5 Essentials for Creating Culture

Essentials for Creating Culture

The new buzzword for start-ups in healthcare is without a doubt the word culture. A quick look at Harvard Business Review finds 7,153 articles that center around culture in the subject of managing organizations alone. There’s all kinds of culture-talk happening. There’s:

• corporate culture
• data-driven culture
• culture of originality
• emotional culture
• continuous improvement culture

When a word is presented at every event or tossed back easily at lunch with a taco and a mojito, it’s easy for it to lose its intended meaning. However, culture is more than a buzzword. It’s actually a crucial component to customer satisfaction and specifically in the healthcare space, to peoples outcomes and quality of life. Culture is far more than a box that needs to be checked off when you’re building, or redesigning, a company, it is the key to how effectively you’ll not only reach your target audience but in the end how loyal they’ll be to you. And, considering it takes far less to retain a patient than to attract new ones wouldn’t this be a great goal to have?

1. What do people mean when they say culture?

As per businessdictionary.com culture is…”social heritage of a group… It is a pattern of responses discovered, developed, or invented during the group’s history of handling problems which arise from interactions among its members…”
As per Wikipedia, “culture is a central concept in anthropology, encompassing the range of phenomena that are transmitted through social learning…”
Key in these definitions is that culture is intimately tied to ones’ audience. There is no way to build, refine or transmit culture without looking to the perception of ones’ members. You can not build an effective culture in an ivory tower. There is most definitely a back and forth. Culture works only when built (or tweaked) to address previous experiences (social learnings) with members.
And, a successful culture only comes into being if the following four things are taken into account.

2. Culture isn’t created in a Vacuum.

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Here’s the thing, you can’t just start listing your vision and values in an office meeting and call that your culture. And you certainly can’t duplicate another company’s culture and call it your own. Culture is created over time and you need one crucial element that ignites the entire process: Your consumers. Your target audience.

Who are your consumers and what do they need, want and expect from you? Before any corporate culture is built, you must know your audience. Culture isn’t created in a  vacuum.
Business, in general, is no longer a function of push it out and have people accept what you’re selling (that may have worked with past generations but that is no longer true now that fresh generations are at the forefront in our society) now it’s truly a matter of pull from them: what do they need, what will they respond to, how do you reach them, how do you keep them? Until you know these things, set your culture aside, it may be your ‘ideal’ but that doesn’t mean anything unless it is also the ideal of your audience.

3. Talk to Your Intended Target.

If you are in the Health Care space, consumer research is absolutely necessary to determine the following answers:
What information do your patients need prior to choosing you as a healthcare partner? What information do they need before stepping foot into your practice? What do they expect once they arrive? What does a patient require as they leave, and beyond, your care?
Once you hear from them, build processes that meet said needs. Consequently, patient experience and satisfaction will correlate positively. If you develop a mission that doesn’t align with the needs of the intended recipients, it will fall on deaf ears. You must find out the following:

• Expectations
• Needs
• Wants
• Pain points

From the answers to these questions, build your mission, processes and internal culture accordingly to hit each and every one of them head on. If you do this successfully not only will your practice flourish but the loyalty to your practice will be second to none.

4.  Build Your Culture from the Outside In.

Once you know who your target demographic is and what their needs are, you can hire based on who can accomplish the tasks needed to meet the clients’ needs. Only after this happens people, practices, processes, and place can be determined.
If you choose to hire before your culture is fully formulated and put it into action it is likely the training you’ll need to do with your employees, so that they can better convey the culture will take away from any benefit you thought you had in filling your work force early.
Take the time first to know who is needed to best fit your culture, who will transmit authentically all that is intended, and then hire accordingly. Once your internal culture matches that of what is expected from your external audience you have the recipe for success, efficiencies, positive outcomes and loyalty.

