Revisiting a Culture of Ownership in Healthcare

This past week, I talked with two leaders about the difference between accountability and ownership. They were not familiar with the work of Joe Tye and Bob Dent on this topic but it seemed to resonate with them. I am republishing a blog that Bob Dent wrote for this site two years ago. His advice is timeless.

By Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE (Guest Blogger)

Bob Dent is the Senior VP, COO and CNO at Midland Memorial Hospital in Midland, Texas. He is also past President of the American Organization of Nurse Executives. This blog highlights some of the key ideas in his important book on building a culture of ownership in healthcare.

The Invisible Architecture of Core Values, Attitude, and Self-Empowerment

In our new book, Building a Culture of Ownership in Healthcare, Joe Tye and I describe how toxic emotional negativity and behaviors such as incivility, disrespect, and bullying deteriorate the culture of an organization. It is recognized these behaviors have a negative impact on employee engagement, nurse satisfaction, nursing retention, quality outcomes and can lead to employee burnout and patient safety events. There have been more than 150 articles and books written on this subject in nursing literature alone over the past several years. We believe that this is the healthcare crisis within! By focusing on what Joe and I describe as the Invisible Architecture of values, culture, and attitude, at Midland Memorial Hospital (MMH) we have been able to improve the workplace environment, thus improving outcomes and saving lives.

Accountability is not enough. To tell someone that you are going to “hold them accountable” implies that you don’t think you can trust them to hold themselves to that standard. For managers, trying to maintain a culture of accountability can be exhausting, and such a culture will never take an organization from good to great. Building a Culture of Ownership is the secret sauce to making the leap from good to great. By connecting our peoples’ personal values to the core values of the organization and empowering them to act upon those values, the mission and vision can be achieved. These personal values and core values of the organization are the foundation of the Invisible Architecture.

Managers can sometimes get caught up in the minutiae of everyday work life and forget the principles of a positive workplace environment. Forgetting their responsibility for promoting a positive culture and encouraging employee engagement, they start behaving in ways that reflect toxic emotional negativity. This type of behavior was recently recognized in one of our patient care units at MMH. The director and I met with the leadership team of that unit and asked each manager to recommit to the work of creating a culture of ownership. We discussed what this looked like in our everyday work. Every manager was asked to decide whether he or she could make those commitments, and if they could not, were told that other roles could be found for them. One manager who was clearly unwilling to be part of the culture of ownership and refrain from participating in toxic emotional negativity was eventually terminated.

Over the past three years at MMH, we have created a new mission, vision, and a set of core values that resonate with our people. As a community hospital, we face tough decisions regularly in a forever changing healthcare environment. The cultural transformation we committed to embracing a culture of ownership including The Pickle Pledge; The Self Empowerment Pledge; and The Florence Challenge to be emotionally positive, fully engaged and self-empowered. In addition, every employee completes a two-day course on The Twelve Core Action Values, a comprehensive curriculum of values-based life and leadership skills. This course helps people connect their personal values to those of our hospital and has resulted in remarkable improvements in outcomes. We are now sharing the program with the Midland Independent School District.

In the new book we outline many practical and actionable ideas for people in all settings and organizations, from the classroom to boardrooms, in academia and acute and post-acute care organizations. Joe and I are on a mission to promote positive healthcare cultures in all settings and with all people. By so doing, we will be able to solve the healthcare crisis within together – and this is the essential first step to effectively and courageously dealing with the healthcare crisis on the outside. We call on all healthcare leaders and caregivers to join with us to build a culture of ownership in healthcare.

This book can be purchased in the Sigma Theta Tau Bookstore.