INITIAL BRIEFING ON THE RESULTS OF THE NRGH

CULTURAL ASSESSMENT
Data Gathered Onsite from October 10 November 6, 2017
Obtained by
theBreaker.news
Presented By
J. Robert Bob Carleton, Founding Partner / CEO
Gary W. Craig, Managing Partner / COO
Vector Group, Inc.
JJ

Nanaimo Regional General Hospital

November 6, 2017
 OVERVIEW
The ChallengeWhere NRGH Needs to Be
The Numbers (Who Contributed to the Assessment)
Typical questions asked during interviews/focus groups
General themes
The Harsh Reality
The Way Forward
 A REMINDER: OUR ESPOUSED VALUES
C.A.R.E. guides everything we do.
Courage: To do the right thingto change, innovate and
grow
Aspire: To the highest degree of quality and safety.
Respect: To value each individual and bring trust to
every relationship.
Empathy: To give the kind of care we would want for
our loved ones.
 OUR STATED VISION

Excellent health and care for

everyone, everywhere, every time.
 WHERE NRGH NEEDS TO BE
Effective organizations are those which produce
excellent results by any measure of costs, quality or
efficiency while simultaneously enhancing the energy
and commitment of organizational members to the
success of the enterprise.
William A. Pasmore
Author of Designing Effective Organizations: The Sociotechnical Systems Perspective
(Bill is a global thought leader on change, leadership and organizational design)
VECTOR GROUPS CHARGE: ASSESS THE CULTURE
"A pattern of basic assumptions--invented, discovered or
developed by a given group as it learns to cope with the
problems of external adaptation and internal integration--that
has worked well enough to be considered valid and therefore, to
be taught to new members as the correct way to perceive, think
and feel in relation to those problems."
Edgar H. Schein, 1985

Or

"Organizational culture is the way we do things around here.

W. Warner Burke and George Litwin, 1989
 JUST SO WERE ON THE SAME PAGE
Organizational culture does not refer to:
tasksproducts or servicesprocedures
Culture does mean response tendencies or typical behavior
patterns that characterize people within an organization.
Culture is tied more closely to the demeanor or attitude
that people exhibit while engaged in various tasks and
procedures.
Culture is a powerful force within an organization.
It is about collective behavior.
 JUST SO WERE ON THE SAME PAGE (cont.)
We told people who met with us that Vector Group was
hired to conduct a cultural assessment.
We defined this as the way we do things here which
includes how people communicate and behave with each
other.
We further stated that we were looking for what works
well here and what does not work well.
 JUST SO WERE ON THE SAME PAGE(Cont.)

When we use the term system we are NOT referring to

a computer system.

What we ARE referring to is the Organizational System

the people, policies, processes, procedures, behaviors,
and attitudes currently in place at NRGH
 JUST SO WERE ON THE SAME PAGE(Cont.)

When we use the term administration,

we are using the NRGH definition we heard
which includes everyone in the corner suite
and anyone up past the Malahat to
Victoria.
 METHODS USED
We met with executives, managers, supervisors, physicians,
nurses, technicians and staff from most units/departments
through:
Face-to-face (F2F) interviews/phone calls
Focus groups and group interviews
Drop-in interviews
Informal walkarounds/observations
E-mail exchanges
 THE NUMBERS: WHO CONTRIBUTED

A total of 473 people contributed

to the cultural assessment at
NRGH*

*This is a sample size significantly greater than normally needed for a statistically
significant sample. The consistency in themes, and even particular stories, is very notable.
 TYPICAL QUESTIONS WE ASKED
What is your role/job? How long have How is your performance
you worked here? reviewed?
What do you like most about working How do you describe your team?
here?
What does C.A.R.E. mean to you?
How do people treat each other?
Would you recommend NRGH to a
How are decisions made? friend or family member as a good
What works well here? place to work?
What gets in the way of doing good What are relationships like
work? What doesnt work well? between units/departments?
What is your view of leadership and If you had a magic wand or three
management here? Please describe. wishes, what would you want to
What changes have you seen over the improve NRGH?
years? Positive? Negative?
 THE NUMBERS: WHO CONTRIBUTED
Data Gathered from:

Executive interviews 10
Director interviews 8
Manager interviews 16
Supervisors/Leads 64
Individual contributor contacts (F2F, phone, or email)
133
Number of people we met in groups 151
Physicians 55
 THE NUMBERS: WHO CONTRIBUTED
Additionally: Other:

35 people including physicians, We also met with Ernst & Young

nurses, technicians and other staff (E&Y) The E&Y lead and one of
responded by way of email to her project people who are doing
[email protected] the IHealth review to get their
Fourteen of these followed with views and experiences regarding
phone or F2F interviews. the culture at NRGH.
 HOW WELL IS NRGH DOING ?

