Atul Gawande, the Brigham surgeon and author, has a fascinating article titled “The Heroism of Incremental Care” in the January 23rd New Yorker magazine. His subject is the importance of good medical management over time. He writes, “Success, therefore, is not about the episodic, momentary victories … It is about the longer view of incremental steps that produce sustained progress. That … is what making a difference really looks like. In fact, it is what making a difference looks like in a range of endeavors.” He concludes that the corporate culture of healthcare must acknowledge, “The heroism of the incremental.”
The importance of careful process is a critically important subject that I tried to emphasize with house officers in training during my academic medical career. As readers of Nesiritide know, I carried that interest in process over to my work in the pharmaceutical industry as well. So, it may not surprise anyone that over a wee drop of very nice Scotch my neighbor, an upper-level manager in the automobile industry, and I fell into a talk about Volkswagen’s diesel emissions problems. I asked, “What went wrong at VW?” Which is how I ended up reading a fascinating article by Robert Armstrong in the Financial Times of January 13th.
After a review of the public-domain facts, Armstrong came to the conclusion that “something went wrong with VW’s culture such that immoral behavior became acceptable,” and he found this “an uncomfortable conclusion.” He went on, “I will confess I understand little about how corporate cultures work or how to improve them.”
Today, I talked with another friend, a businessman from Chicago, who had heart surgery at the Cleveland Clinic a few days ago. He was delighted to be feeling well and walking in the halls, but what he really wanted to talk about was the Clinic’s corporate culture. He said, “They really DO the patient-first thing here; everyone from the janitor to my heart surgeon does it.”
Corporate culture is about what the members of an organization believe about the enterprise and how they behave in both internal and external interactions. Leadership articulates the vision and values of the corporate culture and implements the practices of that culture.
I’ve been working with a group of college classmates on a project related to President Kennedy that’s driven in part by his 100th birthday this year. As President, he articulated a vision of the national “corporate culture” that asked citizens to participate in the great social enterprise. If we hope to get through the next few years, we must all get involved in defining our vision and values. Have a look at the website, watch the short video, and share your thoughts, please.