The principal shareholder of a large Moscow medical clinic, Mr. K., reached out to me for feedback and assistance. Being a highly progressive person with a broad outlook, he very much wanted his clinic to operate at the level of a good German or, say, Israeli clinic. He thought about the quality of the medical service itself and, most importantly, wanted to fundamentally change the attitude of the medical staff toward patients and toward their own work.
K. had enough knowledge and life experience to understand that this task was complex and required a deep, systemic approach.
To begin, he brought in business development consultants, then European medical consultants, and gathered information. He developed a certain understanding of incremental progress. But after some time, it became clear that K. still did not have an answer to the key question: how do you actually implement change? How do you ensure that the clinic's managers, doctors, and support staff do the right things every day? And that they do them not out of fear, but from an internal need.
After several of our meetings and a clarification of K.'s goals for his business, it became apparent that the entrepreneur wanted to completely transform the organization's culture.
The task had been set by him systemically. Some time earlier, K. had invested in state-of-the-art equipment, in a serious renovation and construction of new facilities. He had developed an advanced compensation and incentive system.
And what did he see? Whenever daily oversight was relaxed, specialists reverted to their old ways of working, not using the new equipment. After all, it needed to be studied, and employees either feared it or were too lazy. People's behavioral patterns did not change. If something broke, weeks would pass before it was repaired. Information was not reaching the maintenance department. Why — there was no answer.
The clinic had excellent working conditions, but the team was seething with intrigue, gossip, and conflicts. And this inevitably affected the attitude toward patients. For example, a doctor would under no circumstances refer a patient for a diagnostic confirmation to another department, fearing they would be accused of incompetence. As a result, the patient received a substandard service.
In contentious situations, the conflicting parties rushed to see either the general director or the owner. K. fought against this state of affairs. After yet another scathing meeting, things would hold together for a while, but then everything would return to its old ways. K. racked his brain thinking about how to change this "accursed" organizational culture.
We began our joint work by assembling the "core of change" — a group that included department heads and managers at various levels. And we discovered that only two of the department heads understood and accepted what K. was talking about. Interestingly, it was precisely these two leaders who were perceived by many employees as a foreign body, a source of tension and conflict. K. was extremely surprised by the picture that suddenly emerged: previously, it had seemed to him that employees felt the same way he did and wanted the same things. But now it became obvious that, until a shift occurred in people's minds — until their own sense of what constitutes the good of the clinic and its patients changed — no changes in the clinic would take hold.
K. found himself facing a difficult choice: only part of the team was ready to change and grow. Many who were prepared to resist and introduce destruction had to be let go.
To K.'s deep disappointment, the general director, in whom he had placed his greatest hopes for this new undertaking, was completely unprepared for the planned changes.
The notion that someone would come along and "outsource" a change in the culture and climate of the clinic also proved to be an illusion. K. realized that for the next several years, he himself would have to be the one driving the changes and taking responsibility for them.
I frequently observe how leaders make one and the same mistake, regardless of the scale of their responsibility and their entirely different fields of activity. They underestimate the necessity and importance of their personal contribution to the process of change and, as a result, unconsciously slide from their original good intentions toward palliative measures. In the end, they feel dissatisfied, see themselves as ineffective, and begin to regard their employees as stupid and incapable of progress.
Leaders should remember once and for all: the work of transforming organizational culture must begin with the psychological integrity and effectiveness of the leader themselves. First, they will need to clearly define their goals, resources, and external constraints. After all, in creating and developing a company, they bring to it both the strengths of their personality and their inner conflicts. The leader must be the first to change. And those who categorically refuse to work on themselves would do better to forget about changing their company. The entire endeavor will bring nothing but disappointment and a loss of money and time.
Additional obstacles on the path to change may include the following factors:
An underestimation of the necessary scope and depth of changes in the organization; an underestimation of the importance of working with people — for some reason, many leaders believe that habits, thoughts, and feelings will change if modifications are made to the company's core business processes; an overestimation of one's own strength, which at some point may not be enough; and an underestimation of the influence of the surrounding environment, which may either support cultural change or be deeply hostile to it.