Pursue A Culture of Excellence

Published in the September issue of Vein Therapy News

What makes a medical practice exceptionally good at what it does? How does it stand out from the competition and attract top talent? Great clinical care, solid strategic plans, and exceptional employees all make a difference, but what top notch medical practices have that mediocre practices lack is a culture of excellence – beliefs and behaviors demonstrated day in and day out that enable and inspire everyone in the practice to do their very best.

Wikipedia defines culture as the “set of shared attitudes, values, goals, and practices that characterizes an institution, organization, or group.” Culture is not a “goal” to be mandated, but rather the outcome of a collective set of behaviors. Leaders can influence those behaviors in several ways and, in so doing, shape the culture of their firms.

As a physician and an individual that your staff looks to for leadership, follow (3) steps daily to enable a new culture to be ingrained into your practice …

  1. Convey your vision of a winning culture. Define your aspirations, what will be different, and how these changes make a difference for the success of your medical practice.
  2.  Demonstrate how new cultural behaviors advance your practice. Nothing reinforces new behaviors more than success. So once you define these behaviors, work with your staff to apply them to a project that needs improvement.
  3. Reinforce the new culture by integrating it into personnel management processes. Staff tend to focus on what’s measured and rewarded. So the third step for building a new culture is to use the desired behaviors as criteria for hiring, promoting, rewarding and disciplining staff.

Even in this uncertain time of healthcare reform, the medical practices that I work with that are winning know they should invest in their people. Medical practices that are committed to a strong workplace culture tend to perform very well.

As the owner or managing physician of your medical practice, when was the last time you made the effort to understand, really understand, what the people you work with are thinking and how they’re feeling about their jobs? Despite the dismal stories we hear on the news regarding workplace engagement, there are many successful leaders who do one simple thing: They frequently ask their employees how they feel about their job and what could be done differently or better to make them happier. When this dialogue takes place, they receive priceless information that helps them retain their best employees and optimize their productivity.

Throughout my career, I have gained an understanding of the value of employee feedback. I’m talking about a sincere, consistent effort to make your staff’s workplace the best it can be. Ask employees how happy they are at work and what you can do to make them happier. These two questions indicate to your staff that your care about them and that they have your support. Furthermore, these discussions will provide you with a clear understanding of their concerns so you can provide your staff with meaningful direction. By knowing what motivates your staff, you can boost their performance and their satisfaction at work. These discussions also serve a purpose by allowing you to proactively head off issues before they become larger problems.

Assuming your staff is made up of several high-performing, highly motivated individuals whom you want to retain, here are a few ideas for monitoring and improving their work performance.

  1. Schedule a recurring appointment, monthly or quarterly on your calendar and ask your employees whether they are happy at work and what you can do to make them happier.  Don’t wait an annual wage or performance review to have this conversation.
  2. Maintain open lines of communication so that you can offer support and address issues before they become large scale problems.
  3. Keep the dialogue going. Don’t assume that you have all the information you need if you’ve asked people once whether they’re happy. Circumstances inside and outside of the workplace change over time, and feelings can evolve accordingly.

Remember, relationships are built on a series of little moments that create big impact over time. Sending someone home from work early to attend their child’s school performance is not an earth-shattering event on its own. But it is an affirmation that someone’s personal needs are important and to be honored. Taken as a whole, many small actions can strengthen someone’s foundation or they can tear them down. Be someone who builds others up rather than tears them down.  Little things matter in a big way.

In my opinion, open and honest communication with your employees is a cornerstone for employee retention. By communicating regularly with your employees, you will understand what motivates them and the challenges they need to overcome in order to do their best at your practice. This knowledge will help you reward your most talented staff in ways that are meaningful to them, which can change over time, depending on what is happening in both their personal and professional lives. Your efforts will be rewarded in the form of a highly engaged, productive and, yes, happy group of employees.

Symptoms that the culture within your Practice is in a downward spiral ….

  1. Communication Decreases. When information stops flowing, it sows the first seeds of decline. Staff avoid conversation and close their doors. Decisions are made in secret. Staff distrust administration. Gossip substitutes for facts.
  2. Criticism and Blame Increase. Staff make excuses for themselves and point fingers elsewhere.
  3. Respect Decreases. Constant criticism makes staff feel as if they are surrounded by incompetence. They believe that low performance is common and incompetence is tolerated.
  4. Isolation Increases. Staff retreat into their own corners or subgroups and become suspicious of others and unwilling to engage with them. Withdrawing from contact further isolates them, encouraging others to retreat in kind.
  5. Focus Turns Inward. Staff become self-absorbed and lose sight of the wider context, which may include patient care.
  6. Rifts Widen and Inequities Grow. A few star employees become a privileged elite, claiming disproportionate attention, resources, and opportunities. Power differentials and social distance between staff make collaboration difficult.  
  7. Aspirations Diminish. Staff stop believing that progress is possible. They are willing to settle for mediocrity.
  8. Initiative Decreases. Believing that nothing will ever change, staff become passive and follow routines. They stop taking initiative – even on small tasks – and ignore innovation or change.
  9. Negativity Spreads. Pervasive negativity fuels further decline.

