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This mini-case study is part of our Culture-in-Action Series.

The culture of organizations is affected by the sub-cultures that exist. Every organization has a culture and within that culture sub-cultures exist. Existing sub-cultures work independently and with others to affect the culture of the whole. Sub-cultures are a reality and, at times, are a necessity. For example, healthcare organizations are aggregations of very specialized professionals, services and programs all working independently and together from a shared belief system, vision and values set, all in pursuit of a common mission and set of identified goals. Sub-cultures are natural products of “specialists” working together alone or as teams to ply their knowledge, expertise, skills and judgement to specific needs of patients.

The health of the culture of the whole can, at any time, be affected by the status and stability of one or several of the sub-cultures that operate within the whole. Leaders must be aware and appreciative of the effects of the sub-cultures as they exist at a point in time over time.

Keystone Culture Group Case Vignette:

A community health system is on a journey of integrating physicians as employees of the organization. Independent physicians who are affiliated with the organization are concerned and somewhat threatened by the strategy. A survey of the culture of the organization demonstrates that independent physicians believe the organization values the employed physicians over the independents. This growing belief system is fomenting mistrust, is straining relationships and is re-directing patient referrals out of the health system. Furthermore, there is some risk that new competitors will be invited into the community by independent physicians. The board is concerned for the welfare of the organization, that of the medical community and how this rift might affect patient care. It is time for the CEO to take the lead on the resolution of this problem. The state and status of this sub-culture, within the whole, is such that too much is at-stake and at-risk for all concerned. This sub-culture needs to be effectively re-integrated with the whole. The independent physicians must feel they are an essential to the forward progress mission of the whole. This effort must be set in a context of the realities of the the local and national interests of younger physicians in independent practice vs. employment, and the CEO will need to assemble the right formal and informal physician leaders to address this issue. It is likely that this effort will remain ongoing and a top priority for the CEO.

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