Written by Kim Krisberg

In November 2018, for the first time in recent memory for employees at The Hospitals of Providence in El Paso, staff and others from throughout the community gathered in the halls, waiting their turn to cast ballots. In fact, for some, it was their first time to cast a vote. The turnout followed a voter registration drive held across the four-campus hospital system. But this was more than an effort to get out the vote.

For the Tenet Healthcare-owned hospital system, it is a small aspect of its culture development strategy.


“We’ve been in this community a long time, and we want to make sure our employees know we’re good corporate citizens,” said Stephanie Talley, chief human resources officer at The Hospitals of Providence, who also serves as Tenet Healthcare’s Texas Group chief human resources officer. “That really informs the culture of pride and connection that we’ve built here.”

Along with the voter turnout push, a purposeful effort to engage staff took root in the run-up to last year’s election, which included the system’s CEO sending an email to all 4,500 employees on the importance of civic participation. In addition, hospital staff were trained to help register colleagues to vote. In all, the efforts registered 175 new voters, Talley said.

The effort to build connections to the community ties into recruiting and retaining providers and staff. While just one example, it’s part of the hospital system’s intention to create a culture of community and civic engagement. In fact, Talley said, across Tenet Healthcare, the Texas Group has some of the lowest first-year turnover rates in the company — a significant achievement, considering the health care sector has some of the highest turnover rates in the labor market.

“When we hire employees, we want them to be motivated and committed,” Talley said. “But we also want them to grow with us.”

Understanding hospital “culture” and its impact on how a hospital functions, whether it be employee retention or patient care, leaders are taking a closer look at how developing a good culture can have outcomes that ultimately will have an indirect impact on their bottom line. Studies have linked certain aspects of hospital culture with better heart attack survival rates, greater nurse retention rates and higher physician satisfaction. Every hospital defines its culture differently, but, in general, a 2012 report from the American Hospital Association’s Center for Healthcare Governance describes it as “determined not only by the shared values and beliefs of employees, but also by those of the medical staff, volunteers and others who serve the organization, but who may not be employed by it, including members of the governing body.”


In particular, the report notes that a match between an employee’s values and beliefs and an organization’s — or a “cultural fit” between the two — is a powerful driver of employee engagement in that organization. That’s important because research finds greater provider engagement is often linked with more productivity and efficiency, better patient safety and satisfaction, quality care and employee retention. In fact, Marion Spears Karr, vice president at Tyler & Company, a health care executive search firm, said that “as a recruiter, culture determines fit probably more so than anything else.”

“How an organization’s core values are demonstrated or enacted — that’s where culture comes into play,” said Karr, whose past work includes health care systems of all different sizes across the country. “Culture is how do we treat each other, not just how do we treat our patients.”

Karr believes defining a hospital’s particular culture starts by examining the gap between its values and its actions — “the narrower the gap, the closer we are to defining what the culture is,” he said. For example, Karr said he recently toured a hospital with a CEO who kept stopping to pick up stray pieces of paper. The hospital, Karr said, was “immaculately clean.”

“He was demonstrating certain values — laying a foundation of stewardship for the facility,” Karr said. “And that’s contagious. Now, every time I go back to that hospital and I see a piece of paper on the floor, I pick it up.”

Creating Work Cultures that Connect

In its 70 years of existence, The Hospitals of Providence ranks as the city’s largest private employer probably makes it easier to pin down and define its culture. Plus, many of its young employees already feel a connection to the institution, having had family members born and cared for within its walls. But it takes more than history to create a culture that retains employees, provides quality care and meets the demands of the constantly changing health care sector.

“There is definitely a family atmosphere in the community and that certainly translates to the hospital,” Talley said. “But we have to keep up those connections.”

For example, Talley wants new hires to feel like they’re “joining a family.” To do that, a series of casual check-ins are now formal policy, giving new hires face-toface time with leadership. In the first 60 days of employment, Talley said, all new hires meet with senior leadership over breakfast or lunch. Another informal meeting happens at 90 days, then at six months and one year. Throughout the year, the hospitals’ CEOs also randomly pick a group of 10 employees to meet with twice a month.

“Those activities really set the tone around our culture,” Talley said, “and it cascades down to all the front-line leaders.”

At Baylor Scott & White Health, Texas’ largest nonprofit health provider, a new system strategy known as Our Core is helping employees connect with the system’s mission and values, while fostering a culture of commitment, said Jim Hinton, CEO of Baylor Scott and White Health.


“Most employees working in a large organization might comply, but to me, that’s not the definition of success,” Hinton said. “We want to move beyond compliance to commitment, so that we can really engage our workforce in the success of the organization.”

Developed with input from employees, physicians, patients and a variety of other stakeholders, the Core was designed to serve as a road map and is represented as a square-shaped visual icon. The Core’s four dimensions — mission, values, ambition and strategies — each represent a side of the square and the center is left intentionally blank. In the center, employees are asked to write down their personal commitments. Hinton’s, for example, is: “I commit to the development of a high-performing culture so that patients and members receive the highest quality health care possible.” To date, nearly 40,000 Baylor Scott & White employees have made their own Core commitments.

Since the Core’s launch nearly a year ago, Hinton said employee surveys show a big increase in understanding of the system’s strategy, from 67 percent to 83 percent.

“When you go into an organization where the alignment doesn’t exist, you can feel it,” Hinton said. “What’s different in health care is that people come to us extremely vulnerable and scared — and most people who come into a hospital would prefer to be somewhere else — so we have to step up to a higher standard of alignment around customer needs than any other business.”

Texas Health Resources, one of the largest providers in North Texas with 25,000 employees, has built up an employee retention rate of more than 80 percent, and Jody Thomas, vice president for talent management and analytics, attributes a lot of that success to the organization’s culture. At the core of the culture, he said, is a promise to care for one another.


“We’re cognizant of the care we give to each other,” Thomas said. “We all work together toward a goal of caring for consumers and patients, but we recognize that we can’t do it alone. We have very defined ways and expectations of treating one another, which is all wrapped up in our promise behaviors.”

THR’s promise behaviors were created to engage employees in delivering on its mission and are categorized according to THR’s four overriding values: respect, integrity, compassion and excellence. Promises range from treating one another kindly and earning people’s trust to empowering patients and families in decisions about care and treatment. Each promise behavior also includes ways to realize that promise in everyday practice. For example, one of Thomas’ favorite promises — to treat others with courtesy, dignity and respect — encourages employees to acknowledge and greet people with a smile and a kind word.

“Our culture is our main selling point,” Thomas said, referring to employee recruitment and retention. “We’re trading hugely on competitive benefits and pay, but culture is really the thing that tips the scale.”


In Fredericksburg, a bout of increased turnover has Hill Country Memorial Hospital reassessing and updating its value statements, with a goal of “creating some cultural consistency” across the system and helping all 700 employees feel more connected to its mission, said Alysha Metzger, the hospital’s chief human resources officer. Metzger said the recent turnover signaled a potential “misalignment in cultures and values” that deserved a deeper look.

“We can aspire to be something, but it’s the processes of how we interact with each other that create the culture,” Metzger said. “We’re a very value-based organization, which is what’s driving this new effort to make sure we’re all in sync.”

Metzger said that while the hospital’s defined values — others first, compassion, innovation, accountability and stewardship — have long informed its practices, she hopes a fresh look will reveal new opportunities for its workforce to grow and move forward together.

“When people walk in our front door, they should already feel the culture,” Metzger said. “They should experience it.”