Culture Shift for Medicine - From Disease to Health

There has been a growing amount of focus recently on how people can stay healthy - looking at what we eat; how we exercise; and, how we manage stress - asking us to take more personal responsibility for our own health.  During my last annual medical check-up, I started to think more about the role of doctors in helping people to stay healthy.  What expectations should my doctor have of me and what should I have from her?

 

My next thought was - are doctors trained to help people stay healthy to prevent sickness or is the profession’s focus on identifying and treating diseaseIt seems that the focus should be on prevention, but my sense is that the historical training for doctors is more reactive in nature.  So if people are becoming more proactive in thinking about their health rather than waiting for disease to strike, then we need to have doctors trained and rewarded to help us stay healthy as well as treat disease.  This would be a major culture shift for the profession from a focus on disease to health.

 

Now we can go back to the question of expectations between doctors and their patients, but wait a minute - first I need to think about language.  A patient is defined as - one under medical treatment and when I go in for my annual check-up, I am really a client looking for a health service provider. Let me know if I am sick, but please give me the info I need to stay healthy!

 

Again, the first step of acting differently is to think differently.

Presidential Campaign Staff as a Political Machine

As soon as I wrote my last post about the workplace culture of a presidential campaign staff, a friend referred me to Tom Dickinson’s 7/10/08 post in Rollingstone.com called “Obama’s Brain Trust”.  This post explores the ins and outs of Barack Obama’s campaign staff.  Upon reading, it reminded me of a few ah hah’s about how a workplace culture can make or break a leader’s legacy.

Leaders are the primary creators of a culture for their organization – some do it unwittingly, by just acting the way they do.  Others are very mindful and clearly articulate their personal beliefs and model their expectations about how people should act in the organizations they lead.  It appears that Obama’s approach is one of mindfulness as seen in the following quote from Dickinson’s post.

“When I (Obama) started this campaign, “I wasn’t sure that I was going to be the best of candidates. But what I was absolutely positive of was that there was the possibility of creating the best organization. The way great things happen is when people are willing to submerge their own egos and focus on a common task. That’s my old organizing mind-set. It’s not just a gimmick, it’s not just a shtick. I actually believe in it.”  

You can see from this quote that Obama is talking about his expectations about how people should act and he tells them why - based upon past experiences that proved successful and personal beliefs.  What also struck me while reading the post was how mindfully Obama models how he wants others to act in his organization as seen by this quote from one of Obama’s staffers.

“When he (Obama) is running a meeting, he does more listening than talking, asking questions and taking the temperature of everyone in the room. Regardless of wherever you fall in the hierarchy, he listens to you as though you are the campaign manager. He focuses, he prods, he pushes, to make sure that he fully understands your position. That sets an important tone as well: When you go into a meeting expecting to learn and not dictate, it fosters camaraderie.”

Mindfully setting the tone is a primary role for leaders – most focus on the behaviors that enable strategies and for Obama this includes how his campaign team works together to execute.  It is a balanced internal and external focus and usually the make or break practice that allows leaders to create legacies and presidential candidates create political machines.

Culture of Presidential Campaign Staff

The U.S. presidential election is in the news and there have been a number of in-depth articles about the organizational workings of some of the candidates’ campaign staffs.  One such article was by Peter Baker and Jim Rutenberg in the New York Times (6.8.08) called “The Long Road to a Clinton Exit.”  This article is a treasure trove of information about Mrs. Hilary Clinton’s campaign, but what caught my attention were the clues to understanding the culture of her campaign staff.

 

One of the first cultural clues identified from the article was, as would be expected, a strong drive to win.  But, there are myriad approaches in the world on how to win which in turn create differing ways of working within a staff.  Many of the quotes seemed to point to an offensive or attack approach to winning based on “overwhelming force” and the drive to capitalize on a reputation of past success.  The article authors noted – “…her (Mrs. Clinton’s) campaign represented a back-to-the-future effort to restore the Democratic dynasty of the 1990’s…”

 

Another cultural theme that jumped off the pages of the article was the strong sense of internal competition among campaign staff members which was noted as distracting them from battling their external opponents.  The following quote gave me an insight to the original source of this way of working - “On election night, Mr. Clinton grew playfully competitive with his wife over who had done more events or had more impact…Mr. Clinton wanted to know exactly what the returns were in the places he had been and Hillary hadn’t been. He kept showing Hillary and she would laugh.” So it appears that one of the sources for why the campaign staff competed so strongly against each other was the modeling of rivalry between Mr. and Mrs. Clinton themselves.

 

It is my sense that every grouping of people who work together over time with a common purpose develops a set of shared rules of behavior that can be identified as some form of an organizational culture.  These rules are many times not talked about, but primarily people watch how the leader(s) act - who they promote and follow the behaviors rewarded.  If these behaviors produce success in meeting the group’s purpose – a culture is set in place. 

