Two Hospitals, Two Cultures

The first story begins when my friend went with a team of colleagues to visit Hospital 1 and were warmly greeted at the front door by a man in a top hat. Inside, they saw the usual information desk and waiting area but also spaces available to the community for such things as weddings and cooking classes. As they toured the hospital, they got the impression this hospital was like a five-star hotel.

On their tour, they happened to bump into Hospital 1’s CEO, who welcomed them and asked if he could help them in any way. He chatted with them for a half hour and shared his vision and philosophy.

During the rest of the tour, they asked the employees about the CEO. People at the lowest levels talked as if they had a personal relationship with the man. They also spoke with pride about the vision and values of the hospital. Clearly, people were unified and felt good about what they were doing. Their every word and action seemed to convey that they were fully committed to the hospital’s success. There was a positive culture that seemed to focus, unify, and animate them.

My friend and his associates left deeply impressed. While they were all doctors who have spent their lives in hospitals, it was clear that they had just observed a hospital that exceeded their expectations. They had just encountered a truly “positive organization.”

Shortly thereafter, my friend was dropped off at the front door of his own hospital: we’ll call it Hospital 2. Given his recent visit to Hospital 1, he began to think about contrasts between that organization and his own. He then experienced one of the differences.

As he walked in, he was met by a gruff woman who wanted to know if he was a student. He explained that he was a surgeon and was scheduled to operate. She would not grant him entry, citing hospital policy. He would have to go back out and walk around to the employee entrance. The surgeon tried to handle the situation artfully, but the woman threatened to call security. He went back out.

A few days later, he related what had happened in a meeting with a senior officer of Hospital 2. This person responded to the story by asking for the name of the woman. The executive wanted to fire her.

My friend told me that this particular senior officer put a lot of emphasis on being in control and fixing problems. His first inclination, for example, was to terminate the troublesome woman. He assumed that she was “the problem.”

To the administrator’s mind, firing the woman was the right thing to do. He wanted to establish and maintain order and control. He wanted to make the hospital run better. A person who seeks a predictable, smooth-running organization often focuses on disruptions and disruptive influences: the natural inclination is to fix those disruptive problems. In this case, the knee-jerk solution was to fire the woman.

When we focus on a problem, we are not seeing the whole system. We are paying attention to something within the system. Likewise, when we focus on a single person, we are not focusing on the culture of which that person is a part. The aforementioned senior executive did not stop to wonder what systemic conditions within the culture might have caused the woman to behave as she did. It did not occur to him that if he fired the woman, the problem might not go away. The next person in the same role, responding to the same culture, might eventually behave in the same manner as this woman had.

When people focus on the part rather than the whole, it does not occur to them to ask a most important question: How might the entire culture be reshaped so the people flourish in their work and exceed expectations as they perform?

This book is about creating more positive organizations. The preceding question reflects the simplest definition of a positive organization.

IN A POSITIVE ORGANIZATION, THE PEOPLE ARE FLOURISHING AS THEY WORK. IN TERMS OF OUTCOMES, THEY ARE EXCEEDING EXPECTATIONS.

To flourish is to grow and thrive. To exceed expectations is to successfully do more than people expect you to do; it is to move toward excellence. Hospital 1 had a culture of excellence. The young surgeon and his colleagues entered Hospital 1 with similar assumptions about what a hospital is like. During their visit, those assumptions were challenged. The surgeons saw people were flourishing and exceeding expectations. They saw a hospital that was performing at a high level because it had a positive culture. The surgeons had seen something that created dissonance in the way they viewed the world. Now they would have to decide whether to disregard it as an anomaly or examine that information more closely.