A new VITAL WorkLife and Cejka Search study on the influence of organizational culture on physicians’ satisfaction and experience with key cultural attributes in their healthcare organizations found substantial gaps between the importance of most attributes to physicians’ overall satisfaction with their organizations compared to their organization’s performance.
A companion study of hospital administrators found that while they have a reasonably good sense of what is important to physicians’ satisfaction in terms of organizational culture, administrators consistently feel their organizations perform better with regard to cultural attributes than physicians think the organizations perform.
“The study clearly shows that there is often a disconnect between what physicians are looking for and what they find—and what organizations think they are providing,” said Dan Whitlock, MD, VITAL WorkLife consulting physician. “In our work with physicians and healthcare organizations, we find that this often leads to dissatisfaction, frustration and cynicism, sometimes with behavioral impacts. At a time when physician engagement is of paramount importance and healthcare organizations seek to promote satisfaction and loyalty, closing these organizational culture gaps can have a strongly positive impact.”
A patient-centered care focus is by far the most important cultural attribute to physicians, the study found. This attribute also had one of the smallest gaps between physicians’ expectations and how well they believe their organizations address the attribute, indicating that organizations have made progress in this area. However, there is still a sizeable gap between their satisfaction with their organizations’ efforts in that area, and the ideal.
The highest ranking organizational cultural attributes for physicians are respectful communication, a team-focused environment, and supportive management regarding errors and mistakes. However, their satisfaction scores indicate that all of the cultural attributes surveyed were important to them.
Transparent communication, collaborative leadership style, and organizational adaption to change are attributes with the biggest gaps between what physicians consider to be important and what they perceive their organizations to be delivering.
Some of the cultural attributes that physicians rank as a lower priority--such as clear mission and values, and objective performance evaluations—are areas where the gaps between what they expect and what their organizations deliver are smaller.
Ultimately, the largest gap—and the one that is most relevant to physicians—is that between their satisfaction with their organization’s focus on an attribute and the ideal—a perfect 10 on a ten-point Likert scale. From that perspective, the gaps, ranging from 3.0 to 4.3 points, are considerable.
Administrators’ assessments of how they thought physicians would prioritize the 14 cultural attributes were mostly on target. The key gap is their rating of their organization’s performance against those attributes.
“Perhaps you should add a question in your poll about whether we believe our organization actually practices what they preach,” one respondent suggested. “Not whether they do a good job meeting my satisfaction, but whether we really believe they believe what their ‘culture’ is.”
“Lack of cultural fit is a determining factor in a physician’s decision to join—or leave—a practice,” said David Cornett, senior executive vice president of Cejka Search. “Because turnover and prolonged physician vacancy can cost a practice as much as $100,000 per month, organizations can achieve significant returns by investing in the assessment and cultivation of cultural fit.”
The study also found that administrators underestimate the influence of organizational culture on physicians’ decisions to accept or leave jobs. In the physician study, most respondents agreed that expectations of cultural fit are a determining factor on whether to accept a job, and at least half agreed that lack of cultural fit prompted them to leave a job or practice. By comparison, administrators felt cultural fit was a factor for physicians accepting or leaving a job about one-third of the time.
“Physician respondents said that cultural fit has prompted them to leave or decline a position to a higher degree than administrators estimated was the case,” Cornett noted. “This reveals a gap that organizations can fill by more objectively assessing cultural fit and engaging physicians in on-boarding and team-oriented activities that support a strong cultural fit. This is especially critical in the first three years of joining a practice, when recruits are highly vulnerable to turnover.”
“People in an interview process have to be totally honest about what they are saying about the position and not just hope that things will work out when you arrive to work,” noted one respondent. “The culture of a workplace is difficult to know until after you work there. If only there were some way of finding out beforehand…,” another pondered.
“Administrators’ mistaken belief that their organizations are demonstrating competence when their physicians feel differently can lead to decreased efforts to create cultural congruence,” said Robert Stark, MD, VITAL WorkLife consulting physician. “As more physicians become employed, and work toward healthcare reform proceeds, physician engagement has become increasingly urgent as healthcare organizations work to develop models and systems to improve care and reduce costs.”
As one respondent noted, “Times are changing very rapidly and it is hard for physicians to keep up with them all; it is a time for transition, so morale can be low. Expectations of work satisfaction have also changed a lot in my time in practice.”
Dr. Whitlock stated there is tremendous opportunity for healthcare organizations to understand how they can fully engage physicians—whether they are employed or independent—and create better retention and recruitment programs. VITAL WorkLife and Cejka Search both have practices and programs that can assist organizations in closing the organizational culture gaps.
Several respondents indicated they were happy with their organizations and one respondent’s comment indicates the potential benefits of a healthy culture: “My organization's cultural attributes are what has encouraged me to put off my retirement. It is a pleasure for me to work here.”
Organizations also should be mindful of cultural shifts over time due to staff and leadership changes, as well as organizational and industry evolution, Dr. Stark added. “The organization changed around me. It is not the same place as when I joined,” said one respondent.
Please contact us for more information on how PWS can help, or to learn more about the survey. For more information on effective physician recruitment and retention strategies, please contact Cejka Search. Media inquiries are welcome; click here to contact us.