Cultural fit affects not only physician satisfaction, but also physician recruitment and retention, according to the recent Physician Wellness Services/Cejka Search Organizational Culture Survey. Yet, health care administrators are only marginally addressing the cultural attributes most important to physicians.

The nationwide, multispecialty survey on organizational culture reflected the responses of more than 2,200 physicians (82 percent of whom were in a hospital, group practice or academic medical center). It presented 14 cultural attributes, which fell into four categories: work environment, organization, leadership and management, and communication.

The survey measured the importance of these attributes to physicians' overall satisfaction as well as their views of how well their organizations demonstrated competence of the attributes. It showed that while physicians regard cultural attributes as important, they feel that their organizations do not share those values as strongly. The survey also explored whether physicians examine cultural fit when they consider new practice opportunities.

The Importance of Culture

A notable initial finding was that all the cultural attributes were important to physicians. All but one fell into the upper quartile for importance to physician satisfaction as measured on a 10-point Likert scale, well above the 3.0 to 7.0 midrange.

 

Physicians' Scores, 14 Cultural Attributes

                                                                                                    Physicians' Average Score, 1-10 Scale:

Cultural attribute

Organization demonstrates

Important to satisfaction

Satisfaction with organization

Patient-centered care focus

7.6

8.5

7.0

Respectful communication

7.2

8.6

6.9

Team-focused environment

6.8

8.2

6.2

Supportive management regarding errors and mistakes

6.6

8.5

6.7

Collaborative leadership style

6.1

8.2

6.0

Clearly defined accountability across roles

6.4

8.1

6.1

Adapts to change readily

6.0

8.1

6.0

Transparent communication

5.8

8.4

5.7

Clear performance expectations

6.6

8.0

6.2

Innovative approach to care

6.4

7.9

6.3

Open dialogue across roles

6.4

8.3

6.3

Clear mission and values

7.6

7.5

6.8

Objective performance evaluations

6.1

7.4

6.0

Compensation plan alignment with mission and values

6.0

8.0

6.0

The top cultural attributes were:

  • respectful communication (8.6 average score);
  • patient-centered care focus (8.5);
  • supportive management approach to errors (8.5);
  • transparent communication (8.4).

In ranking their top three attributes, physician responses closely tracked with their absolute scores. Many commented that it was difficult to name their top three, as they felt all the cultural attributes were important.

Physicians gave lower marks for how well they felt their organizations demonstrated competence of the attributes; average scores ranged from 5.8 to 7.6, falling more in the midrange. The highest scores were for patient-centered care focus and clear mission and values (tied at 7.6) and respectful communication (7.2). The lowest score was for transparent communication (5.8).

In the companion administrator survey, administrators were largely on track with what was important to physicians. However, administrators were more positive in assessing their organizations' competence on cultural attributes, with scores ranging from 6.9 to 9.1.

Physicians scored less satisfaction with their organizations' focus on these attributes, with average scores ranging from 5.7 to 7.0. The gap of 3.0 to 4.3 points between the ideal — a 10 score — and their satisfaction scores with their organization is troubling.

The Implications of Cultural Fit

Regarding their own cultural fit, physicians scored 7.0 on average — at the high end of the midrange. When asked how much cultural fit influenced their job satisfaction, the average score was a more robust 8.4, indicating they clearly felt this factor was important. Administrators gave a 7.2 average score regarding the cultural fit between their current physician population and the organization. While not far apart, the gap between these scores and the ideal — a 10 score — is cause for concern.

Asked if cultural fit had been a determining factor in accepting a practice or job opportunity, the physicians' average score was 7.7, showing that cultural fit was a significant factor in evaluating prospective opportunities. Yet, when administrators were asked what percentage of otherwise qualified candidates were not offered a position because of lack of cultural fit, the average response was 36.

Similarly, when physicians were asked if lack of cultural fit had prompted them to leave a practice or job, the average score was 6.5, with 27.1 percent scoring 10. More than 50 percent of respondents felt lack of cultural fit had a greater influence on their decision to leave than not. This finding may be understated, given several comments in the open-ended questions indicating that some physicians wanted to leave, but stayed in their present job due to concerns about family, location, career stage or the economy. When administrators were asked how often cultural fit had been cited by voluntarily departing physicians as a primary reason for leaving a practice or job, they said it was a factor only 32 percent of the time, on average; 46 percent said it was not a factor at all.

Thus, another noteworthy gap has been revealed by the survey: Administrators may be underestimating the degree to which cultural fit affects retention and recruitment.

Closing the Gaps

Each organization is unique, but all can take certain steps to close this gap between physicians and administrators, using a collaborative process:

Determine what your organizational culture is — and where you want it to be. Some organizations work for a long time to define their mission and values — and then stop there. To take this process to the next level:
 
Define your current culture. Develop a list of and definitions for those cultural attributes that are important, then let physicians rate where the organization is strong and weak — and how they feel about it.
 
After sharing the results, prioritize attributes based on the biggest potential impact, or the biggest gaps between expectation and reality.

Make sure physicians are involved in — and, potentially, leading — subsequent efforts.

Pursue one or two attributes that will have the most impact. Set tangible benchmarks and accountabilities, and develop formal action plans. To implement this step:

Ensure agreement about the definition of each cultural attribute, identifying daily behaviors and actions supporting it at the individual, work group and organizational levels.
 
Develop a roadmap for what needs to change, communicate it and act on it, providing tools and resources to support those who are affected.

  • Ensure that physicians are involved in decision-making at every step.
  • Discuss the initiative openly, at the individual and group level. Outside facilitators can be helpful in encouraging openness and creating a safe environment to share ideas and concerns.
  • Provide individual mentoring for those who need more help or who are struggling.
  • Offer training to improve communication skills, manage conflict or handle resilience toward change.
  • Measure progress periodically and adjust tactics, as needed.
  • Communicate results honestly and constructively.

Provide adequate time to work on your change initiatives. When your organization has made significant progress, start on the next priorities.

Institutionalize the cultural attributes. Organizational culture must be reinforced and nurtured. To implement this step:
 
Recruit for cultural fit. Develop assessment tools and processes, and use behavioral interviewing techniques to drill down with candidates regarding such things as conflict management, teamwork and communication — making sure they tie clearly into the desired cultural attributes.

Create onboarding programs that educate new hires and reinforce cultural norms.
 
Choose physician leaders who personify and can model the desired cultural attributes.
 
Develop a mentoring program with specific roles and accountabilities for mentors and mentees. Incentivize behaviors and attitudes that support the desired culture.
 
Continue to measure progress against the desired cultural attributes. Work at exceeding expectations.

Ultimately, achieving cultural fit is about changing behaviors and attitudes — not just those of physicians, but all stakeholders who work alongside them and support them. This will benefit the organization by creating a stronger sense of engagement with its physicians while improving satisfaction with their jobs and careers.

Robert Stark, M.D., and Dan Whitlock, M.D., M.B.A., are consulting physicians with Physician Wellness Services in Minneapolis.