Organization-Wide Culture Change in a Large Healthcare Organization: A Case History

Introduction

The U.S. health care industry has undergone considerable upheaval and public scrutiny over the past 30 years and continues to experience challenges as the Trump Administration is challenging the Affordable Care Act (ACA), which President Obama signed in 2010. To address the current challenges of health care costs and government regulations, while managing the delicate balance of numerous stakeholders, health care organizations are looking for ways to do business more efficiently and effectively.

With the increased rate of change and uncertainty plus the added pressure from the ACA implementation, this large (>300,000 employees) global health care organization, headquartered in the United States, considered various opportunities to prepare for these changes and pressures. Additionally, the organization had recently experienced other challenges, including service concerns and reputation issues. One of these opportunities to ensure on-going success was to implement an organizational culture change to serve as an organizational foundation and a common frame of reference to encourage collaboration and innovation.

Schein’s (2004) research suggested that crises create new norms, thus driving the culture change. These crises usually cause anxiety, and people are more open to shift their thinking to help reduce the anxiety. Schein (2004) noted that there must be “some sense of threat, crisis, or dissatisfaction … before enough motivation is present to start the process of unlearning and relearning” (p. 324). Schein (2000), however, warned that “management should seek not to change culture, but to change effectiveness. Only if it can be shown that the culture is actually a constraint should one launch a culture change program” (p. xxix).

Shifting the organizational culture at this time in its company history and industry environment was strategically important for the organization; as Ribando and Evans (2015) noted, a dynamic culture should change as the organization changes and the old culture behaviors considered part of their success are no longer effective.

However, making large-scale changes is not easy; researchers report that the great majority of change efforts fail (Choi & Behling, 1997; Kotter, 1995). According to Griffith (2010), “Given the dismal record of organizational change, it is imperative that a prescriptive protocol for effective and rapid change be made available to practitioners” (p. 2). Implementing organizational culture change is particularly difficult, due to organizational cultures’ complexity of shared beliefs, behaviors, and assumptions of people. Hofstede (2015) acknowledged that “understanding, and dealing with, culture is strategically important for organizations” (p. 566). Because of the complexity of organizational culture change and the low likelihood for success, this global organization implemented a planned approach by partnering with an external culture change consultancy.