Mordecai Dixon, Implementation Consultant for the Southwestern Plains Hub of CMHIS project at the Texas Institute for Excellence in Mental Health, recently facilitated a learning collaborative focused on organizational change. One topic that emerged from the conversations was the role organizational culture plays when teams adopt new practices, services, and ways of working.
Organizational change does not happen independently of an organization’s existing culture. Its values, relationships, history, and everyday practices can influence how people respond to change and whether a new approach takes hold.
In this article, Mordecai explores why understanding organizational culture is an essential part of preparing for and implementing change.
Culture Guides Practice
During a strategic planning session, an outside consultant challenged my work team to reflect on how organizational beliefs influence everyday practices. The facilitator asked three important questions: Who are we as an organization? What do we believe? And how do those beliefs show up in our daily practices?
These questions have stayed with me as I consider the incredible work of national change leaders collaborating with the Center for Mental Health Implementation Services (CMHIS).
Do organizations implement their corporate culture when they onboard new practices or introduce new services?
The question isn’t meant to be purely philosophical with no bearing on actual practice. Rather, it is an important consideration when organizations take on new change efforts that may have long-lasting implications for the organization, the community, and, in the case of CMHIS, the behavioral/mental health industry.
Is the Organization Ready for Change?
Organizational change can represent a time of growth and development. It can also be a time of setbacks and challenges. Ideally, change is a natural part of continuous quality management and helps an organization raise its performance bar.
Thoughtfully adapting to current work practices and processes can build capacity and impact how work is carried out. However, change can have wide-reaching effects, and leaders at all levels must consider those effects before beginning a change effort. This level of preparation is often overlooked.
In sincere attempts to pivot or adapt, it is not uncommon for organizations to bypass thorough readiness assessment and planning. Even with the best intentions, effective change is difficult without the capacity and planning needed to support it. Leaders must take a sincere look at the way their organizations operate, both internally and externally. Preparing for change is as important as the change itself.
This preparation requires organizations to look at their current and historic principles and examine new perspectives that are influencing the adoption of emerging practices.
These principles are not honored through catchphrases or creative buzzwords, but through actions that honor the organization’s history, recognize its achievements, and acknowledge its failures and setbacks. Although this work requires considerable time and effort, it also provides an opportunity to celebrate where the organization has been while setting sights on continued improvement.
Implementing Evidence-Based Practices: The Role of Culture
When leaders report they are implementing a new evidence-based practice, what exactly does this mean? Where does the momentum for the new practice come from? Who determines what actions are needed to move the work forward? Who selects and supports the people responsible for implementation and ensures alignment among leaders, employees, community members receiving services, and the organization’s mission? And who is responsible for making sure the new practice is successfully implemented?
Organizational change is not the byproduct of evidence-based practices alone. At the same time, organizations providing behavioral and mental health services may struggle to achieve and sustain quality outcomes without evidence-based practices guiding their services.
Although well-researched practices are crucial to an organization’s service design, every service provided to communities and individuals in need is also an extension of the organization’s larger principles and values. These values guide its processes, practices, and activities. Together, they shape organizational culture and influence the effectiveness of evidence-based practice.
Organizations of all sizes have formal and informal structures that reflect their underlying beliefs and values. Like our individual cultures, an organization’s actions speak volumes about how it views the world it operates in and the people it serves.
Implementing a new practice requires organizations to examine these values and consider whether the new practice aligns with the purpose of their work. Without proper readiness assessment, organizations may reduce their opportunity for successful implementation.
In highly functioning organizations, cultural values are frequently articulated, respect and honor differences, and are reinforced in daily productivity. They also help guide the organization when its actions begin to move away from its stated intentions.
The values that shape an organization’s service frameworks are closely connected to its willingness to honestly examine the broader culture that guides its work. No organizational change project should be considered without understanding the larger cultural context in which the organization exists.
Culture Is Part of Every Change Effort
To answer my earlier question, organizations always implement their culture.
Every member of an organization, regardless of role or function, plays a unique role in bringing the organization’s goals and objectives to life.
The challenge for leaders guiding organizational change is to understand the culture in which that change will take place.
This requires routinely examining the organization’s current and historical culture, building cross-functional implementation teams, including nontraditional voices in change efforts, and exploring evidence-based tools and frameworks to improve quality services for the people they serve.
Ask Difficult Questions
Leaders can create environments that encourage asking tough questions and openly exploring the answers. What does this organization believe and why? What is the company’s service intention, and how is that communicated? Who does the organization serve, both internally and externally? Are we measuring what matters?
These questions are not all-inclusive, but they can initiate important conversations about organizational change that evidence-based practice alone cannot address. Our charge is not simply to identify answers, but to continue asking ourselves, “What questions are we missing?”
Successful change requires more than identifying and implementing the right practice. Organizations must also examine the culture that shapes how that practice will be carried out.
Ultimately, change is fueled by a commitment to continuously assess whether our organizational values and culture align with our actions. Our ability to achieve desired changes depends on our willingness to look beyond existing service designs and ask ourselves hard questions about our organization’s culture.
About Southwestern Plains Hub of CMHIS
CMHIS is housed at the Stanford Center for Dissemination and Implementation in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. CMHIS, along with the Southwestern Plains Hub and the other four bi-regional hubs, draws on the latest research and extensive experiential knowledge of how to sustainably implement practices to support organizations and systems in improving mental health care. We can help you map the course to desired changes, navigate roadblocks, and provide support to ensure that the people who need it receive the excellent mental health care that providers always strive to deliver.
