DCLP Cohort Recommends Cultural Changes

A 2022 Duke Clinical Leadership Program (DCLP) cohort has taken a deep dive into the culture at Duke Health and come up with several recommendations for substantive changes that it says are essential to the organization’s health moving forward.  

The group’s main objective was to define the kind of culture that should be created as Duke Health undergoes major changes in its organizational structure. Their recommendations are:

  • Co-create, with staff from all levels, a clear Duke Health mission statement - the ‘compelling why’ we come to work every day
  • Address these four instrumental drivers of work culture:
  • Respect and Value
  • Diversity and Inclusion
  • Safety and Well-Being
  • Communication
  • Create a multidisciplinary Duke Health Office of Workplace Cultivation and Sustainability
  • Anchor leadership strategy in restorative principles to regain and maintain trust among frontline employees, managers, and directors

David Ortiz-Melo, MD, assistant professor, Nephrology, was the Department of Medicine’s representative on an interdisciplinary team of DCLP participants that took on the project of "Duke Workplace Culture in Times of Transition” as part of the program work. Their work culminated in a team report called, “We Need Each Other: A Restorative Strategy for Shaping Duke Health’s Workplace Culture,” which received this year’s Thomas Gorrie Clinical Leadership Impact Award.

“This was an outstanding experience,” says Ortiz-Melo. “I am looking forward to implementing what I learned and some of our recommendations. I strongly believe that with restorative practices we can make transformative and sustainable changes to our culture.”

The award recognizes the project team which best meets the objectives of cultivating strategies for effective team management, engaging in a thorough and collaborative discovery process, and developing a plan to effectively move their project through a complex organization while considering institutional goals such as equity, diversity, and inclusion. 

The group’s work is part of DCLP’s mission to help expand leadership capacity within Duke Health. DCLP program fellows participate in a six-month curriculum designed to deepen awareness of healthcare operations and develop individual leadership skills. The program is supported by the Chancellor’s Office and managed by the School of Medicine Office for Faculty. In addition to a didactic curriculum, fellows engage in group projects that address current challenges within Duke Health. 

As the team embarked on their research, the first challenge was the recognition that many silos characterize Duke Health with several entities that collaborate at different levels, each with their own core values, different leadership structures, and varied organizational aims.

The distinctions that exist between the entities dilute a common goal to provide cutting edge and equitable healthcare to all in need, while harnessing the power of elite academic minds to continue forging the future of medicine and healthcare delivery through research, education, and training. The proposed strategy makes our workplace culture more restorative and sustainable, by engaging front-line caregivers to co-create policies and strategies that will reshape our workplace culture, one driven by our core-values, Ortiz-Melo says.

The group also notes that, while Duke Health’s current strategic plan identifies “Joy in Work” as the cultural base of its framework pyramid, the written plan contains no action items to address this mission. Their proposal outlines current culture data, identifies the main drivers of Duke work culture, and offers an accountability strategy and actionable items to foster an inclusive culture at Duke Health. At its heart is fostering trust and belonging for all of Duke Health’s team members so that every individual may function at the best of their ability.

“Recognizing and valuing the contributions of each team member to our unified mission of serving patients is embodied in our belief statement, “Our patients need us, and we need each other,” the report concludes.

Findings include:

  • There is not currently one clear vision or a ‘compelling why’ we choose to work at Duke Health.
  1. At least seven different mission statements across the system was discovered.
  2. Senior leadership must be aligned in institutional vision, overarching system mission.
  • The current organizational matrix has fostered siloed microsystems rather than cohesion, alignment, clarity, and accountability to an overarching institutional mission.
  1. Workforce culture development is paramount to restoring trust, ensuring success in our mission to foster a positive work culture through an environment of inclusion, belonging and value.
  2. This is important now, as we move into a period of uncertainty related to the pending dissolution of the PDC and alignment of the health system.
  3. A global accountability structure is needed to promote change to longstanding actions and inactions across the enterprise.
  • Inefficient communication creates strain in the work environment and detracts from promoting trust, positive culture, and demonstrating values.
  • Actions to achieve our goals must include a system to disseminate information to all team members, to listen to everyone and close the loop on feedback; ensuring every team member is aware, is heard, and is acknowledged.

The next step is to engage the right interdisciplinary and diverse team members across the organization to begin defining the compelling “why,” says executive sponsor, Rhonda Brandon, chief human resources officer and senior vice president for Duke University Health System.

“Now, more than ever, especially given the forthcoming Duke Health Integrated Practice, we have the opportunity to define our new future together,” Brandon adds. “Agreeing on the values, mindsets, and behaviors are vital next steps to catalyzing the change and transformation we all want to see and our people deserve to experience.  This is a time of renewal, and we must seize this moment with urgency.”

In addition to Ortiz-Melo, the DCLP team is comprised of Bruce J. Derrick, MD, Departments of Surgery and Anesthesiology; Jacob P. Feigal, MD, Department of Psychiatry and Behavioral Sciences; Amie Kawasaki, MD, Department of Obstetrics & Gynecology; Robert K. Lark, MD, MS, Department of Orthopedic Surgery; Martha A. Snyder, MD, Department of Pediatrics; Emily C. Sterrett, MD, MS, Department of Pediatrics; and Jodi J. Hawes, MD (coach), Department of Neurology. The project’s executive sponsor is Rhonda Brandon, chief human resource officer and a senior vice president of Duke University Health System.