5. Patient Driven Culture vs. Doctor Driven Culture

Right now the health care space is seeing the beginning of a paradigm shift. Patient-driven culture is growing because the doctor-driven culture has shown itself to be lacking.  In the past patients were apt to take a doctor fully at their word, never question a diagnosis or a set protocol for recovery. Now, not only have the times changed but the generations with it and they demand more; they demand a voice, they demand a partnership, they demand a seat at the proverbial table of their own healthcare.
As we are in the midst of this shift we’re finding not all practices are getting the memo. Until such time that we are all speaking the same language practices will find patients will look elsewhere for care. Now care is literally only a click away and the newly empowered generations are quick to go that route or to use easily accessibly walk-in-clinics and they don’t feel history with a practitioner is as important as convenience. Once healthcare providers and healthcare recipients align the efficacies of our system will greatly improve. The current burdens, such as wait time, costs, and even (re)occurrences of diagnoses will decrease.
A patient-driven culture creates the empowered patient which encourages ownership of their own health. Healthcare is no longer a ‘silver bullet’ directed by doctor but, better yet, decided upon, analyzed by and bought into by the patient. Study after study proves that the more the patient is empowered the more committed they’ll be to their own care and the more committed they are will lead to better outcomes and lower healthcare costs and a higher quality of life.
Here’s to health. Here’s to happiness.

The Team Approach to Caregiving



A dear friend is completing her life’s final journey…at home.  Strong in her faith and experiencing joy with friends and family, she is at peace. At this stage her care is straightforward: Manage her pain, uphold her wishes, keep her comfortable, celebrate her moments of joy, and keep her safe. This is done through the loving care of friends and family who share in her days and nights, and the visiting hospice nurse who stops by a few times a week. Together, they are her care giving team.

This is the second time in as many years that I’ve shared in this sacred part of a friend’s final journey; winding down, buttoning things up and preparing for what comes next. 

I’ve learned that seeing someone through the process at home adds extra challenges, but if it is important to them, it is worth the effort. People are more likely to visit and linger, and there is levity generally not found in a hospital or hospice.  

So, how does a team of mostly inexperienced care givers do this and maintain their sanity as they help another through this final stage of living?  Home hardly provides a controlled environment. There are issues with personal care, feeding, safety, and, of course, the cultivation of joy.  The team that works best here consists of a Ringleader, a Researcher, a Social Media Manager, Doers, an Uber-Organizer, a Cheerleader and an Advocate.

The Ringleader knows the person journeying through (the Journeyer), all team members, and their roles. They need people to research, release information, gather food and supplies, or visit and offer joy to the Journeyer (or the team). They are the one that, when/if anything falls through, they must step in and take the reins and responsibility. This is the care giver who most needs support and encouragement. 

The Researcher brings options for care, updated processes and opportunities and new insights. The Researcher is objective, yet thorough. There are multiple confusing choices available from doctors and facilities, to treatment and nutrition. Several people need to fill this role as it’s quite complex. One can focus on the traditional options, and the other on the alternatives. Remember, because something is proven to extend life, it doesn’t mean that’s the acceptable choice. It is up to the Journeyer and/or their loved ones to determine quantity or quality, and how they’d like to balance those to generate peace.  Empowering the patient to make choices at this time can give comfort and control to one who is at the point of saying their goodbyes. 

The Social Media Manager is the glue…the person who disperses information regarding the Journeyer. The key strategy here is to build a large team. There is heavy turnover since it is both mentally and physically draining. Time being unpredictable, one must be prepared to loop in others to keep moving forward with as few interruptions as possible.  The Social Media Manager will frequently post updates and photos on various sites (e.g. Caring Bridge, Lotsa Helping Hands, Meal Train, GoFundMe, Face Book, Twitter, Instagram, etc).  This keeps the journey at the forefront for those who will want to lend a hand.

The Doer(s) are the muscle and the heart. They are ‘boots on the ground’ and the lifeline for the Journeyer. This is the group with the highest turnover. It’s a lot to ask people to cut the grass, clean the house, cook meals, or drive for a few days let alone for weeks or months.  Even loved ones reach their limits. It’s OK.  Be prepared and have new people ready. Manage the Doers in a way that best fills vital roles but still speaks to their core capabilities. You may find some suited to cooking but uncomfortable with visiting. If you need something more than another, focus on that and let the rest fall into place. It will.  The Doers need a leader. This Uber-Organizer is the person that takes the lead for all Doers. She/he utilizes resources wisely so as to not over-extend any one Doer. Tools are Voxer, Meal Train, Face book, or Lotsa Helping Hands. 

