Does Culture Nurture or Slay Quality

I'm interested in thoughts on how culture either nurtures or slays improvement work in healthcare. To lead off the discussion, I've posed the question to a friend and great thinker on the topic of performance improvement and quality in healthcare, Dr. Chuck Schauberger. Chuck writes:

"You are pondering an interesting topic. I’m sure that culture has been adequately defined in many scholarly works over the last few decades. Without getting into my own thoughts in great detail, I would suggest that the definition of culture may have drifted over the last few years with the influx of Generation X and Generation Y members of our medical staff. I don’t think it is nearly as monolithic. Just my humble opinion.

Anyway, does culture nurture or slay quality improvement? The obvious answer is “both”. We all know the saw of modern business culture: “culture eats strategy for lunch”. Indeed, culture maintains its grip on strategic planning and almost all we do. I still think the vast majority of doctors don’t understand or accept quality improvement. I think there is growing fear over how it will change our daily work, but few look forward to its emergence. The whole “Pay for Performance” idea scars the bejesus out of them. The biggest problem: doctors don’t understand that the insurance companies, health plans, and CMS really don’t want to control their practices. They want the physicians to accept leadership in this area. They have begged us for so long; now they are even offering money for our leadership. Doctors have exhibited fear that it will require major changes in their practices. If doctors could overcome this fear, they would quickly find that what is required is really easy. It doesn’t take much time or effort to be a star in quality improvement in an area in which they have knowledge and passion.

Within my own department, the department chairman has developed the expectation that all doctors and associate staff will accept responsibility for improvement work within one small clinical area. I’ve been mentoring many of them on how to perform their tasks. They quickly “get it” and I’m having trouble keeping up with all the projects and fulfilling my part of the projects. AMAZING! Most important to me is that we have moved beyond the element of “counting” in most of these projects and are really involved in looking at ways of improving processes, educating patients, enhancing patient satisfaction, and other elements that truly improve the processes of care and the experience of the patient. My next goal for these doctors: accept responsibility for improving the care provided by others (physicians, nurses, etc).

I do believe cultural inertia is our greatest enemy in healthcare quality today. However, I would predict that winning the first few battles will be all that it takes. "