Culture Assessment

Introduction

The presented cultural assessment is for the Lutheran Community at Telford, a Continuing Care Retirement Community located in Telford, Pennsylvania.

To better understand your organization, our consultant interviewed a tenured Certified Nursing Assistant, who has been employed since 2019. CNAs are at the forefront of patient care for the Lutheran Community at Telford and were an ideal role to speak with while conducting the assessment.

We are presenting the cultural assessment in two parts- research and summary.

Research

Guided by a proprietary template, we obtained vital information about our client through a campus walk-through, employee-based interview, and web-based research. This part is a direct report of the opinions of your current employee and the non-bias examination conducted by your consultant.

Summary

Our consultant will provide their interpretation of your organization's culture. Their reflection will include considerations of key organizational culture models and guidance from academic experts and experienced practitioners.

Research

Part One

Language, Metaphor, and Jargon

A tenured Lutheran Community at Telford employee has answered the following questions.

How are organizational members referred to as it relates to job title?

"No one really refers to me as my job title of a CNA. It's just mostly my name, Jacqueline."

Does your organization utilize company-specific acronyms? Job function-specific? If so, how long did it take for you to get up to speed on the internal jargon?

"Where I see acronyms within my job is mostly just medical terminology. Specifically, conversations with physical therapy, our speech therapists, and other doctors. In the beginning, some of the more widely known acronyms were easy to pick up, but more specific ones having to do with injections and medications took a lot more time to get up to speed with.”

Do you more frequently hear individuals within the organization use the word “we” or “I”? Do your teammates ever speak from the perspective of who they are serving?

"We always talk from the perspective of our patients, which are who we are serving, and we work as a team because our job is easier done that way. So, we say things like "we" frequently."

When being provided direction, are tasks direct or open to interpretation?

"Tasks are definitely given directly, but they are open to interpretation. I have the flexibility of figuring out what works best for me."

Communication

A tenured Lutheran Community at Telford employee has answered the following questions.

What is the predominant method of communications?

"My company communicates a lot with flyers. They are everywhere, in the elevators, at timeclocks, lots of high traffic areas. They also communicate by text messages, emails, and word of mouth."

When vital information is shared, is it directly received or passively available for you to discover?

"Important information tends to be discussed in a sit-down meeting before my shift, especially during the pandemic. The early days we would have multiple sit-downs a week just to discuss where we were at and where the CDC would like us to have been. As we've gotten more out of the heat of the pandemic, our information tends just to be put up on flyers in the nurse's station."

Does leadership speak directly to all employees within the organization? Passively? At all?

"The leadership actually tends to be relatively open in communication towards all levels of employees. I've been in sit-downs when they really didn't know what to do with staff shortages or how to handle CNA staffing in the middle of the pandemic, and they actually opened it up to a forum discussion. They wanted our own ideas and were very receptive to what we had to say."

Is feedback encouraged from your leadership team, or is communication only top-down?

"Communication occurs between the highest person down to the lowest person. There are numerous times that our executives walk on our floor and say good morning and check-in with us. It's just a very welcoming setting. We can provide feedback at anytime"

Artifacts

Your consultant performed a campus walk-through at your organization. The following questions were answered with unbiased intentions.

What is the general aesthetic on your organization’s campus?

There are two buildings on the campus I was able to observe- the Healthcare Pavilion and Administration Building.

Healthcare Pavilion: Does not look like a typical skilled nursing setting. Long-term patients have brought in their own furniture and decorated their rooms according to their own aesthetic. It feels like you are in someone’s home. However, at the nurse’s station, it looks like a hospital. There are binders, computers, paperwork related to charting.

Administration Building: Looks like a typical administrative building. There are “homey” touches. However, it still provides a sterile business environment aesthetic.

Are organizational members able to customize their working space? Are there parameters by which you must abide?

Administration Building: Customization exists in personal offices.

Healthcare Pavilion: Employees have lockers, and they are individually decorated. Further, the nurses' station is presently decorated for the St. Patrick's Day holidays. The break room looks very typical with policies, relevant flyers, fridge, chairs, and seats.

