The Culture Club: Building Culture in Your Group

Episode 97: The Culture Club: Building Culture in Your Group

Welcome to today’s episode, where we’re diving deep into one of the most important but often overlooked aspects of running a successful medical group: building a positive, intentional culture. You’ve probably heard the phrase, “Culture eats strategy for lunch”—and if you haven’t, you’re about to understand why that idea is so critical, especially in healthcare.

Now, what do we mean by culture in a medical group setting? It’s not just about the company picnics, coffee in the break room, or inspirational quotes on the wall. As we reviewed in episodes 27 and 36, culture is the shared values, behaviors, and communication styles that shape the way everyone in your organization works together, makes decisions, and ultimately cares for patients. In short, culture is the how behind everything you do.

Even the best strategy for improving patient care, cutting costs, or expanding services can collapse under the weight of a toxic or unintentional culture. Why? Because culture sets the tone for how effectively—or ineffectively—a strategy will be implemented. If a medical group has a strong culture of accountability, trust, and respect, new initiatives tend to thrive. But if the culture is fragmented or dysfunctional, even the most brilliant strategy won’t stand a chance.

Let’s break this down with a quick example. Imagine two medical groups. One group has a clear set of values around collaboration, where physicians, nurses, and administrators all contribute to decisions. They’ve invested in creating an open environment where team members can give and receive feedback respectfully, and the leadership is consistent in communicating the importance of accountability. On the other hand, the second group hasn’t spent much time thinking about their culture. Their communication is more hierarchical, with decisions made at the top and trickling down. When issues arise, blame is thrown around instead of solutions.

Which group do you think would be more successful when they implement a new strategy, say, for improving patient care metrics? The first group, right? Their culture of collaboration and accountability makes it easier to adapt, respond to challenges, and work toward common goals. The second group, without that foundation, would struggle with resistance, miscommunication, and finger-pointing, even if their strategy was just as strong on paper. And that’s why culture really does eat strategy for lunch.

The key takeaway here is that while strategy is essential, it’s culture that determines whether that strategy will succeed or fail. As Peter Drucker’s famous quote suggests, the right culture creates an environment where strategy can thrive.

So, how do you intentionally build the kind of culture that supports—not undermines—your goals? That’s where the hard work comes in, but it’s absolutely worth it. And it all starts with building consensus within your medical group.

In a medical environment, consensus isn’t just nice to have—it’s a necessity. Think about it: you’ve got physicians, nurses, administrators, and support staff, all with different responsibilities, perspectives, and sometimes conflicting priorities. If everyone isn’t on the same page, it’s easy for communication breakdowns, frustration, and inefficiency to creep in. And when people are pulling in different directions, the quality of patient care suffers.

So, what does building consensus look like in practice? First, it’s about creating space for open dialogue. If your leadership style leans heavily toward top-down decision-making, there’s a good chance you’re missing out on valuable input from team members on the ground. Regular, structured opportunities for feedback are key—whether it’s through town halls, smaller group meetings, or even anonymous surveys. The goal is to ensure that every team member, regardless of their role, feels heard and valued.

Another crucial piece of the puzzle is having a clear, shared vision. When everyone understands and believes in the group’s mission and values, you’re much more likely to build consensus because people are working toward the same end goal. Take the time to define what your medical group stands for—not just in terms of patient outcomes, but in how you treat each other as colleagues. Is collaboration a priority? What about transparency or innovation? The more specific you can be, the easier it becomes for your team to align with those values.

Involving all stakeholders in decision-making is another great way to build consensus. Obviously, not every decision can involve every team member, but when it comes to major shifts—like introducing new technology, restructuring departments, or setting group-wide goals—engage a diverse set of voices. You’ll not only make better decisions, but you’ll also have buy-in from the people who need to execute those decisions.

Conflict is inevitable, of course, especially in a high-stakes, fast-paced environment like healthcare. But the goal is to manage conflict constructively rather than let it fester. Encourage regular feedback loops, where issues can be raised and resolved before they spiral into bigger problems. This isn’t about avoiding conflict but addressing it head-on in a way that strengthens, rather than undermines, team relationships. We love to talk about the notion of “disagree and commit” which only comes from a consensus-driven organization where all perspectives are heard and respected. The leadership understands that while we may not always agree, we can assure all perspectives are heard, and then the outliers can “disagree and commit.” It’s powerful stuff.

When you’ve built that foundation of consensus, you’re in a much better position to create high-performing teams. But what exactly makes a team “high-performing” in a medical setting? It goes beyond clinical skills and expertise, although those are obviously important. The best teams trust each other, communicate openly, and hold one another accountable.

In a medical group, where patient lives are on the line, the stakes are higher, and that trust needs to be rock solid. High-performing teams share information freely, collaborate across departments, and work together to solve problems. They don’t operate in silos. When a team has strong dynamics, they can adapt to challenges, adjust to new information, and support one another—whether they’re handling a complex surgical case or navigating an administrative hurdle.

But strong teams don’t just happen—they need to be built. That starts with hiring and onboarding people who not only have the technical skills but also fit the culture you’re creating. Training and development are also key. Beyond clinical education, offer opportunities for your teams to learn soft skills—like communication, leadership, and conflict resolution. These may seem secondary, but they’re critical to creating a cohesive, high-performing team.

Now, let’s talk about accountability. As we said in Episode 80, holding people accountable is one of the toughest but most necessary aspects of managing any team, especially in healthcare, where mistakes can have serious consequences. But there’s a fine line between accountability and blame, and if you’re not careful, holding people accountable can erode trust and morale.