What should you do to shift a culture from the behaviors of
decline to the habits of success?

  1. Keep communication open and information flowing. Foster widespread problem-solving dialogue. Face issues openly and honestly.
  2. Emphasize personal responsibility. Ask each staff member to take responsibility for their part of a problem.
  3. Demonstrate respect for talent and achievements at every level. Offer frequent public thanks. Praise those who meet high standards while helping poor performers improve (or weeding them out if they don’t).
  4. Convene conversations among departments. Involve departments in problem solving.
  5. Stress common purpose. Communicate inspiring goals that transcend any individual or group. Find a challenge to unite staff.
  6. Strive to reduce inequities. Require experienced staff to mentor others. Provide opportunities for learning and growth.
  7. Raise Aspirations. Use small wins to show the potential for bigger successes. Encourage realistic stretch goals and offer staff the help to reach them.
  8.  Reward Initiative. Make brainstorming a habit.

Many practices that VSA consults with mistakenly assume that leadership style is a function of personality rather than strategic choice. Instead of choosing the one style that suits their temperament, they should ask which style best addresses the demands of a particular situation.

Research has shown that the most successful leaders have strengths in the following emotional intelligence competencies: self-awareness, self-regulation, motivation, empathy, and social skill.

What Is “Emotional Intelligence”

Emotional Intelligence is the ability to manage ourselves and our relationships effectively. It consists of four fundamental capabilities:



  • Emotional self-awareness – the ability to read and understand your emotions as well recognize their impact on work performance, relationships, etc.
  • Accurate self-assessment – a realistic evaluation of your strengths and limitations
  • Self-confidence – a strong and positive sense of self-worth
  • Self-control – the ability to keep disruptive emotions and impulses under control
  • Trustworthiness – a consistent display of honesty and integrity
  • Conscientiousness – the ability to manage yourself and your abilities
  • Adapability – skill at adjusting to changing situations and overcoming obstacles
  • Achievement orientation – the drive to meet a self-imposed standard of excellence
  • Initiative – a readiness to seize opportunities


Social Awareness

  • Empathy – skill at sensing other people’s emotions, understanding their perspective, and taking an active interest in their concerns
  • Organizational awareness – the ability to read the currents of organizational life, build decision networks, and navigate politics
  • Service orientation – the ability to recognize, meet and exceed our patient’s needs


Social Skill

  • Visionary leadership – the ability to take charge and inspire with a compelling vision
  • Influence – the ability to wield a range of persuasive tactics
  • Developing others – the propensity to bolster the abilities of others through feedback and guidance
  • Communication – skill at listening and at sending clear, convincing, and well-tuned messages
  • Change catalyst – proficiency in initiating new ideas and leading people in a new direction
  • Conflict management – the ability to de-escalate disagreements and orchestrate resolutions
  • Building bonds – proficiency at cultivating and maintaining a web of relationships
  • Teamwork and collaboration – competence at promoting cooperation and building teams

There are six basic styles of leadership, each makes use of the key components of emotional intelligence in different combinations. The best leaders don’t know just one style of leadership – they’re skilled at several and have flexibility to switch between styles as the circumstances dictate.

  1. The coercive style. This “Do What I Say” approach can be very effective in a turnaround situation or when working with problem employees. But in most situations, coercive leadership inhibits the organization’s flexibility and dampens employee’s motivation.
  2. The authoritative style. An authoritative leader takes a “come with me” approach. They state the overall goal but gives staff the freedom to choose their own means of achieving the goal. This style works especially well when a business is adrift. It is less effective when the leader is working with a team more experienced than the leader.
  3. The affiliative style. The hallmark of the affiliative leader is a “staff come first” attitude. This style is particularly useful for building team harmony or increasing morale. But its exclusive focus on praise can allow poor performance to go uncorrected. Affiliate leaders rarely offer advice which often leaves employees in a quandary.
  4. The democratic style. This style’s impact on an organizational climate is not as high as you might imagine. By giving employee’s a voice in decisions, democratic leaders build organizational flexibility and responsibility and help generate fresh ideas. But sometimes the price is endless meetings and confused employees who feel leaderless.
  5. The pacesetting style. A leader who sets high performance standards and exemplifies them has a very positive impact on employees who are self-motivated and highly competent. But other employee’s tend to feel overwhelmed by such a leader’s demands for excellence – and to resent their tendency to take over a situation.
  6. The coaching style. This style focuses more on personal development than on immediate work-related tasks. It works well when employees are already aware of their weaknesses and wants to improve, but not when they are resistant to changing their ways.

The more styles a leader understands and can implement successfully, the better. In particular, being able to switch among the authoritative, affiliative, democratic, and coaching styles as situations dictate creates the best climate within your practice and optimizes staff performance.


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