Are past or present organizational leaders memorialized on campus?

Yes. In both the Administration Building and Healthcare Pavilion, there are photos of past and present administrators. Further, there are architectural photos that demonstrate the growth of the organization. Additionally, donors can be memorialized through plaques, benches, or even wings within buildings.

Considering the visible artifacts, what is the overall feeling the organization emits?

Healthcare Pavilion: Surprisingly “homey”

Administration Building: Professional workspace

Stories, Myths, and Legends

A tenured Lutheran Community at Telford employee has answered the first three questions. Web-based research from our consultant answered the final question.

Do organizational members understand your company’s history?

"I think so. For the most part, it really just started as a retirement location within a small farm community. It was created by the Lutheran Church in town and, over the years, has grown into a massive campus that has independent cottages, an assisted living facility, and a healthcare Pavilion that includes a dementia unit."

Are stories of the organization, either positive or negative, shared openly? Is an opportunity for learning or growth present within these retellings?

“Not really. They only really speak to how much the company has grown in size over the years.”

Does your organization share a founder’s story?

"The founder story isn't something that's openly discussed or talked about a lot at work. I definitely read about it before, but I don't really remember the story."

Is the organization’s history made available to the public?

A brief history of the organization is made available to the public. The following information is easily accessible online:

“The idea for the Lutheran Community at Telford took shape when twelve local church leaders came together to discuss the needs of their older congregation members. They became inspired to create a new kind of community where seniors could live with care, dignity, friendship and respect.”

“In the 50 years since our founding, the Lutheran Community at Telford has provided the highest level of care that promotes the well-being of every resident, and we continue to be responsive to the needs of our residents and have a clear vision and plan to meet the needs of those who will join our community in the future.”

Ceremonies, Rites, and Rituals

A tenured Lutheran Community at Telford employee has answered the following questions.

What reoccurring events or perks does the organization provide its staff?

"Annually, we get a holiday bonus and raise from anywhere between 2.5% to 3 %. We also have holiday parties most years. They give us lots of free food other holidays throughout the year as well as general staff appreciation days."

Do these ritualistic events increase, decrease, or have a neutral effect on morale?

"I think it's neutral because it's just expected at this point."

Are family members and friends invited to these ceremonies and rituals?

"Only for the large milestones of employment. There is a small ceremony for years of service."

Are events or perks ever added on an ad-hoc basis when times are especially difficult for staff?

"Throughout the pandemic, especially in the early times, there would constantly be morale-boosting. We had Belgium waffle trucks, food trucks, water ice trucks come to campus. We've had pizza parties and catered lunch from local restaurants provided. Additionally, they do raffles. I've won multiple raffles just because they pull my employee number."

Values, Ethics, and Moral Codes

Web-based research from our consultant answered the first question. A tenured Lutheran Community at Telford employee answered the final three questions.

Does the organization have a vision and/or mission statement? Are organizational values clearly defined?

The organization's vision and mission statements are made available to the public. They are easily accessible online. The organization's values are not clearly stated but can be inferred through reviewing the organization's website.

Vision Statement: “Rooted in the faith of our founders; building on our passion for care to be recognized as an industry leader in Continuing Care Retirement Communities.”

Mission Statement: “The Lutheran Community at Telford is a secure retirement community providing a progressive level of care. We are committed to a Christian environment dedicated to the compassionate, loving and spiritual well-being of our residents.”

Is the vision and/or mission statement shared top-down within the organization? Values? What is the frequency? Is the vision and/or mission statement embodied bottom-up within the organization? Values?

The tenured employee answered these two questions within her one response.

"Yeah, the organization definitely does speak around our vision and mission statement. That tends to happen in meetings with the higher-ups, but sometimes it is reminded of us from other employees during our day-to-day."

When making immediate decisions, do organizational members look to the vision for guidance? Is there a specific value or individual considered when making a quick decision?

"It's (values, vision, mission) not really spoken about on a day-to-day basis. However, during the pandemic, it has definitely been brought up more, conversationally, between lower-level employees."

Decision-Making Style

A tenured Lutheran Community at Telford employee has answered the following questions.

