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“[Growth outliers—organizations that achieve outstanding growth over an extended period of time] focus management attention on culture and shared values. We found (as have others who study high-performing organizations) that the outliers on our list pay close attention to values, culture, and alignment. What does that mean in practice? We saw significant investments in creating an appropriate corporate culture, in employee training, and in executive development among these companies … These organizations invest seriously in corporate values, which their leaders back up through meaningful symbolic actions.”

–Rita Gunther McGrath, “How the Growth Outliers Do It”

Harvard Business Review, January–February, 2012

Chapter Goals

  • Understand our metaphor for the Invisible Architecture of an organization in which the foundation consists of core values, the superstructure is organizational culture, and the interior finish is workplace attitude.

  • Explain why Invisible Architecture is more important than the visible architecture of bricks and mortar in determining the employee experience and the patient experience and why you should create a Cultural Blueprint with the same care and attention as the blueprint used for the design and construction of the physical facility.

  • Describe “the healthcare crisis within” of incivility, bullying, and toxic emotional negativity in the workplace and the way it contributes to stress, burnout, and compassion fatigue.

  • Describe the validated VCI-17 Culture Assessment Survey used by Values Coach to provide a unique and unvarnished window into how an organization’s people perceive their culture and the nature of relationships within that culture.

When a new physical facility is designed, professional architects and engineers guide companies through the process. There are multiple iterations, from schematic design to final construction blueprints. Committees give input on wallpaper design and carpet color. Room designs are laid out with masking tape in the parking lot to ensure a good fit between the new design and the processes and equipment for which that space is being designed. At each step along the way, revisions are made. No detail is left to chance. By the time construction begins, large groups of people will have participated in the design process, creating a clear vision of what the facility will look like.

But when it comes to employee engagement, patient satisfaction, effective communication, and even quality, safety, and productivity, the visible architecture of the physical structure is less important than what we call Invisible Architecture—the core values, organizational culture, and workplace attitude of an organization. Yet most healthcare organizations do not put nearly as much thought and attention into the design of their Invisible Architecture as they do into the design of their physical facilities. A patient care floor would not be remodeled without a detailed blueprint, but once the remodeling is finished and staff move in, the Invisible Architecture is allowed to evolve haphazardly, with the result that there is cultural fragmentation across the organization. This is one reason that many healthcare organizations have no consistent overarching ...

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