The Cheerleader is the person who enters smiling. Their role is to lighten the mood for the Journeyer. This journey is stressful: it’s heart wrenching, it’s beautiful, it’s loving, it’s life and it’s death. We will all pass through this journey; some of us suddenly, and some will wish to wind down in as peaceful and loving a way as possible. It is this final option to which I speak.  The Cheerleader helps the Journeyer to reminisce, share laughter and stories, and talk of joyful things. The Journeyer’s role is to absorb the good and put forth whatever they choose to leave behind. A great tool is Voxer. 

The Advocate is similar to the Ringleader but may not have previously known the Journeyer. The Advocate is a professional  touch point for the care team,  objectively managing ‘the system’ and offering options that fall ‘within coverage,’ financial abilities or time constraints.  

There are so many nuances at life’s end: constantly changing issues with healthcare, alternative offerings that need to be carefully vetted,  managing the dynamics of the family; how  to keep everyone in the loop and who has authority to do what and when? Conversations need to be held with the Journeyer regarding living will and their chosen course of care, who to connect to for a spiritual advisor, and discuss funeral arrangements and wishes for disbursement of specific mementos. Working closely with the Ringleader the Advocate is there to tend to wishes and alleviate any stressors along the way, helping to move toward joy in living and peace with passing. The Advocate is also there to lend support, a shoulder to cry on, an ear to listen and a caring heart for all those who are on the care giving team during and after the journey is over.

Here’s to health. Here’s to happiness. Here’s to finding one’s joy during each and every part of the journey.

Healthcare is a Grassroots Effort

I am fortunate enough to have the opportunity to talk to people about their experiences in healthcare all the time. Be they a patient or a caregiver there is a great degree of discourse out there. Maybe it’s because I’m a Market/Consumer Researcher? Maybe it’s because I’m a Sociologist? Maybe it’s because I listen? Maybe it’s just because I care. That being said maybe we all need to care just a little bit more because we’re in the midst of a significant shift and the writing is not only ‘on the wall’ but in the hearts of so many. I say it all the time that Millennials are teaching us how to live and the Baby Boomers are teaching us how to die and their wishes, their needs, their ways of doing things will alter how we do healthcare, whether or not the healthcare system is ready.

If you’ll come along and be a ‘fly on the wall’ for a couple examples of what I hear.

Caregiver/granddaughter: I just don’t know what to believe anymore. Hospice tells me one thing, the facility another, and the doctors a third, not to mention the in-fighting and competition between the sitters.

Caregiver/daughter: We never had a close relationship and now I’m the one in charge of her well-being. I just don’t know her wishes? We never talked about it? I want to do what’s right for her, she is my mother, after all, but I don’t know where to start.

Patient: I can’t get my doctor to listen to me. They’re in and out in no time and I just need more information. I feel like I’m being led instead of having a say in my treatment. This is my health after-all, right?

Caregiver/spouse: It’s my job, my obligation, to care for him. I don’t need help. This is the least I can do. I’m exhausted but I want to do everything myself. It’s the right thing to do.

Caregiver/daughter: It’s expensive! We’re talking $8-$11,000 a month for basic care and the facility. We’ll be out of money in three months. How do people do this?

Caregiver/daughter: We’re just living too long. When my day comes I say just give me something and let me drift away. You know there are states that allow that?

Caregiver/son: I think we’re regretting the decision that a few years ago, when mother was 90, we used heroic measures to save her and now she has dementia and what quality of life does she have? Maybe she wasn’t meant to still be here?

There are so many unknowns regarding healthcare and especially end-of-life, and that’s why we are where we are right now. This part of the journey is not scripted. There is no ‘So you’re expecting …’ manual for the end-of life like there is for the beginning. The multitude of the unknowns teamed up with various opinions, life experiences and technical know how bring us to the point where we are needing to strip down the system to its most basic and build it up again to suit the needs of the ‘new consumer’.

