Culture: A Top Concern for Academic Orthopaedic Leaders

Alan Friedman, MA

CEO & Founder of J3P Healthcare Solutions

In a recent survey*, orthopaedic department chairs rated “department culture” as the MOST important leadership initiative.

This is not a surprise. It’s consistent with our experience at J3P Healthcare Solutions working with physician leaders—so consistent that we’ve integrated the concept of culture into our four-part model for Department Success:

  1. Strategic Planning and Tools
  2. Supporting Physician Success
  3. Effective Leadership
  4. Culture

*summarized in the AOC Connect 2020 Academic Faculty Compensation and Clinical Productivity Report 

What IS Culture?

People can often describe what a good or bad organizational culture looks and feels like, but they can’t nail down what makes it so. So let’s start with a definition. We like this one:

“[Culture is a] pattern of shared basic assumptions that the group learned as it solved its problems … which [is then] taught to new members as the correct way to perceive, think, and feel in relation to those problems.”
Schein, Organizational Culture and Leadership, 4th ed.

Or let’s summarize it this way:

Culture is NOT a program.
Culture IS about what your organization stands for.
Culture IS established, and reflected by, a collection of individual behaviors by people within your department.

“Leaders cannot simply tell people to function more like a team or be more collaborative.”

What does desirable culture look like?

While culture is a dynamic concept, a solid, productive culture is usually indicated by the following attributes:

  • Clinical and administrative leadership understand and share a common vision.
  • Clearly defined behavioral expectations. People understand the types of specific behaviors that support the culture, and those that are not accepted or tolerated.
  • There is a high level of trust, psychological safety, effective communication, and collaboration among physicians, administrative staff, and other disciplines.
  • Effective meetings and communication that support the strategic plan.

Your challenge as an academic orthopaedic leader: How do you change culture?

Once behaviors start to change at the individual level AND between people, culture change will follow. Here are a few key concepts about building the culture, as defined by some of the departments we’ve coached:

  • Those who don’t embrace the culture can’t be part of the team.
  • Those who remain, reinforce the expectations and behaviors because they accept that these support success, and this becomes the way the team functions.
  • You change culture by integrating training on the desired behaviors into the work (NOT through “culture” training).
  • People learn while doing the work and by constantly evaluating and improving behaviors in the moment.

Any sports fan knows: Great teams rarely talk about culture. They are constantly working on it!

“Every meeting, discussion, email, and decision establishes your culture.”

The individual psychology of culture: People WANT to succeed.

Here is a concept that we don’t leverage enough in healthcare: People generally want to be part of a team, of something larger than themselves—to feel connected.

Although healthcare has long valued professional expertise and autonomy, this concept is true across all settings and all professions.

The challenge, sometimes, is getting people to realize that they want this and that they will be happier, more fulfilled, and able to achieve their goals as part of a group where they are valued and where they value others.

You cannot simply tell people to function more like a team or be more collaborative. You need to define the specific individual and team attributes that contribute to a cohesive culture and help a “group” of people become a “team.” A team is able to accomplish the agreed-upon goals because they have “goal congruence.”

This only happens when leaders commit to helping their people develop these skills.

Effective teams display these common characteristics:

  • Clarity of purpose and agreement on what’s important
  • Role clarity
  • Confidence in the future
  • Trust and psychological safety

Each of these needs to be deliberately fostered and modeled by departmental leaders.

An example: the Navy Seals

The Navy Seals are renowned as an elite force, built on both individual excellence and outstanding teamwork. How do elite fighting forces like the Seals achieve their high levels of teamwork?

Their entire training program is thoughtfully and carefully designed to create a certain culture. Even in an environment that pushes people to the limits of individual achievement, Seals value the teammate they can trust over the one with the outstanding individual scores or talent.

To build trust, you must build relationships. Building faith in the vision… this is the job of a leader!

Culture and behaviors happen everywhere, 24/7 — and so must the work of culture building.”

Building and sustaining a culture

Great coaches don’t teach technique and strategy on the practice field and then teach “culture” and behaviors in the classroom! Culture and behaviors happen everywhere, 24/7 — and so must the work of culture building.

In our work, we’ve developed a practical approach that has positively impacted the organizations we advise:

  1. Identify the aspiration of the future state—and articulate it powerfully.
  2. Co-create a structure that emphasizes and leverages collaboration.
  3. Define the behaviors that are valued by the department/team because they will support collaboration and success.
  4. Connect these Behaviors to what people individually value— so they are motivated to learn, grow, and change their behaviors as appropriate. (This does not mean they have to change who they are.)
  5. Build the capacity of your people by teaching them these behaviors. Provide insight, support, and tools.
  6. Integrate these efforts into the work itself.

This last point is critical and often overlooked. Every meeting, discussion, email, and decision establishes your culture. Leaders are always creating a culture, whether intentionally or not.

Finally: Always consider the value of competence, autonomy, and connection.

None of this works if you don’t provide people with an environment that accounts for the things they consider important, under the theory that a sense of “self-determination” motivates people and keeps them engaged.

Find ways, within the context of your overall plan, to give your people:

  • A sense of COMPETENCY in feeling that they have the confidence to do their job.
  • A sense of AUTONOMY to find/implement solutions.
  • A sense of CONNECTEDNESS. Start with their team, then the department, and ultimately the organization (harder than ever in pandemic time).

These concepts keep people engaged and motivated – both as individuals and as part of your team.

Related: Self-Determination — Physician Success and Career Satisfaction

Alan Friedman, MA, is the CEO and Founder of J3P Healthcare Solutions. To learn more about J3Ps solutions, visit