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Committed to culture change: Transforming a working environment


Leaders at a 100+ bed general acute care hospital knew they had an excellent care team. But they also observed that the staff wasn’t living up to its potential. After intensive investigations, leaders determined that a tepid workplace culture was holding the staff back. Recognizing this, they wanted to orchestrate a comprehensive cultural overhaul to elevate clinician performance and deliver the exceptional outcomes that their patients deserve.

To effect this transformation, the healthcare organization turned to NRC Health. In 21 months, the team achieved remarkable results, including:

  • 11% reduction in nurse turnover
  • 60% decrease in workplace injuries
  • 6.4% increase in patient satisfaction with physician staff
  • 3.6% increase in patient satisfaction with nursing staff








Though a relatively small facility, the hospital faced outsized obstacles in meeting its patients’ needs. Part of the organization serves patients in one of the most diverse ZIP codes in America. This high-acuity, low–socioeconomic status population (over 85% of the hospitals patients are on Medicare/Medicaid) brings unique demands to care staff—demands that staff sometimes struggled to satisfy.

That changed decisively when new leadership joined the facility. The new CEO was determined to root out the cause of patient dissatisfaction. Leadership personally interviewed more than 80 employees, and from these interviews, a consensus emerged. Employees overwhelmingly agreed that a lagging workplace culture was the heart of the problem.

Culture, however, is notoriously difficult to change. Meaningful, sustainable cultural change would require rigor, discipline—and data. For all this and more, leaders turned to NRC Health.


With help from NRC Health’s Improvement Advisors, leadership developed an approach for comprehensive cultural reform.

“Our people are caregivers. They’re showing up every day to do their best and help others. The question is, how do you connect them to that purpose? Culture is the key.”

—Hospital CEO


First, NRC and hospital leadership co-developed a customized training program for every employee. To underscore the program’s importance, each two-hour session would be personally led by a member of the senior-leadership team.

The session revolved around a concept called PARTnership. The term incorporates an acronym for Professionalism, Accountability, Responsibility, and Teamwork, and it would become a cultural touchstone for the hospital’s operations.


Of course, these principles, once taught, would need continuous reinforcement if they were to motivate lasting change within the organization. NRC worked with leaders to develop sustainability practices that would ensure that the PARTnership would endure.

Along with more conventional tactics—public recognition, rewards, and special merchandise and communications—the most impactful sustainability practice was a new cultural-leadership development program. Promising employees were cultivated through a customized series of training sessions. This helped build a roster of enthusiastic cultural ambassadors for PARTnership, which in turn kept the staff committed to a high standard of performance.


To stay motivated in the midst of cultural change, staff would need assurance that their new approach would bring results. They found these credible results in NRC Health’s patient feedback capabilities.

NRC Health’s patient-satisfaction survey tool collects data from 100% of patients immediately after their care episodes. This gives leaders—and frontline clinicians—an immediate view into how patients feel about their care encounters.

Using NRC Health’s data, leaders gave staff a totally transparent view into how the new cultural approach affected patient satisfaction—indisputably proving what the hospital’s caregivers were truly capable of.

“With the data we were gathering, we were able to ensure that our tactics were really focused, instead of just throwing things out there and hoping they would stick.”

—Patient Experience Program Manager


Within just a year of mobilizing this cultural-transformation program, staff saw remarkable results.


Clinician burnout is an intractable problem for many health systems. In its cultural transformation program, the hospital has found a significant lever for change.

In the months since the deployment of PARTnership, nursing-staff turnover has declined more than 11%—from 18% to less than 7% year-over-year.


The “T” in PARTnership stands for Teamwork—the idea that clinical care will always be a team pursuit fundamentally. But the concept also signifies employees’ commitment to each other—especially in the prevention of workplace injuries.

In just one year, PARTnership training, combined with a revised approach to safety training, reduced workplace injuries by 60%.


Coaching physicians to conduct more meaningful clinical encounters was an integral part of PARTnership training. Patients, evidently, took notice.

In just one year, patient satisfaction with physicians improved by 6.4%. Likewise, satisfaction with nursing staff improved by 3.6%.


Nor are these clinician-specific rankings the only improvements that the program brought about. Patients’ understanding of discharge instructions also improved, as did their ratings of communications about medication and post-care transitions.

Little surprise, then, that in just 12 months the hospital’s overall satisfaction rating increased by 5.6%.

“Fundamental to all this is having the vision—believing that better is possible. If you use data to back that vision up, that’s what gets people believing they can do better.”

—Hospital CEO


increase in patient satisfaction with physicians in just one year

“When you’re consistent with the process, you get to the point where it isn’t management enforcing these things. It’s the staff holding each other accountable. Everyone is coaching everyone, we’re all holding each other up.”

—Patient Experience Program Manager


Continuity is one of the PARTnership approach’s chief benefits. Once begun, there’s no need for the work of culture improvement to stop. The hospital can keep pursuing a workplace culture that inspires and invigorates its staff.

Now leadership’s eyes are on the future. With a sustainable strategy for cultural transformation firmly in place, they’re ready to evangelize their approach across the organization. They’re currently working with one of NRC Health’s Improvement Advisors to develop a cultural toolkit, with the hopes of replicating their success at other facilities.

“Accountability is the most important part of the daily rigor behind creating change. People need to see that your efforts are actually meaningful, and leveraging NRC Health data is how we reinforce that.”

—Patient Experience Program Manager

Key Takeaways

For organizations seeking similar results, leaders offer some advice.


Hospital leadership found that without an element of discipline, efforts at culture change will likely flounder. Staff members need to see a visible commitment from leadership at every stage. That will help them internalize the change that leadership is driving for.


In the same vein, leaders emphasized the personal stake they took in their organization’s culture. They personally walked the floors, conducted trainings, and coached floor staff through the change they wanted to see. Tactical and technical execution follow a firm commitment from leaders, which leadership made a central part of their work in the organization.


Leaders have one more reminder for hospital executives: cultural change is a long and difficult process. While that’s no deterrent for committed caregivers, anyone facing such a challenge deserves encouragement.

“When you start progressing, you have to start celebrating. Recognize people for the little things, and the big things will come.”

—Hospital CEO


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