Defying Conventional Culture

In the young surgeon’s story from the beginning of this chapter, Hospital 2 appears to be led by people who only hold the more conventional or common mental map. I had the opportunity to work on a project designed to elevate over 60 nursing units in Hospital 2. We worked with the directors of the nursing units, dividing them into small groups and spending a week with each group to help them see how they could better empower themselves and their people.

The work proved to be a great challenge. It seemed that each time we surfaced some positive practice that might improve a unit, one of the directors would explain why it was impossible to employ it. They spoke of administrators who were punishing, doctors who were insensitive, policies that were inflexible, peers who did not cooperate, and employees who just wanted to do their job and go home. Experience taught these directors of nursing that the organization’s culture was constraining. They did not expect the people in their units or people in other parts of the hospital to flourish and exceed expectations.

As we sought to modify their beliefs and elevate their aspirations, we began to examine the nursing units more closely. We looked, in particular, for a positive exception, a unit that defied the conventional culture of the hospital. The exception existed and was easy to find. When we asked administrators if there was such a unit of excellence, they all answered in the affirmative and named the same one, which I will call Unit 5.

Unit 5 served children who were seriously ill. This was demanding work, and yet they were usually first or second on every hard performance measure. Measures of morale were also high. In many of the other units, turnover was high; in this unit, however, the turnover rate was close to zero, and there was a long list of nurses waiting to transfer in. Why?

Other units in the hospital also served populations like Unit 5, but none performed like Unit 5. They seemed to take a unique approach to everything they did. Earlier in the hospital’s history, for example, every unit had been given money to hire a hostess to greet new patients. Nearly all the units hired a nurse. Unit 5, however, hired a drama major and then sent her to clown school. When very sick children and anxious parents arrived on the unit for the first time, a very skilled clown greeted them. Within minutes, they felt they had become part of a special community in which they would be treated as full human beings.

When we interviewed the nurses in Unit 5, they told stories of people going the extra mile to take care of patients and each other. They spoke of collaboration and achievement. It seemed to be a place of high commitment and compassion.

The people we interviewed spoke of the unit director in the same way the people in Hospital 1 had spoken of their CEO. It was common for them to express extreme gratitude for the director of their unit. In our interviews, some nurses actually shed tears as they spoke of their leader. Their descriptions suggested that she was deeply committed to creating a positive unit in a conventional hospital.