The younger generation is full of ‘want it now’ and ‘want it my way’ types. This is a good thing when you learn to adjust and listen well to their voices as you do so. Build in tools which bring healthcare to them where they are, when they want it and complete enough to offer them the options to choose the best course of action for them. Give them treatment options, pros/cons, costs, timing…give them the information they would have at the ready when purchasing any other good/service. They are fully aware they are capable and they insist on being empowered to make their own decisions.

The older generations have seen their share of grief and hardship. They were the children who witnessed the greatest generation fight in wars, as did they themselves. They were the generation who saw their loved ones through death in their own homes when they were children. They were the generation that came to adulthood as the boom of nursing homes took hold and we started the great shift toward ‘institutionalizing’ our elderly. There were scars left on their hearts when they saw their parents through end-of-life out of their homes and away from loved ones. This generation is opting out of that for themselves. This generation is of the belief that quality trumps quantity and they want to ensure when they have lived their lives that they can finish their journey with as much dignity and pride as the current state of healthcare will offer.

What’s happening now is ‘the great conversation’. Sometimes behind closed doors because people still don’t know where they (or others) stand in this new way of navigating the system, but often being had none the less. People are hungry for information. People are thirsting for support. People are desperate for insight on how to manage not only their own health but that of loved ones in a way which is dignified and affordable.

Enter Go-Fund-Me and other such tools which offer a platform to raise funds to help in many ways but more and more specifically for healthcare and end-of-life. With the restrictions of insurance and the limitations within traditional healthcare people are expanding their net and looking elsewhere and paying out of pocket.

Enter Caring Bridge and other such tools which offer an outlet to disseminate information to the masses to encourage group participation in your loved ones care. Caregiving is exhausting work and even those with the best intentions are due to burn out. Having people in the loop and ‘at the ready’ ensures that your loved one will always have someone to take them here or there or sit with them and hold their hand or, at the very least, offer them moral support or send lovely cards or gifts to brighten their day.

Enter Meal Train and other such tools which offers support to feed not only the bellies of those in needs but hopefully their souls as well. When people know there are others who care enough to build and deliver a meal for them it offers them hope and a certainly a glimpse of the good in humanity.

Enter Support Groups which give caregivers or patients an outlet to vent and realize their not alone, share advice and offer hugs. These groups also offer them insight that there are many ways to walk through this amazing thing called life and often there are options available they simply never knew existed.

Healthcare is a grassroots effort. We are using more and more tools to aid us as we journey forward. We are bringing more voices into the conversation, sifting through more information and building our own protocols that fit our wishes and beliefs. We are shifting away from an organized system with a set entry point, protocols which serve the masses and relatively predictable end-points. The script is being muddled, we’re living longer and people are taking their own lives into their own hands and all they ask is for support and access to information along the way. We find that the more one is empowered the better their quality of life. We have learned that the more say one has in their care the less of a burden they are on the system. We have studies that show us lower healthcare costs if only we can come to weave into our current system new ways, new processes, new opportunities, and, in the end, less heroic measures.

At the end of the day if you ask a patient it’s about quality. If you ask a caregiver it’s about quantity. Our loyalty to those we love leaves us fighting for more as that’s how we believe we show our love and devotion. It’s beautiful, it really is, but before we fight for someone else let them have a say before they lose their voice. Have the conversation. Keep your fight on task…fight to abide by your loved ones wishes not simply for more days. These are tough conversations to have but necessary and loving at their very core.

These are interesting times and I am honored to have been a part of loved ones lives and end-of -life journeys and I am empowered by the knowledge I gained during those days and months of care and constant researching to find the best ways to handle whatever was, and is, at hand. I am hopeful that when we step aside and set ego and greed on the back burner we’ll find a way to enrich the quality of our lives from start to finish. It’s not always about more test, additional surgeries and more days.  Of course, sometimes it is…and that too is a choice and one which ought to be respected. It is after all a journey and every journey must end.IMG_7610






Communicating in the New Millennium


Strauss and Howe’s categorization of the Millennial puts the birth range from 1982-2004.

