Culture Is Built in the Small Moments
Building Culture Through Clarity, Fairness, and Psychological Safety in Healthcare Leadership
I’ve spent a lot of time thinking about workplace culture—what creates a good one, what destroys one, and what responsibility leaders have for both.
My personal belief is that culture isn’t built through slogans, employee appreciation weeks, pizza parties, or a list of values hanging on a wall.
Culture is what people experience every day.
It’s what happens when an employee makes a mistake.
It’s whether someone feels safe enough to say, “I think we have a problem.”
It’s how a leader responds when a team is overwhelmed.
It’s whether expectations are clear, whether accountability is consistent, and whether people believe they will be treated fairly when something goes wrong.
I believe deeply in psychological safety.
But I also believe psychological safety and accountability have to coexist.
Psychological safety without accountability can turn into avoidance. Accountability without psychological safety can turn into fear.
Neither creates a healthy organization.
The goal is an environment where people can say, “I made a mistake,” “I need help,” or “This process isn’t working,” without immediately worrying about blame—but where we can also have an honest conversation about what happened, what needs to change, and what each of us is responsible for doing next.
Some of the most important lessons I’ve learned about culture have come from managing struggling teams.
When performance begins to decline, I don’t believe the first question should automatically be, Who isn’t doing their job?
My first question is usually, What is getting in the way of people doing their job well?
Sometimes the answer is performance.
But sometimes it’s a broken workflow.
Sometimes responsibilities aren’t clear.
Sometimes an employee has quietly absorbed three additional duties because someone left six months ago.
Sometimes the technology is working against the staff.
Sometimes the expectations were never actually communicated.
And sometimes people have been raising the same concern for months and eventually stopped because nobody listened.
That distinction matters.
I have seen what happens when you address the system instead of immediately blaming the person.
I’ve watched access problems that had patients waiting months improve to less than two days after changing the way referrals were triaged and scheduled.
I’ve seen a process review uncover approximately $60,000 in unbilled charges in a single month—not because people didn’t care, but because the workflow had allowed work to fall through the cracks.
I’ve walked into overwhelmed teams, phone queues, and backlogs and learned that sometimes the fastest route to better performance is not demanding that people “work harder.” It is removing the barriers preventing good employees from succeeding.
That doesn’t mean avoiding difficult conversations.
I believe employees deserve honest feedback.
They deserve to know exactly what is expected of them. They deserve measurable goals. They deserve follow-up. And when performance isn’t meeting the standard, leaders have an obligation to address it.
But I also believe they deserve coaching, resources, and a reasonable opportunity to improve.
Accountability should never require humiliation.
One of the things I am most proud of in my career isn’t a financial metric or operational accomplishment.
It’s hearing employees tell me they felt supported.
It’s hearing someone say they felt heard.
It’s having a provider tell me that he was the happiest he had been coming to work in ten years.
Those comments matter to me because healthcare is hard work.
The people answering the phones are talking to patients who may be frightened, frustrated, or in pain.
Clinical staff are balancing patient care, documentation, regulatory requirements, and constantly changing workflows.
Providers carry an enormous responsibility.
Leaders do not get to remove all of that pressure.
But we can make sure our organizations aren’t unnecessarily adding to it.
That means creating clear processes.
It means documenting expectations instead of assuming everyone “should know.”
It means building training materials and giving people the tools they need.
It means explaining the why behind a change.
It means listening to the people actually doing the work before redesigning their workflow.
It means addressing gossip, exclusion, disrespect, and divisive behavior instead of allowing it to become “just how this department is.”
And it means being consistent enough that employees don’t have to spend energy figuring out which version of leadership they are going to get that day.
Culture is also built in what leaders tolerate.
If your highest performer treats everyone around them poorly and there are never consequences, that is culture.
If employees stop reporting problems because previous messengers were punished, that is culture.
If leaders take credit when things go well and look for someone to blame when they don’t, that is culture too.
But the opposite is equally true.
When people are encouraged to bring forward problems, that becomes culture.
When a mistake leads first to curiosity—What happened? Why did it make sense in that moment? Is there something in the system we need to fix?—that becomes culture.
When people know that poor performance will be addressed fairly, high performers know their work matters too.
When employees see leaders admit their own mistakes, ask questions, change course, and keep learning, it gives everyone else permission to do the same.
Over the years, my leadership philosophy has become fairly simple:
Be clear. Be fair. Listen first. Fix the system when the system is the problem. Coach generously. Hold people accountable. Protect dignity. And never underestimate how much a leader’s behavior affects whether someone dreads coming to work or feels proud to be there.
Because ultimately, every operational decision creates a human consequence.
The policies matter. The metrics matter. The financial performance matters. Compliance matters.
But organizations accomplish all of those things through people.
And I believe one of the most important responsibilities we have as leaders is to build an environment where good people have the clarity, support, and safety they need to do exceptional work.
That, to me, is culture building.
#Leadership #HealthcareLeadership #WorkplaceCulture #HealthcareOperations #PeopleLeadership
