In a recent article, Johns Hopkins Medicine CEO Dr. Edward Miller was quoted as saying “Culture eats strategy every day for lunch.” He was discussing how to get a program instituted within a very diverse organization. To me this means even the best intentions mean nothing if there is not cultural alignment between two different groups that need to work together.
This viewpoint is very relevant in healthcare design projects where one group, a client, works with another team, a designer and builder, to get a building built. Much like singles on the dating scene, finding someone in need of a project (unattached) is easy; the real challenge is matching cultures between the two organizations (compatibility) that is the difficult part. Identifying similar cultures is the crux of any match-making exercise.
Dr. Miller’s earlier quote was in reference to how quickly change should be instituted at a company or hospital. Too fast or too slowly and failure is likely; it is important to gauge the pace at which you can make change happen. And it comes down to culture.
Similarly, on project work the design team may have great ideas and the construction team some really innovative things to benefit the building process, but without similar interests and motivation on the client end it could be wasted. Some hospitals value this innovation and quick thinking; others may not value it, but are hands-0ff in implementation and trust the team’s judgment as long as it betters the project; still others want to stay conservative and micromanage details using only proven methods—innovation, schedule and savings be damned.
Much like a couple headed for a break up, it would be fruitless to get married to a person with whom you had major cultural conflicts because, in the end, it will simply not work out. When designers are seeking out hospitals to work with, a lot of time should be spent asking questions that uncover the culture of how decisions are made at a hospital. Decision processes—consensus, democracy, majority rule, dictatorship—lie at the heart of company culture and are the avenue through which progress is made. If a decision process frustrates the methods of the design or construction team, a break up is imminent: do not get married.
Some hospitals do not have a dominating culture or cult of personality to drive decisions. In these cases, culture is dealt with on an individual basis but it is still present and not to be ignored. For some it can be difficult to pass up anyone willing to pay a monthly bill in exchange for project work. But in the end, the most successful teams occur when the wise designer and builder pay attention to the little things like cultural match with clients and get the most done in a way that satisfies both parties comfortably.
Owner's Toolbox 
Posted on November 10, 2010
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