Organizational culture is the third priority that we want to talk about on the 5th anniversary of Greg’s premature death. When we think about culture we see it as a group of individuals with common beliefs and a consistent approach. One of the definitions from Merriam-Webster is:

“the set of shared attitudes, values, goals, and practices that characterizes an institution or organization.”

Most people can appreciate “culture” as it relates to team sports. The teams that have team members who are committed to supporting each other and who worry less about individual awards or recognition often outperform teams with individuals that have greater talent but are more self-centred.

This is also true in business. Successful organizations have employees who feel valued, who understand the organization’s goals and feel they are a genuine part of both the organization and its achievements. Alberta’s health treatment system as an organization, was not created by a common movement of the people delivering care, nor from regional leadership consolidating to work towards a common goal, nor was it because a large population of patients and their families or the public were demanding it. It was created by the provincial government of the day, based on its own political priorities, and imposed on the system. The culture has been impacted by this top-down approach.

The past and present management of this consolidated system has had the difficult, if not impossible task, of trying to satisfy their provincial political masters while delivering treatment to patients. This is extra difficult because the people forced together were not part of developing the new direction and new rules. We need to collaborate to develop a common and clear vision for the system to work towards.

The governance structure of Alberta’s health system is the worst possible example that could be dreamed up. Its top down command and control character actually penalizes team-based initiatives and discourages innovation and improvements. Politicians make decisions and allocate money in order to gain favour (votes) leading up to elections. Elected officials then expect the appointed leaders they pick to act in a way that talks progress while shielding them from political risk. This process is disruptive and impacts the decision-making and efforts of people trying to provide quality care. And of course, transparency and accountability are not priorities for politicians themselves. Again if the culture from the top of the organization, is secretive, unhealthy and even vindictive it negatively impacts both the people needing care and those who are trying to do the very best they can to deliver that care.

There has been a never-ending string of statements by politicians and system leaders about how they are dedicated to patient centred care, the importance of teams, and how well things are progressing. These words do not fit with the actions being taken. We have had many discussions with Albertans in the last 5 years and both those working inside the system and those who that have needed care, would agree that what the leadership says is not reflective of what the system does.

We have seen that there has been an increasing willingness of some of the great people inside the system to take some risk and speak more publicly about what is needed to make things better. They have also spoken about some of the shortfalls that exist. This is beneficial for all of us, and we certainly appreciate their courage. We also have seen willingness of some of the larger organizational players to work together to close gaps and to improve the continuity of care along the lines of the recommendations of the HQCA’s December 2013 report.

In order to shift to a better culture Albertans need to stop simply accepting what the leadership tells us about our health system and start asking questions. This applies as our experience as patients and when talking to our elected officials. We, as Albertans, must make it a political priority to get the politics out of it. We must push for improvement and not allow the system to stagnate behind a veil of political assurances. We need to play our part in promoting a culture that seeks to continually improve and learn from everything from the near misses to the tragic errors. Greg’s death was a result of multiple flaws in the system. Others have their own and similar stories. We all hope to ensure the same failures never happen again. It has been 5 years and unless the urgent need for change in culture is recognized and acted upon we will continue to hear more tragic stories.

Healthy Culture
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