensional Insight Book Club. Several of us here have been reading the book and will share our thoughts on it. There’s still time to read along with us—our review will appear on July 12.