For many clinicians and educators, finding a good idea is simple. We can easily identify 2 or 3 things that could be changed within our home institutions to improve clinical care or the educational mission and can likely find others who agree about the need for change. So why is it so difficult to make lasting change? Culture, or the unspoken rules that shape the values and behaviors of an institution, is often overlooked by would-be changemakers. Without dedicated attention to institutional culture and the potential need for a culture shift, clinical and educational initiatives often fizzle despite early momentum and success, with backslide to the status quo. As a result, change is not sustained or, more discouragingly, never made.
As one example from women’s health education, ineffective practice patterns (e.g., referring all routine women’s care to gynecology) persist within many institutions despite ACGME expectations that residency graduates be able to provide comprehensive primary care. As a result, many programs struggle to ensure that residents receive adequate training in basic women’s health topics and physical exams. Ultimately, greater institutional culture, manifested by lack of buy-in and the absence of a community of educators dedicated to women’s health education, hinders the ability to move from educational and clinical goals (health equity) to action (addressing women’s health disparities seen in breast cancer screening and maternal mortality in women of color). Similar examples exist in other educational and clinical domains, such as care for patients with opioid use disorder, severe and persistent mental illness, and social justice and health equity initiatives.
Drawing from the business literature, we first contextualized why achieving sustainable culture change is challenging, and then identified key steps and strategies for enacting culture change.1 The latter included identifying the big vision and how to break this down into actionable keystone changes. Participants also discussed the need to develop change teams and brainstormed ways to utilize the team to network the movement and enact their ideas. Finally, workshop leaders discussed the necessary final step to creating lasting change—helping the team survive victories without losing momentum and identifying ways to effectively anchor change in the culture.
Workshop leaders provided 3 real-life examples of challenges and successes faced at their individual institutions (developing initiatives around women’s health, care for hospitalized patients with opioid use disorder, and primary care for those with severe mental illness). Using these examples as a starting place, participants were guided through the steps of enacting culture change and the resources to develop and sustain the infrastructure needed to support ongoing efforts at their home institution.
Key take-home points discussed during the workshop included the following:
- utilizing friendly competition to network the movement, such as a resident contest
- identifying leadership values and connecting this to the intervention
- connecting with others who are working towards a similar goal, including key shareholders, and engaging a multidisciplinary approach
By including a focus on institutional culture, educators can develop a multidisciplinary team and building long-term change. These strategies prepared participants to move an idea from action into lasting culture change that extends beyond their tenue or individual program.