Why Culture Can’t Wait and the Order of Operations Matters

Very few leaders have complete disregard for the people they serve—they do care about the human margin. What tends to happen more often is that the order of operations is wrong.

In elementary school math, we learn that the order of operations in an equation can completely change the answer. PEMDAS (Parentheses, Exponents, Multiply, Divide, Add, Subtract) is drilled in with cute mnemonics like Please Excuse My Dear Aunt Sally.

Every margin matters—financial, operational and human. But the order of operations matters more. In human-centric industries like healthcare, nothing happens without our humans. If our people are not cared for and given conditions to support their success, we have poor operational and financial performance.

Why is it then that creating a great culture sometimes takes a back seat in terms of urgency, priority and funding?

Because it isn’t on fire. Or at least not in an obvious way.

The stakes in healthcare are life and death. If operations aren’t going smoothly patients die. Financial strain can also result in harm, forcing the cancellation of vital services or halting progress in much-needed scientific discovery. The consequences are quickly felt, creating a sense of urgency.

Poor culture? It’s a slow burn.

Over time, a negative or toxic culture wears on people. They burn out, they disengage, and leave one by one. Because they are often replaced by new hires, it doesn’t always result in immediate or noticeable harm. As a result, it is easy to prioritize financial and operational goals over the long hard work of culture-building.

Just because the damage occurs slowly, doesn’t mean it isn’t just as harmful. People in distress are more likely to report recent medical care errors, and turnover is expensive and bad for patient care. Of greater concern, people may leave the healthcare workforce altogether?which threatens our future ability to care for patients as an industry.

Warner Thomas detailed the culture transformation work he has been doing since taking the helm at Sutter Health in November of 2022 during a session I moderated at #ACHE Congress 2024. Despite the ongoing pandemic, he started immediately on culture transformation. In contrast, other organizations paused important culture-building work like employee engagement measurement and leadership development so that people could just focus on getting through the pandemic. Warner didn’t.

When he described his meetings with new leaders, he first asked about their teams and how they treated their people. He told them they would discuss financial performance later.

These two choices send a clear message—people are the first and most urgent priority. He got the order of operations right and made sure his team knew, felt, and saw it.

Did it work?

Yep. Engagement of medical group physicians is up 31%, and turnover is down 30%--stunning results.

When humans feel supported and cared for, they do their best work and financial and operational performance follows.

Ask yourself these questions:

What gets my first attention? Culture, finance, or operations?

Where do I spend most of my time as a leader?

What priorities am I explicitly or implicitly communicating to my team?

Am I waiting for the “right time” to get started on culture?

Hint: Today is the right time.

Lead Well,

Katherine

Katherine A. Meese, PhD

#HumanMargin

To learn more, check out my new book with Quint Studer , The Human Margin: Building Foundations of Trust, available online.

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