So how do you do it right? First, accountability starts with clear expectations. Everyone on the team needs to know exactly what’s expected of them, from the day-to-day tasks to the larger goals of the group. This clarity helps avoid confusion and ensures that everyone is working toward the same objectives.

Next, it’s important to create a feedback culture. Accountability doesn’t just happen during formal evaluations or when something goes wrong. It should be an ongoing process, where team members give and receive constructive feedback regularly. And it’s crucial that this feedback is delivered in a way that’s respectful and focused on improvement, not punishment. No one should feel attacked or singled out; the goal is to foster a sense of shared responsibility for success.

When someone does fall short of expectations, approach the situation with empathy and a focus on solutions. Instead of focusing solely on what went wrong, ask how it can be fixed and what support might be needed to prevent the issue from happening again. This is how you build a culture of accountability that’s based on mutual respect, not fear.

And let’s be clear: accountability isn’t just about individual performance. It’s also about team performance and holding each other accountable. In high-performing teams, accountability is everyone’s responsibility. When someone on the team isn’t pulling their weight, it’s addressed not just by leadership but by peers as well. That’s the kind of culture you want to foster—one where everyone is invested in each other’s success.

This brings us to leveling the professional playing field. In healthcare, the traditional hierarchical structure can sometimes create power imbalances, where certain voices—whether it’s nurses, physician assistants, or junior physicians—aren’t heard as often or as loudly as others. But if you want to build a truly inclusive, high-performing medical group, leveling the playing field so that all voices are heard is essential.

While it’s tempting to believe that culture will naturally develop over time, leaving it to form accidentally can lead to major issues down the road. If culture isn’t built intentionally, it can develop in ways that might not align with your values or goals. This unintentional culture can result in cliques, resistance to change, or even a toxic environment that’s difficult to turn around.

So, how does a culture like this form without anyone realizing it? Usually, it’s the result of ignoring small problems as they arise—things like poor communication habits, tolerated bad behavior, or a lack of accountability. Over time, these patterns get ingrained into the daily operations of the group, and before long, they become part of the culture itself. Without clear leadership and an ongoing focus on maintaining a positive culture, it’s easy for negative habits to take root.

You’ll often notice the signs of an unintentional culture creeping in through low morale or high turnover. People stop feeling motivated, they disengage, and eventually, they leave. That’s not only costly from a recruitment standpoint but also a red flag for something deeper going wrong. You might also see symptoms like miscommunication between teams, staff mistrusting leadership, or complaints of favoritism.

What’s interesting is that many groups don’t realize they have a culture problem until it starts affecting patient care. That’s when you hear stories about mistakes being made because people were afraid to speak up or because departments weren’t collaborating well. These are the kinds of issues that arise when a group allows culture to happen by accident instead of cultivating it intentionally. The key is being proactive. Regularly assess your culture—whether through surveys, one-on-one conversations, or outside evaluations—and make changes as needed. A cultural audit can help identify where the cracks are forming before they widen into bigger issues.

Another significant challenge that arises when culture isn’t built intentionally is the role that egos can play in disrupting group dynamics. Let’s face it: the medical field attracts high achievers—people who are often used to being the smartest or most accomplished person in the room. That can be a great thing for patient care, but it also comes with risks. When physician or executive egos aren’t kept in check, they can damage the entire group’s culture.

Unchecked egos can lead to power struggles, where individuals are more focused on being right or protecting their own status than on the collective success of the group. This is especially problematic in a medical environment, where collaboration and shared responsibility are crucial for patient care. If certain individuals dominate the conversation or make unilateral decisions without considering the input of others, it can create resentment and disengagement among the rest of the team. Over time, this damages trust and makes it harder for the group to function effectively.

Egos can also contribute to a culture where feedback is taken personally, rather than as an opportunity for growth. In a high-stakes field like healthcare, where lives are on the line, it’s critical that feedback is embraced and used constructively. But when egos get in the way, team members may become defensive or even retaliatory, which stifles innovation and improvement.

So, what can be done to manage egos and avoid power struggles? First, it starts with cultivating humility at the leadership level. Leaders set the tone for the entire group, so it’s essential that they model the kind of behavior they want to see. When leaders demonstrate humility—whether by admitting mistakes, actively seeking input from others, or sharing credit for successes—it encourages the rest of the team to do the same.

Another powerful tool is promoting emotional intelligence within the group. Emotional intelligence, or EQ, is the ability to recognize and manage your own emotions while also understanding and influencing the emotions of others. Physicians and executives with high EQ are better equipped to manage their own egos and avoid getting caught up in power struggles. They’re more likely to listen, collaborate, and focus on solutions rather than being concerned with their own status.

Team-building exercises can also help diffuse egos and build stronger connections across the group. Activities that encourage trust, collaboration, and mutual understanding can help team members see each other as equals, rather than as competitors. These exercises don’t have to be complicated or time-consuming; even regular, informal check-ins or collaborative problem-solving sessions can help build a sense of camaraderie and shared purpose.

Finally, accountability must extend to leadership as well. It’s important that even the most senior leaders in the group are held to the same standards of behavior and performance as everyone else. If leaders or physicians believe they’re exempt from accountability because of their rank or experience, it creates a toxic double standard. The message should be clear: no matter your position, everyone is accountable for contributing to a positive, respectful culture.

So, as we wrap up today’s discussion, remember that ultimately, the work you put into building and maintaining a positive culture will pay off. Not only will it create a better environment for your team to thrive, but it will also lead to better outcomes for your patients. And at the end of the day, that’s what we’re all here for.

Thanks for joining me today as we explored the role of culture in medical groups. I hope you’ve found some practical insights you can take back to your own team. Be sure to subscribe, and don’t miss our next episode where we’ll continue discussing ways to elevate your medical practice.