What in your mind is the culture of the Harbin Clinic?

Culture is arguably one the most powerful intangibles an organization can have. There has been a siesmic shift ongoing within the HC over the past 5 years. Share your thoughts and opinion how this transformation has changed You, Your Department, Your staff, your colleagues and most importantly your Family. Feel free to sign in with your own private pseudonym if anonymity will create comfort for you and give you free reign to speak your mind. We plan to eventually publish these comments in our new HARBIN CLINIC CULTURE BOOK. Let dialogue begin and thank you for your time to contribute. After all this is to be OUR Culture Book.

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11 Responses to What in your mind is the culture of the Harbin Clinic?

  1. George F. Goldin, M.D. says:

    Al, I think the culture of the Harbin Clinic is quite simply one of caring. It harkens back to the time of our grandfather’s grandfather when physicians cared about their patients while caring for their patients. The difference now is that instead of assuming that this culture is still here, we are activley engaged in trying to propagate and promote that attitude throughout the clinic- from the doctors to the nurses to all staff, whether clinical or non-clinical. Each person is capable of positively impacting each patient whether that action is seen or unseen.

  2. al2decho says:

    Thank you for your insight George. I particularly liked the distinction you make about caring for your patient and caring about your patient. It is subtle and I had to re-read it but extremely powerful. In line with your thinking we as Physicians bring our technical and clinical skill to our patients. We bring our Values. However the most important thing we bring is our Attitude. That is what will ultimately motivate and emotionally engage our patients. Emotional bonding breeds compliance which in turn brings us the provider not just job satisfaction but career contentment which resonates higher and is in synch with our calling which is not just a job. We wake up with purpose, do meaningful worthwhile work and go home at night feeling that we made a difference. Cultures are not created nor born they are lived. It is the HC Community living it that will keep it strong, vibrant, and infectious to all those exposed and receptive to it. It is why we love what we do and do what we love. Nietsche tells us that if we understand and love the “WHY” there is no “HOW” we can not bear. Peace………Al

  3. Matt Mumber MD says:

    It seems to me that the Harbin Clinic’s culture has always supported the provision of the highest level of expertise combined with the highest level of caring for all people involved in the health care process. “Providing the best care available anywhere in the world, here in rural Rome, Georgia.” The implementation of this cultural theme has varied over time. In the recent past, the strategy seems to have been mainly based upon the sovreignty of individual physician preferences. This probably evolved by necessity as the clinic grew from less than 30 docs 20 years ago to well over 100 now. The recent development of clinic wide mission, vision and value statements has laid the foundation for those physician preferences to be guided by an overall theme. In so doing, the culture is shifting. Before, it was based primarily on individual preferences of what the vision of the highest and best care might look like. Now, the entire physician community, guided by an active Board of Directors, is being asked prospectively to decide what multidisciplinary, integrated care should look like. There is definitely still a need for implementation and processes to remain unique and guided by individual physicians within their individual offices, but the multidisciplinary, integrated nature of the new vision requires much greater coordination with all colleagues, all staff and the entire community that we serve. So the new culture incorporates and builds upon the old one. It also is doing so in a way that mirrors the growth and changes in Medicine and society, especially with regards to technology and communication.

  4. al2decho says:

    I agree with your assessment Matt especially with regard to multidisciplinary integration. I believe the greatest challenge that our organization faces is not improving our technological, and clinical expertise nor setting up and adding complementary holistic offerings to our patients. I see that happening as you do more each day. The conundrum remains on how to navigate the delicate balance of professional and personal life and focusing some of our attention on our personal well-being which we have historically neglected. Building a safe community, building self-awareness and embracing mindfulness is a great start. In my mind it becomes very difficult to carry out the needs of my profession if personally I am not whole and still searching for meaning. Something for us to explore as our culture matures and becomes pervasive throughout our organization. Thanks for your input.

  5. Rich Donadio says:

    I think that you all have some interesting comments about the way that healthcare is shaping up and how it affects all those involved. The truth of the matter is that significant changes are about to take place and it will affect everybody involved from the doctors to the patients. Is seems to me that out of this crises we have opportunity. The opportunity present is that for us in this community to define a new way in which we will provide healthcare and perhaps it will be better than what we have become accustom to. In order to effect such a change we must have the buy in of all the healthcare provider groups in the community. This end will not be easy to achieve, but it is a goal worth obtaining; one I am sure that administration believes in but is grasping to find the answer to just how we go about moving everybody in the right direction. Therefore, let me put forth some thoughts on the subject.

    First, I think that we need to plan for change using the standard business model for problem solving. This approach is widely used and can be found in classic business texts (Gomez-Mejia, 2002). Often it involves a nine step approach. The first step being identification of the problem. This will need to involve a situational analysis including evaluation of the landscape with tabling of the issues and opportunities. Next stakeholders need to be identified and each stakeholder’s interests, values, and motivation delineated. As a result of this the situation will become clearer and ethical dilemmas will present themselves. It is then that the problem of identifying how the Harbin clinic can proactively lead the community to develop a healthcare implementation system which embraces governmental and third party payer changes will present itself in a clearer light.

    Next we must redefine the end state vision that would include the coming changes. For example: New End State Vision: The Harbin clinic will communicate and model their vision of our success as evidenced by the commitment to this vision by all stakeholders. The Harbin clinic prides itself by operating a healthcare implementation system that incorporates expected governmental regulatory specifications and bundled charges. Furthermore, the Harbin clinic has done so with the buy in of FMC, RRMC, and has maintained or enhanced physician and employee earnings with improved patient outcomes. The end result, the most successful and growing physician multispecialty group in the southeast.