 

The last sentence above sounds very final, but what happens if the culture does not help a group to achieve their purpose?  In a fast-paced environment, it just may be too late.  The alternative is for leader(s) to pay attention to the rules of behavior within their organization – ask the question if these rules are helping and if not, start first by modeling the behaviors they think will bring success.

How Do You Know?

It was a long time ago, but there was a time that prominent social theorists accused behaviorist of being communists. Those of us who believed that the best understanding of human behavior was achieved through systematic observation rather than theorizing about the nature of humanity were a minority but were not communists. We eventually won the day; behaviorism is now the dominant paradigm in the social sciences. But we did so not by casting theory aside, but by integrating theoretical and empirical approaches.

 Theory is only theory unless tested by observation. Empiricism is often only description without a theoretical framework. Behaviors are only behaviors unless viewed within the perspective of a unifying theory. So, two different ways of understanding the world around us have come together to enhance our understanding of why we behave the way we do in different situations. Adherence to extreme positions got us nowhere until we understood that we were both trying to understand human behavior.

 The study of culture has advanced from theory to concept. The concept can be tested empirically. After observation of many different organizations we now know that there is something called organizational culture that influences people’s behavior within an organization. We can use this concept to structure systematic observations of organizations in order to understand why the people within organizations behave the way that they do. We can then use this information to compare and contrast different organizations and different organizational cultures. I wonder where we’d be if we had stayed in two opposing camps tossing names back and forth without seriously examining our similarities and differences.

Just Say No to Shrimp…who would’ve thought?

My family likes to eat shrimp all year and not only in season, but I recently read an article in the Atlanta Journal & Constitution (7/10/08) about “The Hidden Cost of Shrimp,” and I am ready to act differently. How I reacted to this article is a good example of one kind of push people usually need to change how they act.

The article outlines the pro’s and con’s between purchasing “wild-caught, farm-raised, U.S. or Asian shrimp.” The reporter, Meredith Ford gives the reader details about how shrimp gets to our fish markets and they are not pleasant - spread of disease, use of antibiotics & pesticides and destruction of ecosystems - all this info made me think differently about the shrimp I love to eat

But, the part of her article which affected me the most were her final thoughts - she recommends that we need to think about eating less shrimp; saving them for special occasions; and, to understand the greater cost to our planet than the price we pay per pound of shrimp!

Wow, this thought is coming from the Food & Drink section of a daily newspaper in the United States - asking us to think less rather than more. This pushes against the grain of our American cultural belief that we have unlimited natural resources. Essentially, she is asking us to think differently about the food we eat and our lives. 

Thinking differently is the first step towards acting differently.  

Diversity Precedes Learning

I don’t remember when it started – just a general unease when everyone around me seems to agree – but I think I started becoming aware of my unease when I was teaching at night in a suburban junior college in the mid ‘60s. The Dean had said – “when teaching adults you have to be creative and find ways of getting your students involved in the classroom.”  

Well, my grand idea to engage my students was to juxtapose the principles of the Nuremberg trials with the arguments for and against the exodus of draft-age American men to Canada. To my surprise, I found myself the only one in the classroom on one side of the argument – all thirty some odd of my students were on the other side of the argument. So much for engagement - enter outrage - so creative was I that my teaching contract was terminated.  

But I persisted in my teaching and later became an instructor at a major state university while earning a graduate degree - bright young students, all 18-22, white, from middle-class (and up) families. As with any profession that puts you in front of people for long periods of time, all professors have to enjoy hearing themselves pontificate (interjecting, of course, the obligatory joke or two during each class period). But after a while, it becomes boring.  

My fellow graduate students – from all over the country – could debate the finest points over multiple pitchers of beer for hours at a time. No such luck when it came to the undergraduate classroom. I continued to spray my lectures and prayed that some of my students picked up some of the pearls while I entertained myself. (This, of course, is the widely used “spray and pray” method in teaching.) But I did begin to realize that I was unlikely to be successful in eliciting student participation if no one in the room had any “different” ideas. 

Next stop in my career – a large urban university in the center of a major metropolis – students from throughout the country, around the world – different backgrounds, socio-economic, cultural, racial/ethnic. I learned everyday – so did my students – I learned that if there are no “different” ideas to exchange, no one learns. Diversity is an antecedent of learning. I stayed awhile — 28 years — and learned something new everyday. Perhaps there’s a message here for organizations that aspire to be “learning” organizations.

Founders and Culture

 The Sunday New York Times recently had an article (6/15/08 by Anand Giridharadas) about a founder and his company - Mr. Mukesh D. Ambani and Reliance Industries. It is an epic story about a man’s drive, inherited from his Father to make a living for his family that evolved into something bigger - ”a revolutionary thinker with bold ideas for what India ought to become” - a visionary who is now the richest man in India - a second-generation billionaire.

