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Culture and climate: pre and post Francis

26-February-2013 0:00
in General
by Dr. Megan Joffe

If culture is the way we do things around here then climate is what it feels like around here.  When, as Francis so clearly pointed out, the only way we do things around here is to put targets in place as the control measure then the way it feels to work here is almost certainly likely to be focused, determined and fearful about not meeting those targets. When it is common knowledge that the average life of a Chief Executive is 2-3 years and that their success appears to be simply based on them meeting the targets they are set, it is difficult for the climate to be anything but tense, demanding and punitive. It starts at the top.  Challenges to the targets, explanations for why they are difficult to meet and expressions of concern about things not being right are ignored. Professionals and everyone who cares about patients feel their values are infringed. But because of fear and intimidations feelings are forced underground – no one listens. The climate feels dangerous – so everyone tries to keep their head down and their mouths shut. While we are not suggesting targets are completely unimportant they should not be the only performance measure.  What it FEELS like to work here and how I feel about my job and the things that I feel I am allowed to do and say are very important. This is what culture and climate are about – these intangibles – whether or not the managers say “my door is always open” is irrelevant. What is relevant is whether people feel they can enter that door and that they will be listened to. Gagging orders and other legal and systemic constraints challenge the notion that you can talk out and these too need to be explored for their hindering effects on developing an open and patient focused culture.

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