Please remember that what you are about to review

is the current majority perceptions of NRGH.
Like it or not, for people in this organization their
perception IS their reality
Contrary to many of your beliefs, this is not about
specific individuals but about a systemic problem.
 HOW WELL IS NRGH DOING ?
From all indications Nanaimo Regional General Hospital is failing
significantly in regard to managing people.
Focused too much on budget and not enough on peoplewhich
includes all stakeholders - physicians, nurses, staff, patients and
their families
Not living the values of C.A.R.E. and allowing a toxic culture to exist
that most here describe as disrespecting and devaluing everyone
Maintaining a top-down, heavy-handed, command and control
hierarchy that ignores the willingness of people to provide the best
patient care despite budgetary realities
 HOW WELL IS NRGH DOING? (cont.)
Maintaining an atmosphere of fear, bullying, intimidation,
retaliation and censure that prevents people from raising
questions, issues or concerns
Placing high value on cronyism and nepotism in recruiting, hiring
and promoting
Excluding physicians from decision-making processes
Failing to establish/demonstrate a pattern of positive leadership
behaviors from anyone in Admin/management at all levels
 HOW WELL IS NRGH DOING? (cont.)
Decisions are based solely on budget with little to no regard for
employees well-being or quality patient care
Maintains an actual value of go along to get along or ask no
questions, raise no issues, and keep your head down
Only those coming out of Emergency get recognition and
promotions
Maintains a top heavy bureaucracy with unclear management
roles, responsibilities and accountabilities with no focus upon
people
 HOW WELL IS NRGH DOING? (cont.)
Constantly tells people its their fault for things not going well
whether it be IHealth or some other issue
Ignoring the pleas for guidance, direction and support
Reward and recognition for good performance is not utilized
Accountability for abusive behavior is non-existent
Admin/management at all levels not responding to staff issues
Maintains a cloak of secrecy around all decisions, keeps people
in the dark about what management is doing
 Further Damage
Would you recommend NRGH as a good place to work to a
favorite niece or nephew just finishing training/university?
Almost universal response of NO!
Numerous people in several parts of the hospital volunteered
that theyve instructed their friends/families to take them
elsewhere (the mainland) for care if they get sick.
Basic trust between people is non-existent at all levels.
Suspicion, fear and often loathing predominate organizational
members thinking about Administration
 A HARSH REALITY

No individual performs in a vacuum.

A bad system can break the best of performers.
Geary Rummler (1937-2008)
Author of Managing the White Space on the Organizational Chart

Currently, NRGH is maintaining a bad system on several

levels.
 With all that said,

This is NOT an indictment of specific

people but a call to action to fix the
system that devolved into the current
way of doing things
 THE GOOD NEWS?
NRGH does indeed have a number of people who:
Love their jobs
Love the work they do with patients
Love their immediate team/co-workers
Want NRGH to be a beacon of patient care
Want to be involved in making NRGH a better place
But the numbers are far, far lower than even an
average poorly performing organization
 CULTURE SUMMARY
1. Managers spend 80%+ of their time on paperwork and upward focus

2. People have become the least-valued commodity in the system

3. Displaying a sense of pride and a willingness to help each other out is a

rarity and when present is viewed with suspicion

4. Groups and functions that used to support each other and get along
well have lost trust in each other and often become overtly hostile