As the world spins faster and faster into the digital age, companies need to know that they are communicating with two distinctly different consumers and workers. Baby Boomers and Millennials find themselves trapped in lockdown of miscommunication. They may speak the same language, but a translator is needed to bridge the gap of understanding. Particularly in marketing to these consumers and in hiring boomers and millennials, businesses must approach each group with the care and uniqueness that sets them apart.

I’ve made it easier for you to find the distinctions that drive each generation and then how to communicate, motivate, and cooperate with these two groups of people.

baby boomers-6Baby Boomers

Born approximately between the years 1946-1964, these 52-70 year olds came into the world during a time of conflict. World WarII was barely in the rear view mirror, and many of their parents, those of our Greatest Generation, fought in that war so it was never far from conversation. The Vietnam War — a highly contested and volatile war —trailed closely behind, while the Civil Rights Movement and Martin Luther King, Jr. dominated the news. These boomers experienced social changes in women’s rights, birth control, and abortion. During their formative years, the Berlin Wall was built and the Cuban missile crisis kept them practicing drills at school.

They were also born during a time of expansion. The world saw the 1st man on the moon,
Televisions became more widespread and available to the masses, and
suburbs were created. Boomers lived during the time where the adage of work hard and reap the benefits was never more true. The economy was booming and people were living well after the war, up until the early 70’s. This set of kids saw their parents going to college and working in ‘traditional roles’ in traditional fields, for them it was unlikely their parents were entrepreneurs.

This is a generation that:

Is patient and not at all entitled – They saw their parents work for all they got, and they had those same expectations instilled in them. They were raised by the Greatest Generation who lived as though at any moment the bottom may fall out again. They were conscientious spenders and hard workers.

Had a voice – This is the generation of marchers/protesters and flower children. They saw great conflicts in their life times, and the pump was primed for them to jump in and lend a voice and a hand.

Are collaborative workers – They learned when you join forces through their marches and protests that there is more strength in numbers and that followed them into the workforce. They were happy to work as a team and leave their own interests at the door for the greater good.

Put themselves last – this generation was far from coddled as their parents were busy re-establishing their families, getting educations and making a new life for themselves. These kids were independent and were expected to step up and help the family as a whole. These kids are also the ‘sandwich generation’ – carrying for both their kids as well as their parents, this, in and of itself, left little place for ‘me’ time.

Experienced death differently and less ‘intimately’ than generations past:  Aging in America became a business during this time. While the process started in the mid-50’s to establish elderly homes it was really in the 60’s – 70’s that this business model burgeoned and started to take in great numbers of our older population. Baby Boomers watched their parents…their heros…die in homes and institutions unlike any generation prior. For example when Boomers were children they likely saw their parents tend to their grand-parents through the end-of-life in their own homes. It was not unusual to see Grandpa take up residence in what used to be the family living room. Therefore this new ‘outsourcing’ of end-of life put both an emotional stressor on their shoulders, as they felt as though they were abandoning their parents, and a fiscal stressor on their pocketbooks. Now, with life extended they had to cover costs for nursing homes and/or they had to build in travel expenses to visit their continually aging parents possibly across many states. This was far from an intimate was to die, this was death in the age of commercialism and capitalism.

Are fiscally aware but not necessarily prepared – this generation saw great growth in the economy and for some time tremendous strength in a growing middle class but if they didn’t, or weren’t able to, prepare accordingly for a rainy day, this generation also saw the dramatic shrinking of that very middle class with the passing years. Boomers also experienced a significant shift in power and the reality of our dependence on other countries for things so important to our everyday lives as oil. This generation remembers quite vividly the gas shortages and the lines at the pumps with their babies in tow, during the 70’s. They also had the aforementioned hardships of carrying for multiple generations which often depleted their savings and the likelihood that they would over commit to savings such as 401Ks, according to The Fiscal Times (October 2015), ‘the average retirement portfolio… has just $136,200 in it.’ This severe shortfall has led this strong and capable generation to rely heavily on the promise of social security.

