1. Hader, Richard RN, CHE, CPHQ, NE, BC, PhD, FAAN

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Shared values, attitudes, and beliefs are the key ingredients that define the culture of a group of individuals. Deeply rooted and difficult to change, a culture is fertilized over a significant period of time. Far too often, leaders become overly ambitious and believe they can rapidly change the culture of their area of responsibility. Lack of progress becomes frustrating and both the leader and her reports become disenchanted, resulting in management turmoil with competing priorities. Time and persistence will work to a leader's advantage when attempting to infuse cultural change. If you're consistent and don't retreat when confronted with opposition, evolutionary progress will occur.

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As a chief nursing officer, I make departmental rounds on a regular basis. Each unit throughout the organization is composed of its own unique culture. From the second I walk off the elevator, although difficult to express in words, I get an immediate awareness of the unit's culture. The tone of the department is palpable. I sense differences in personality types, levels of experience, leadership, and work habits. I'm able to distinguish how department members interact with each other and their patients. Why is there a cultural difference between units even though they all work for the same organization?


Before you attempt to change the culture, you must conduct an objective assessment to identify and clarify what the team members believe are the shared vision and goals of the department. You must appraise what they value in the work setting. What are those elements that they consider nonnegotiable? Do they value continuing education, innovative change, or do they prefer the status quo? Who informally leads the group? What makes them excited about the profession? These are just a few of the basic questions that will guide you when developing a long-term strategy for improvement or change.


After you assess the current status of the unit, develop a plan for what needs to be changed. Your team's values and beliefs are essential components of the plan; strategize accordingly to reach mutually agreed upon objectives. Remember, certain strategies that are effective and efficient with one group may not be transferable to another. The success of the implementation primarily depends on the department's culture.


Don't be intimidated if some of your current team members aren't accepting of change. Although difficult, they may need to consider seeking employment elsewhere. This may cause initial disruption and hostility, but it needs to be considered for the overall success of your team.


As with any substantive change, culture must be consistently nourished by the leader. Staying the course and rewarding and recognizing outstanding performance, consistency, and a commitment to change will facilitate rapid enculturation of the vision for the department.


Richard Hader