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“Joy in work—or the lack there of—not only impacts individual staff engagement and satisfaction, but also patient experience, quality of care, patient safety, and organizational performance.”

–Institute for Healthcare Improvement, IHI Framework for Improving Joy in Work

Chapter Goals

  • Explain why culture does not change unless and until people change, and why people will not change unless given new tools and structure—and the inspiration to use them.

  • Describe the Attitude Bell Curve and the characteristics typical of spark plugs, zombies, and vampires.

  • Describe the cost of toxic emotional negativity—to the organization and to the individual employee—and the duty of managers to protect people from its effects.

  • Lay out the parameters of the Passion-Performance Matrix.



When he was 7, my nephew Ammon wrote this on a sticky note and left it in his bedroom. His mom found it and sent me the picture. Each day we wake up, I believe we intend to have a great day. Sometimes life throws us a curveball. Perhaps we can give each other the benefit of doubt that for the most part we plan to come to work with a positive attitude and contribute to a great working environment. If we see someone with an attitude that is not normal for them, ask them if there’s anything that you can do to help them that day. They may be struggling with a personal problem and need a friend or helping hand.

Core values are the foundation—the heart—of an organization. This foundation gives a solid base to the superstructure of culture. But there’s one last element in any beautiful, functional building: interior decor. The interior finish of an organization’s Invisible Architecture is attitude.

Culture is profoundly shaped by the collective impact of individual attitudes and behaviors. For this reason, culture does not change unless and until people change. You can have all the pep rallies and programs-of-the-month you want, but until attitudes shift and behaviors evolve, you will not fundamentally change the culture.

Of course, change is hard. Think about it: What have you tried (and, to your great regret, failed) to change? Maybe you’ve tried to quit smoking, to lose weight, to exercise more; or to stop spending, to save for retirement, to get out of debt; or to network better, to keep up with old friends, to spend more time with family. More often than not, despite our best intentions, we slide back into old routines and patterns of thought. We’ve all had New Year’s resolutions show up dead on arrival. And if one definition of insanity is doing the same thing over and over and expecting a different outcome, then in that sense we are all just a bit crazy.

Culture won’t change unless people change—but people won’t change unless they are given some new tools (and, ideally, the tools’ instruction ...

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