Does every organizational member have autonomous decision-making abilities? To what extent?

"For the most part, decisions are really made on our own. We each have a flow that all goes along with our work. However, if there is a medical emergency that requires transport to a hospital, there tends to be more guidance provided from supervisors or the DON, who is the director of nursing."

Estimate what percentage of decisions you can make autonomously, without consulting leadership?

"I'd say that my decision-making abilities are probably about 50 % autonomous."

Does the opportunity exist for organizational members to persuade the decision-maker into making alternative decisions?

"I can definitely persuade the supervisor or nurse to make a different decision. My opinions and expertise are also valued if I feel that patients should be sent out to the hospital due to symptoms that I witnessed versus symptoms that the nurse or supervisor witnessed. I will advocate against the supervisor's initial judgment, and it is usually listened to."

When organization-wide policies and procedures are being amended, is there a timeframe where all organization members can provide feedback?

"Employees are normally a part of company-wide policies, especially when vaccines became available. Opinions were shared at a company-wide meeting. All opinions were heard out. However, the fact that we are a healthcare facility ultimately trumps the opinions of those who were against a vaccine mandate."

Summary

Part Two

Schein’s Six Questions

Describe the organization’s existing culture, including specific examples of artifacts, rituals, and language.

The organization seems similar to many I've encountered in the healthcare space. Having eleven years of experience working in various healthcare settings, I feel comfortable with making this general statement. Where the Lutheran Community at Telford appeared to be an outlier was not with their employees but with the environment they are providing their patients. Frequently, the sterile feel of a healthcare setting would trickle into patient rooms and living spaces. This is not present. However, as it relates to organizational culture affecting employees, the artifacts and rituals were relatively textbook. I did, however, have a note regarding the language used.

During my interviews, I quickly realized that the CNA employed by the organization kept referring to herself as a "lower-level" employee. A distinct divide was shared between her type of employee status and "upper-level" employees. I am unsure if this is a cultural element of the Lutheran Community at Telford or an individual emotion that the employee would carry with her into any organization. This is something to be keenly aware of and observe over time.

Define the organization’s explicitly articulated values.

The organization does not have explicitly articulated values.

Analyze whether the values fully explain the existence of the artifacts or whether there are underlying assumptions that amount to additional hidden cultural values.

Explicit values are not shared on the organization's website, nor did the interviewed employee articulate what they are. My observations showed that the employee was solely focused on her patients and placed exceptional care as her core value. No other value was alluded to during our interview.

Assuming that the organization shares this same value, I believe that the artifacts explain the existence of exceptional patient care. Patients are provided an environment that feels like a home, even in the presence of medical devices and personnel. They have individual freedoms to customize their own living space.

This value cannot be experienced within the Administration Building. What exists is pride in growth- both property expansion and funds donated. Within this setting, the Lutheran Community at Telford is very proud to recognize past and present "higher-ups" and those individuals who have shared their wealth with the company.

Describe how the explicit or hidden values inhibit or strengthen how the organization achieves its goals.

It is rather interesting to see the connection between the perceived organizational values and hidden values. Patient care employees located in the Healthcare Pavilion appear to have fully committed to providing exceptional care to their patients. The organizational commitment is reinforced through artifacts and the level of regard shown towards patients.

The Administration Building does not reflect the same value. During my tour of the building, one very apparent hidden value was conveyed, and that was growth. The company was very proud to share how they have grown in size through their before and after architectural photos. They were very willing to show off how many donors have contributed over the years. Finally, we could see those "higher-ups" being memorialized throughout this building. What was absent? Photos of patients or anything that helps share the value of exceptional patient care.

Share any subculture differences among the teams.

There appears to be a distinct divide between "lower-level" employees and their "higher-ups," from the perspective of a lower-level employee. The perceived lower-level employees are those who interact with the patients daily. The higher-ups are those that work in the Administration Building. They occasionally come in to visit the Healthcare Pavilion but predominantly stay within the confines of their building.

Discuss and come to agreement on action plans to change the negative cultural values.