    Then alternative solutions can be discussed and developed followed by choosing the best ones with the use of an alternative analysis solution matrix.

    Risk and mitigation strategy will need to be developed followed by an implementation plan. Once implemented the results need to be followed with metrics.

    This is where I see the clinic going; best case scenario. This will need to have the support of all of the shareholders and employees to effect such a change. The culture of the clinic will change. But I think that rather than sit back and let it happen to us, we have the opportunity to move ahead and be the on the forefront of change and be able to direct its path. I would rather this than just sit back and be left like a whipped puppy groveling in the mud.

    Gomez-Mejia, L. R., & Balkin, D.B. (2002) Management. New York : The McGraw-Hill Companies.

  6. al2decho says:

    Hi Rich. Thank you for your comment..
    Interesting ideas to be sure. I will have to look up Gomez-Mejia. Your concepts have tremendous merit but in my humble opinion overlook some basic preemptive needs. Before the HC can go out and preach to the masses we need first to get our house in order. We have a lot of tedious but necessary work to do at home. Just look around the clinic and see where everyone sits. We may be in the same park but there are one too many benches with one or two people on them and the benches are not even facing each other. We need Rich to come together as one and only then can we as an organization go out and spread the “word.” Let’s start the dialogue and see if we can reach common ground, put the benches in a circle so we can at least see each other when we speak and realize that although we sit in different places our “playground” is one and the same. I feel strongly that we need that mutual covenant of trust and understanding before we can leave the bus station. We are more likely to pick up more passengers along the way if our “marquis” clearly states our destination. Would you get on a bus not knowing where it’s headed? A Harbin Clinic family member might but for sure not most people who come from different churches. Let’s get all members or as many as we can from the HC on to the bus, set a course, and leave the depot and as has been said, we can build the sails as we row and “leave a trail” for those to follow and for all others, well we do have spare life jackets. “A good plan executed this week is better than a perfect plan executed next week!” Nemaste

    • Rich Donadio says:

      Al,

      I appreciate your comments. Yes I believe that we should all be called to action. And that our own house needs to be in order before we move out into the community. Of course if we do not have everybody on board here at the Harbin clinic it will be a hard sell to the rest of the community. The problem is that we need to have everybody see the urgency in initiating such a change. Such a change will not happen if everybody is comfortable. Therefore, people need to have a mechanism by wich they can come to a realization that the way we practice medicine is coming to an end. I think that this is why we are not on common ground. Even during WWII when Hitler was advancing his army into various countries after he said that he would not and people were still denying its reality. People in general do not like change. If people can see the need for the change they may be called to action. Perhaps discussing in frank terms that likely we are about to lose our freedom and a substantial portion of our income will be a motivating factor. Once a heightened awareness of the problem exists (urgency) people may be pushed to action. The Lewin force model is worth looking at when changing an organizational culture. Basically the model states that an organizational culture is in a state of equilibrium and in order to cause change the forces of resistance need to be broken down and the forces advancing the change need to be accelerated. Sounds like, as you put it a realizing that a “common ground” exists with regard to this issue ia a starting place in decreasing the force of resistance. Sounds simple but it appears that a lot of strategic planning with clear goals needs to be first of all agreed to, developed, communicated, and modeled. I would get on the bus if the goal, risks, and benefits were evaluated and clearly delineated. Everybody wants to know were they are going when they get on for a ride.

      • al2decho says:

        Hey Rich. I am familiar with the Force Field Analysis Technique just did know it was formulated by Lewin. Raising our sense of urgency and creating discomfort is certainly necessary and no argument from me but I am not sure what other “thunderbolts” need to light up the skies here. Physicians are in an uncomfortable state and the great majority are in some phase of burnout. Working on an assembly line in our Fee for Service world is not very gratifying at all. The culture the Harbin Clinic needs to aspire for is one of OWNERSHIP. If everyone in our organization, and I don’t mean just physicians, held themselves accountable, and empowered to provide patients with the best experience possible our transformation would catapult us into a new dimension. Patients would be happier, more engaged; our staff would love to come to work and our doctors would rediscover the meaning of “true healing” and the rewards that come with it. The best model of medicine put forth in the 1960’s by George Engle a Psychiatrist was called the BIOSYCHOSOCIAL model. Most of us are very good when it comes to taking care of biological diseases but how much time do we spend paying attention to the psychological aspects of the different diseases that afflict our patients; how much time do we take to consider the social environment in which our patients live, their financial status, their living conditions, their nutrition, their caretakers, their families and loved ones? I dare say very little time is spent on these “non-reimbursable” items yet how critically important they are to the overall wellbeing of our patients! We could talk all day about all of the problems with healthcare but why don’t we change the focus and look at these problems through a different set of lenses. Let’s look at them as windows of opportunity to help us innovate and create new systems of healthcare delivery. Let’s not close the shades on these windows and muster all we can together and craft a new patient centered, staff enriched, and Physician directed healthcare system. I have my “quarter” for the bus, do you? Regards, Al

  7. Rich Donadio says:

    Well said. Certainly I wish that everyone in healthcare could have a similar comprehensive vision as you have nicely outlined. As you know this would take a massive overhaul of the current system and a lot of attitude and organizational cultural change. However, I agree with the over all premise and would jump on that bus and even may pay a dollar to ride!

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