Leaders of organizations like ours spend a lot of time thinking and talking about their “culture.” Why? Because this system of shared values and beliefs is the primary driver of organizational behavior. Culture is the closest thing to the essence of an organization - what it stands for, how it is known by others. Like your reputation, culture is built over many years and is less about what you say and more about what you do.
Recently I came across a great example from UMMC of “culture in action.” Dr. George Russell, chair of orthopaedic surgery, shared a story with his department about an experience with a patient in the ortho clinic (Suite D in the University Physicians Pavilion). Although the patient had a fracture, he had also been seen by another service for a nonorthopaedic issue and it was clear that this other issue was not fully resolved and required medical attention. I'll let Dr. Russell pick it up from here in his own words:
“We identified the responsible service and went to their clinic location in the Pavilion. We requested that a faculty member come to Suite D to evaluate the patient but we were told another physician was in charge and suggested that we give him a call. We returned to Suite D and made a phone call. When we reached the responsible faculty member and described the situation, the response was 'Send him to the ER.' At this moment I became a bit apoplectic. I exhaled, collected myself and proposed another solution.
“Ultimately, a resident from the other service was sent to the clinic. The resident was like a vapor: evaluation, disposition, then gone. Now what? Was it our job to handle their problem? We were not responsible for the problem. Why should we be burdened with managing their complication? Although nothing like this was said, these are questions triggered by real emotions of right and wrong.
“The patient was alone; no family members were with him. However, we did not abandon the patient at the front of Suite D with a 'good luck' and a map with directions to hospital admissions. Instead he was personally escorted to admissions in a wheelchair, and I would like to add, this was the second patient to be personally escorted to the hospital from our office.
“This story is not to cast aspersions about another department but to illustrate a few points. In the description above, no one did anything wrong, and no additional harm would have come to the patient had he been treated in the ER. Yet, is that what we would want for our families?
“It is said that culture is the backbone of any organization. Culture is what guides our decisions when the boss is not around, when no one is watching. As we have embarked upon a new academic year, it is imperative that we review our Orthopaedic Culture.
“We Are Privileged Learners, Educators and Caregivers. Each of us in our chosen profession is privileged to care for people seeking our help. In the specialty of trauma, this message is particularly acute. Regular people like you and me were having a normal day until something bad happened. However, across all our subspecialties is a plea for help from someone who is relying upon us to ease their suffering. It is a privilege not to be taken lightly.
“We Do the Right Thing. This one is tricky because it is often interpreted as the act of an individual, relying on that person's moral compass. While the individual is important, we have elevated the 'Right Thing' to the larger orthopaedic department; therefore, we hold each other accountable to a higher standard. The illustration above highlights the impact of our culture to do the right thing. How do I know? Because everyone caring for the patient never hesitated to go beyond their personal convenience to best care for the patient.
“We Say 'Yes.' Saying 'Yes' is not for everyone. 'Yes' requires accommodation and sacrifice. Dr. Kevin Plancher, our J.T. Davis Visiting Professor, gave a talk about success in practice. One of his guiding principles was to say 'Yes.' He told an anecdote of being called to the ER to see a patient in the middle of the night for a nondisplaced fracture. He made his way to the ER and met someone who has positively shaped his practice in many ways far beyond his expectations. Granted, situations like that are the exception and not the rule, but to summarize, 'Yes' begets success and that is why we do it.
“We Do Our Best Every Day. Our best changes from day to day. The death of a family member, the birth of a child, returning from vacation…lots of external events shape our work performance. But every day we give our best effort possible. Giving your best is contagious.
“We Care About People So We Can Care Better for Our Patients. It is easy to become jaded by the evolution of health care. For many of us, health care was better in the good old days, and for the newbies it is not what you expected. Challenge yourselves to think back when you decided to enter health care. I imagine each of us wanted to help people. To help people you have to care about people. If you care about people, caring for patients is a natural extension.
“The illustration above highlights the impact of culture. Culture dictates whether we go beyond ourselves for a patient's benefit or place our convenience as the guiding principle. It is more onerous, frustrating, inconvenient and demanding to live out our Orthopaedic Culture. There is no even exchange for doing the right thing. So why do we do it? We do it because it is what we would wish for family members or ourselves if we were relying on someone else for our health care. Is there any question that it is worth it?
“These are moments we celebrate as a department for elevating the care of patients and expectations for ourselves. We are highly regarded across the institution and the community for living our Orthopaedic Culture. Let us use the story above to congratulate each other for going beyond what is acceptable and reaching for what is exceptional. Regards, GR”
Thank you, Dr. Russell, for your leadership and for this wonderful lesson in organizational culture. We can learn a lot from our Orthopaedic Culture, and I know there are similar subcultures around UMMC because I have witnessed them. Let's hope they are, indeed, contagious, and that all of us will take this lesson to heart, on our journey to A Healthier Mississippi.