How they need to be reached and communicated to:

  • They still read newspapers and rely on the TV for their news.
  • They prefer face-to-face interactions over being buffered by forms of technology
  • They are happy to make due and while they have proven themselves to have a voice; they also believe in the greater good and tend to not want to make waves.
    • This tends to keep this generation a bit quieter than the millennial and more likely to ‘do as they’re told’.
  • They tend to have have more scattered families therefore are more likely to feel the need to maintain their independence and not have to rely on others for their well-being.
  • They tend to choose quality over quantity of life as they saw the harm done to their own psyche as well as the well-being of their parents due to the options and institutionalization of the end of life (noted above).
  • They are not quite as adept at researching their options and tend to lean on others who are ‘at the helm’ be it in commerce or healthcare. They want to be involved in decisions which keep them healthy and capable but are overwhelmed by the vast amount of information available to them.
  • Offer a support team to help in major healthcare decisions and the ability to decide how they’d like to proceed.


Born approximately between the years of 1982-2004, Millenials are between the ages of 12-34 years. There is a great discrepancy on the range for this generation but for the sake of defining the borders of the generation we’ll ascribe to the categorization as set by Strauss and Howe. They were born during a time of connectivity. The internet was growing…exponentially. The Berlin Wall came down, unifying Germany and offering hope to the world.

While born into a time of unification it was also one of great uncertainty and lack of control of ‘others.’ There were bombings (Olympic Park, Unibomber, 911), and the OJ Simpson’s highly televised ‘chase’ and trial brought a new level of ‘reality TV’ into our homes. Drama was everywhere and now instantly accessible 24 hours a day. AIDS was an epidemic, and school shootings began, starting with the Columbine High Shooting, and continued.

This generation of Americans are technologically versed and fragmented. This was truly the MTV Generation; they never knew a world without music on TV.
The internet was accessible – AOL (1985) and email became a part of their world. Many were never aware of a ‘before the internet’ timeframe. News came predominately from TV and the Web, with Newspapers taking a back seat.

This is a generation that is:
Connected – Millenials are always connected to others and by various devices. “Smart” devices (phones, watches, cars, appliances, etc.) are responsive—or work across platforms or other devices at once— and support the use of multiple use as they thirst for a connection to the world.

Multi-taskers – Due to the multitude of devices at their disposal along with managing their ‘off-line’ existence, they’ve become amazingly adept multi-taskers.

Involved and wanting to give feedback – This generation relies heavily on others who came before and also, a type of a trickle down effect, are more willing to give feedback to those who may follow. They feel their voice has value, and they want to share opinions. This generation was likely raised in a household where things often revolved around them unlike the generations prior which were not nearly as child-centric. The generation proceeding them, Generation X,  was full of ‘latch-key’ kids so the parents for this generation tended to over compensated for this one. I believe the benefit of this is a stronger more confident voice for this generation which is in direct dispute with the other option and misnomer, the ‘Me Generation’.

Community oriented and ones who wish to effect change – As per the reasons above, they have a level of self-confidence not seen in past generations and with that a belief that they truly can change things. Consequently, there is a willingness to try to find opportunities to succeed often in niche ways (entrepreneurial) not seen possibly since our Greatest Generation (Those who grew up during the depression, fought in WWII and went on to build what is ‘modern-day’ America).

Comfortable with self-expression – Again their level of self-confidence leads to their ability and willingness to express themselves how they see fit —whether it be body adornments such as tattoos or piercings or freer expressions of themselves sexually. This freedom extends to other behaviors and groups as well and affords them a higher level of acceptance for people of other faiths, ethnicities and race.  For them, all is permissible within the realm of being true to themselves.

How they need to be reached/communicated with:

  • Meet them on their terms, where and when they want and bring them into the discussion and decisions – Don’t talk to, or sell them.
  • Utilize many avenues of communication from internet/social media, tv and lastly print.
  • Prove how working with, buying from or partnering with you affords them the opportunity to effect change and make a better world.
  • It’s not aways about the bottom line financially for them as much as it is about where the rubber meets the road and what it means for the greater good.
  • Lead them through their options and allow them to mix and match things as they see best suits their needs be it on a purchase or their own well-being/healthcare.
  •  Incentivize them to give positive feedback so others, like them, will follow suit.


If you still aren’t sure how to cross the generational divide, the magazine Gold Digest offers some more specific advice on how to play golf with a boomer versus a millennial.