Why a Belief System is Essential to the Success of Culture in Organizations: An Application to Healthcare
A “belief system” of a person or society can be defined as a collection of beliefs held about what is right or wrong, true or false. Beliefs form a foundation of principles that guide behaviors and cultures in societies and social units, including social units at work.
Most leaders of organizations will agree that cultures in organizations affect the behaviors of the people that compose the organization and thereby the performance of the organization. But where does culture come from? Culture in organizations happens by design or default; ideally by the former and not the latter. “Culture by default” is problematic more often than not. The effects are a challenge to manage, at least, and at it’s worst, the pathology of culture by default becomes intractable and deleterious to performance.
What is the Purpose and Value of a Belief System as the Foundation of Culture?
The most basic, practical foundation of a culture is its belief system. Every enduring religion and great society is based upon a foundation of beliefs. Beliefs guide principles and behaviors of organizations. Beliefs are the building blocks of culture. Beliefs can be enduring, such as those that guide religions (often referred to as a creed). Beliefs can be temporal, subject to the vicissitudes of markets, economies, governmental policies and related dynamics, as well as the changing views and perspectives of leaders.
Belief systems in organizations come from the top; ideally a governing board working closely with senior leadership. Belief systems are collection of beliefs about the organization and its role and function in its environment. A belief system guides behaviors of the organization, including mission efforts, strategy, the investment of resources and the ongoing development of organizational competencies. For a belief system to become effective in the guidance of culture, it must also be effectively installed and instilled with the people of the organization.
Belief systems need not and should not be lofty. In fact, the loftier, the less useful. When well-devised, they convert readily to the practical becoming actionable by leaders at all levels.
Moving to Process and a Work Product
The development of a belief system is, by definition a process. It involves the proffering of assertions, assumptions and likely interactions of dynamics by leaders. Debate, argument and disputation define the process of belief system formation. The test of the final product is the ability of leaders to apply the beliefs individually and together to produce and execute on a plan of action for an organization. Beliefs, stated to organizations by leaders become public declarations of commitment and implied intentionality of behaviors. The people of the organization rely upon the constancy of the belief system for needed emotional and social psychological well-being and stability. Clarity of a belief system enhances faith in leadership.
Let’s move from here to to an example of an abbreviated belief system applied to guide the plan of a health system; community-based or academic. The culmination of a managed process summarized above produces a belief system. Each,”belief” is annotated for context.
Belief #1: “We believe the independent practice model will not produce a sufficient number of the right physicians in the right specialties, in the right locations to best ensure success with the mission goals of the organization.”
This belief causes the organization to face a critical shift in tradition, convention and design of the “medical staff” model and strategy; a shift to the employment of physicians across specialties.
Belief #2: “We believe patients will demand a more seamless, integrated and well coordinated care experience across sites, locations and time; especially patients with chronic conditions.”
This belief causes the adoption and adaptation of an integrated electronic record. Investments in the development and deployment of a satisfying patient experience will be made made as well.
Belief #3: “We believe the payers in our markets will focus much of their care management effort on total costs of care as opposed to the price of services delivered per episode of care.
This belief causes an internal focus on the understandings of total costs of high cost conditions produced across clinical programs, related specialties and time.
Belief #4: “We believe our competitors will pursue our most profitable clinical service lines with attempts at superior access, ambulatory care delivery innovations and new, larger and more “patient friendly”service sites in our key geographic markets.”
This belief stems from the reality that as the economics of healthcare delivery are subjected to accelerating, downward pressures on utilization and total costs of care, excess provider side capacity is revealed in markets. This excess capacity has to find new markets. It naturally moves to the high margin opportunities with increasing efficiency, with a principal goal of increasing market share at the expense of competitors.
Belief #5: “We believe that unsupportable variation in the philosophies of care delivery within our health system causes excessive costs and puts patients at unnecessary risk.
This belief is supported by multiple examples; one of special note is a 49% variation in rate of referral of non-emergent adult patients to hospital emergency departments by primary care sites owned by the health system.
These five examples of beliefs represent a good start at the development of comprehensive enterprise belief system, including the basis for culture development and deployment.
Connecting a Belief System With Culture
As with the brief examples above, a well devised and designed belief system answers four timeless questions central to the human condition and the human condition in organizations:
- Who are we?
- Why are we here?
- Where are we going?
- How will we get there?
A belief system forms the basis of culture. The belief system serves to define the “what” of how people in an organization move forward together, while the culture serves to guide “how” they move forward together. With the belief system in hand, leaders can attend to the culture of the organization; either a wholesale re- design or the modification of what is in place.
As with a belief system, culture requires definition. One worth considering is:
“Culture is the foundation of intrinsic beliefs that bind and inspire people in communities to pursue unity for purpose.”…the “Keystone Way”.