The fun part for me in reading this in-depth article was to tie all the personal stories, company myths and the author’s insights into a simple picture of the Reliance Industries corporate culture.  As I finished developing my list of values, it looked very similar to some of the pioneering American-based companies that we have worked with over the years, but with clearly the feel of India. Some examples are - Mr. Ambani’s early childhood living in Mumbai’s “chawls” or tenements instilling in him the “combative mentality of an outsider.” - and his Father’s early ventures in the yarn trade business requiring a “special canniness…or creative maneuvering around the bureaucracy,” due to regulations of a socialist-leaning government.  

So if you have the chance, read this article about Mr. Mukesh Ambani and share with me what you think are the corporate culture values driving how his company Reliance Industries does business.

Leaders in brand cultures

We have worked with a number of companies who use branding as a way to market their products.  These companies are diverse in the products or services they market from consumer goods, medical products to wilderness preservation, but an interesting common cultural theme amongst them all is the need for folks within these organizations to embody their organization’s  brand if they want to fit-in and be successful. The phrases we hear from these folks in our culture discovery work are:

  • Need to manage your personal image as if it were a brand
  • Important to represent our brand image when interacting with customers
  • Need to live and breathe our mission in your personal life

This common cultural theme was confirmed for me again when I recently read an article about the transition in leadership occurring at Coca Cola. This is a company which uses branding to market its products and my sense is their brand image is upbeat, about feeling good and about fulfilling dreams.  The article by Joe Guy Collier in the Atlanta Journal and Constitution (7/2/08) quotes a  beverage industry specialist as saying that the retiring Coca-Cola CEO, Neville Isdell - “basically fixed the company and its culture … he used the force of his own personality and style to provide leadership - giving people faith and confidence in the company again.

It appears that Isdell knew how to embody the Coke brand and capitalize on it, and employees felt comfortable and galvanized with this kind of leader.  Sure he did many other things to return the company to growth and profitability, but improving employee morale is mentioned many times as one of his successes.  So the question is when do leaders in organizations that have what I call - brand corporate cultures need to live and breathe their organization’s brand image in order to be successful in their role?

Harnessing the Hustler…

I cannot help myself from writing more about the hustler  instinct in the American persona and how it manifests itself in the corporate cultures of some companies.   One of the clear themes in historian, Walter A. McDougall’s book, Freedom Just Around the Corner - A New American History, 1585-1828 is that “we are a country and a people with a ‘penchant for hustling’ - in both the positive and negative senses.”  He talks about “how hustlers are folks who are known for getting things done, but also cut corners and cheat and above all are always in a hurry… fleeing into the future.” 

You can sense that hustler persona emerge in companies today, especially those with a “win-at-all-costs” culture.  When asked what it takes to be successful in these companies,  the following  behaviors are many times noted by employees:

  • must create opportunities & exploit them
  • must be aggressive, compete & take calculated risks
  • do whatever it takes to get the deal done

In the more successful of these companies, there are two important values that are in place in order to harness the hustler instincts and these are:

  • Achieve Results for the Good of the Customer/Public Mission
    • not for industry dominance or for personal gain
  • Working Together to Serve the Customer/Public Mission

It is clear from these two required values that having a focus linking the hustler instinct to something beyond personal gain or power is important.  This is not an easy job and usually very much of a juggling act on the part of leadership. Their work is to set and maintain the customer/public service mission front and center at all times without sacrificing the willingness of individuals to take personal risks and create opportunities for the future.

American Culture On Steroids

I recently saw the documentary movie – “Bigger, Stronger, Faster*, and was enamored how this movie so unexpectedly summarizes a powerful aspect of American popular and corporate culture.  The movie filters out the American “win-at-all-costs” characteristic as one of the underlying drivers for rampant steroid use in sports today.  We see this characteristic as a strategic cultural driver in many American companies as well and it can be hard to manage.

 

Then I read Bob Longino’s interview with the film’s director, Chris Bell in The Atlanta Journal-Constitution (6/13/08).  I realized director Bell’s perspective that you need rules and they need to be reinforced in sports as similar to how the “win-at-all-costs” culture driver needs to be harnessed in companies.  In new fields or markets when the game has not been clearly defined, there are great opportunities and usually a lack of rules – think of the de-regulation of the energy business in the late 1990’s and early 2000’s.  Some individuals and companies were solely out for personal gain – they saw the energy trading business as a “gravy train and they did not want to do anything to upset the train for themselves.”

 

Harnessing the hustler instincts of the American persona is what good leaders should be about – providing ground rules, incentives and adherence to an over-riding mission and values.  The culture of a company does not develop in a vacuum and director Bell’s sub-title to his movie – “*The Side Effects of Being American” reminds us that we are all part of the great American dream and having rules to play by can help us all.