While my reporting may read as a cause for alarm, I am very optimistic about the ability to solidify a harmonious organizational culture. I believe that the foundation of a culture that believes in exceptional patient care and growth can exist in perfect balance.

Growth significantly serves the employees of the organization. Assuming that financials are handled appropriately, growth will provide stability and security for all employees. Displaying the focus on growth within the Administration Building is optimal. However, an effort should be made to loop in the value of exceptional patient care. And further, this value needs to exist on the website and be shared within all organizational meetings.

Within the Healthcare Pavilion, everything is ideal. The focus on exceptional patient care is present in the building itself and the individuals who work within it. A key observation was that the interviewed employee honestly believed that she was respected and that her voice would be heard if she chose to share it. The "higher-ups" should be applauded for their open discussions and frequent visits to the Healthcare Pavilion to check in on medical staff.

I am reminded of Ying and Yang- the two values (and buildings) work as complementary forces, rather than in opposition. The only and critical change that must occur is the elimination of employees feeling like there are higher and lower levels of employment. If left unresolved, this could create an Us vs. Them culture where significant organizational damage could occur.

Conclusion

What impact will the culture of the organization have on a major change initiative?

The culture of the Lutheran Community at Telford will have a significant impact on a change initiative- The culture of any organization will impact any implemented change initiative. The good news, this organization's culture is suited to embrace change.

What have you learned from your cultural assessment that will be most valuable in helping me build a change strategy?

Clearly articulated values are not present within the organization. Additionally, there is a vocabulary used in casual settings that will be detrimental in the future if not addressed soon (i.e., "lower-level" and "higher-level").

What do you see as the greatest cultural change?

The most significant cultural change must be removing the language around "higher-level" and "lower-level" employees. To use hyperbole, this is a ticking time bomb. The cost of not changing could be highly detrimental as we anticipate the culture will turn into an Us vs. Them environment.

What do you see as the greatest cultural opportunity?

The greatest cultural opportunity is to mitigate future risk by acting now. This is the scenario when we should ask ourselves the question, "what is the cultural cost in five years if we do not implement this change today? How about ten years?"

What are the negative cultural values?

There aren't any explicitly stated cultural values. This is a problem that needs to be addressed. However, the hidden cultural values, exceptional patient care, and growth complement each other and work in harmony.

What are the positive cultural values?

Exceptional patient care and growth are both positive cultural values that are complimentary of each other.

Is this culture ready for change?

Yes, morale is high from all employees around the building. Even a self-described "lower-level" employee feels heard and can work autonomously. The identified change is small in scale. I do not anticipate finding employees resistant to the change of altering vocabulary and clearly defining values.

Given what you have learned about the culture, what might you (and my change team) do to best prepare the culture for change?

I would minimize the notion that change is occurring across the organization. What we have here is a problem with clearly identified values. Additionally, the vision statement is not a vision at all. It is not an aspiration for future success. This, too, would need to be corrected. The entire organization does not need to be a part of these changes. Rather, a small change team. Generally, I would advocate over communication. However, the organization's culture is in a great place, and we can not come in and disrupt that. The changes needing to be implemented are minor in scale.

What is your assessment as to the likely success for major organizational change given what you know about the culture? How can you increase the chances for successful change?

I am not concerned about failure at this organization for the change we are suggesting implementing.

What must you consider to be able to sustain major organizational change?

The only outlying consideration that could present itself as a challenge is a passionate resistor to change. Suppose an individual insists on identifying employees as lower-level or higher-level. In that case, this is a specific scenario where I would heed Kotter's advice and "get them out of the way." There can be significant fragility around this matter, as it directly speaks to people's emotions. Relating someone's work can easily be misunderstood as worth, and individuals do not want to feel their worth is lower than others.

What is your greatest learning from your cultural assessment?

This might sound odd, but I assumed that every organization that employs a sizable number of people would require major change. I was pleasantly surprised when I realized that the change initiative that needs to occur within the Lutheran Community at Telford was small. Even while there are no clearly defined values or vision, the organization runs effectively. With a minor change initiative, the organization will continue its growth trend while keeping employees satisfied in their work.

Submitted 3/3/22