5. Teams and Communities of Practice were systematically dismantled

which added to the loss of a sense of community
 CULTURE SUMMARY (cont.)
6. No evidence, no signs, of active management/leadership focused upon
people performance or people concerns and interests.
7. Accountability does not exist, other than the fact you may be blamed for
anything at anytime. S/he who blames first wins.
8. Keep your head down, say nothing, raise no issues or uncomfortable
questions and you will not be noticedwhich is the best you can hope for
9. NGRH culture is clearly characterized by bullying, coercion, harassment,
intimidation, lack of trust, nepotism and favoritism. NRGH maintains an
atmosphere of fear and uncertainty. Advancement is about who you know,
not about performance.
10. People feel the reality is clear; NRGH is headed downhill and nothing will
ever change.
ORGANIZATIONAL DYNAMICS: RELEVANT GENERAL RULES
1. Any and all organizations composed of more than 7 people are, by
definition, dysfunctional. Comparative effectiveness and efficiency is
about being less dysfunctional than other organizations
2. In general, it is rare that people actually try to screw things up and make
accomplishing the organizational objectives less attainable.
3. Generally, people at all levels in the organization are characterized by
coming to work every day and doing the best job they can as they
understand it and as the system will allow.
4. Organizations, unless actively managing the people aspects of the
business, will tend to grow less and less responsive to human concerns
and as a result become quite dehumanizing places to work.
ORGANIZATIONAL DYNAMICS: RELEVANT GENERAL RULES
5. Regarding Management, What you do speaks so loudly people cannot
hear what you say. How do you spend time and energy?
6. If organizational goals require the efforts of people, at least as much time,
energy and resource must be spent on their well-being as on other issues
7. Many studies indicate people are more complex with thoughts, feelings,
anticipations, and varying reactions and require more effort to manage
8. How many ways can a person be misunderstood? Become a manager and
start counting. But this reality must not and cannot be an excuse for
disengaging. It is simply something to be aware of and actively manage.
 ALTERING THE CULTURE: CRITICAL ELEMENTS
1. Management, as a group, must come to agreement on required
management behaviors for which they are individually willing to be held
accountable.
2. Time must be created for managers of people to spend significant effort
focused upon those people. This cannot be another pile on task where
managers are to magically make more time in the day. This means cut
out and cut back on other demands to make time available.
3. A metric system for tracking the above agreed behaviors must be put in
place. Usually, this takes the form of a 360 feedback program.
4. A formal, rapid response, approach to seeking out and resolving any
issues having a systemic negative impact upon the ability to get the work
done must be put in place.
 ALTERING THE CULTURE: CRITICAL ELEMENTS (cont.)
5. Management must be visibly in action and seeking feedback before
asking individual contributors to make personal commitments to join in
and become part of the solution to making NRGH a preferred place to
work.
6. Find a few current very visible issues that are irritating large numbers of
people. Move quickly to fix them giving people hope that both: a)
things CAN be better and b) the management and administration DO care
and want things to be better.
7. Formalize a process for seeking out and incorporating relevant and
opposing views in the decision-making process. Most decisions should be
the result of focused effort to gain consensus among all critical parties to
achieve the purpose of the institution.
ONE WAY FORWARD FOR NRGH: 8 CRITICAL STEPS
1. Move rapidly in rolling out IHealth through the rest of Portfolio 2 utilizing
a proven change management model and follow-up processes. Couple
this to an effective computer-based training (CBT) component.
2. Move without delay into an aggressive management and leadership
functional program coupled with a customized 360 feedback system.
3. Communicate quickly with the staff at NRGH on study findings and make
a clear statement the current situation is not acceptable. Authority
figures must take responsibility for improving the situation and announce
a clear action plan with timeframes for moving ahead.
4. Fix the scheduling problem for holidays and vacations ASAP as an initial
salve to show things CAN happen for the better.
ONE WAY FORWARD FOR NRGH: 8 CRITICAL STEPS (cont.)
5. Run Partnering (Teamwork between Teams) with Physician groups and
actively monitor and modify agreements as appropriate to maintain
robust but constructive conflict assuring better overall strategic results.
Also develop Partnering agreements between functions as necessary.
6. Institute use of Tiger Teams with initial projects on reinstituting viable
teams, collaborative efforts, and Communities of Practice
7. Utilize staff from rest of Portfolio 2 to help provide temporary relief for
NRGH staff to take part in training and Tiger Team activities.
8. Move to All-Staff Days to spread the change and invite the individual
contributors to come and join the party. Include some form of Yellow
Card program to facilitate constructive discussion between management
and staff during times of conflict or failure to live up to the values.
 The biggest concern
for any organization
Posted on LinkedIn, October 30,
should be when their
2017, Author Unknown
most passionate
people become
quiet.
 How Critical is The Current Situation?
In Vector Groups collective opinion the organizational
culture is past the tipping point. The simple act of
continuing with daily operations exacerbates the toxicity
of the culture. This situation is not sustainable and will, in
due course, lead to some form of self-destruction.

Howeverit is very fixable in relatively short time frames

with sustained and focused effort.
 A SIMPLE CALL TO ARMS
Going forward from today people will have a simple choice to
make:

Either become a part of the solution, or remain a part of the

problem

Unfortunately, there is no neutral ground

 WHERE NRGH NEEDS TO BE
Effective organizations are those which produce
excellent results by any measure of costs, quality or
efficiency while simultaneously enhancing the energy
and commitment of organizational members to the
success of the enterprise.
William A. Pasmore
Author of Designing Effective Organizations: The Sociotechnical Systems Perspective
(Bill is a global thought leader on change, leadership and organizational design)