Developing Culture in

By Levi Nieminen, PhD

This brief article explores the meaning and management of organizational culture in the new ‘Gig Economy.’ The Cardiology Fellowship Training Program at the University of Michigan provides a fascinating case example of an organization whose people are always on the move. What they have learned about how to create (and sustain) their program’s culture holds strong relevance for many organizations today, including some (like Uber) who are defining new organizational forms, and many others who are grappling with a high-churn millennial workforce.

Let’s first admit that many of the traditional perspectives on how cultures get created and modified need to be re-imagined when we think about companies like Uber, Lyft, or Airbnb. These new organizational forms are radically different from the ones our founding fathers had in mind when they adopted metaphors like icebergs and ocean liners to set our sights on a slow-moving, evolutionary process. What does culture really mean, and how does it get defined and sustained in a fluid organizational setting? What roles are needed from the part-timers, short-timers, and consumer-employees in the new age of the ‘Gig Economy’?1

Consider for a moment the case of Uber, the innovative multi-billion dollar transportation app company. A 2015 survey of Uber’s workforce found that half of new Uber drivers left within their first year, while one-third viewed “Ubering” as a temporary job while searching for full-time work elsewhere.2 With this much changeover, I wonder how Uber will sustain its customer service, and what might be lost (or is most challenging) from a cultural perspective.3 Perhaps the latest controversies and lawsuits are indicative of these challenges. Perhaps Uber will learn new ways to create a culture around a fluid workforce, and teach us all how in the process.

As a change practitioner, the Uber case fascinates me as to how we can reach out to people who may not see themselves as part of the organization and ask them to play a central role in creating and sustaining its culture.

There is a unique additional challenge when those people are in competition. How do you get a collection of individuals to see themselves as a collective? How do you build a connected organization?


What can we learn from universities?

Universities are interesting settings to witness these ‘fluid’ dynamics in action, and where the payoff of being intentional about the culture can be enormous. As with the Uber drivers, students are often in the role of consumer-employees when they simultaneously work for a department (or program) and receive an education and training from it. This means that students are an important part of what makes up these academic organizations and the cultures within them. But do others at the institution see them in this way, and more importantly, do they see themselves in this way?

Within the world of medical training programs, the traditional answer has been not exactly. The trainees, in their first years practicing medicine post med school, are there to learn from the attending physicians, and with plenty of reminders of the established hierarchy along the way. Many if not all who have survived their training have their war stories and battle scars to show for it. And this is the culture that not only trains the next generation of physicians, but also that shapes the next generation of physician leaders. This begs the question: What cultures will they go on to create in the hospitals, health systems, and universities they will one day lead? For many, they will recreate what they experienced in their training.

The Cardiology Fellowship Training Program at the University of Michigan provides a compelling story of a graduate medical training program looking for a better way. The fellows come to the program from the best medical schools in the world. When they leave (typically after three years), many take prestigious jobs and make important contributions to the field. The program is among the top tier of a very competitive sub specialty of medicine. So, what is there to improve?

“Why do we need to change? Like everybody in the business world knows, the world is changing around us,” described the program’s director Dr. Peter Hagan.4  “We’ve had an explosion of knowledge and technology. The learners are changing. Society’s needs are changing. And we have a culture problem.

Not everyone would agree with that last part. In my opinion, this is what makes Peter’s perspective so special (though my saying so will certainly make him uncomfortable). In a training environment that is by any measure very good or even great, Peter sees how the program could be even better. He also knew that the cultural challenge runs deep, well beyond his program and the university. “Most programs operate on an old apprentice model, a cottage industry in the post-industrial world. We don’t apply modern, validated, education principles. So, how we train people is not a whole lot different than how people were being trained decades ago. I had this gnawing sense that there has to be a better way than the way we’re doing it right now.”

“There is a bigger story here. This isn’t about technology. You need to look at the culture and the environment, and how you’re training people.”

Peter credits an early discussion with a colleague, Chris Chapman (a media professional in the med school), as the spark for looking more closely at the program’s culture. Peter went to Chris bemoaning how they were ‘PowerPointing’ the fellows to death (or at least partially disengaging them from the lectures). Chris told him, “There is a bigger story here. This isn’t about technology. You need to look at the culture and the environment, and how you’re training people.”

For the fellowship, the key to the improvement process was going to center on empowering the fellows to build the program and the culture they wanted. In a fluid organization, not everyone will see the value and invest in a difficult change process. Instead, the strategy was to start where the intrinsic motivation was strongest and look to create a tipping point with the others. “You need some people who are going to be your champions, who see the vision or have the ideas. The law of diffusion of innovation is something that we learned about. Not everybody bought in straight-up, and even to this day, some people don’t buy in.”

For those fellows who did buy in, they have found a cadence for honest discussion about the program culture. “We set a vision. We want to be the ideal training program. We want to empower and leverage our fellows to be builders. We want to develop a strong culture, a culture of ideas, a culture of support and openness. We want to improve that sense of community and energy.”

The ongoing dialogue about the program’s culture
helped to set an agenda for fellow-initiated improvement projects. At first the wins were small but important. They hosted a barbecue with faculty and alumni, they made more time for socializing with their peers, and they all got fleeces with a program logo as a symbol of getting more intentional about their brand. “If you say you’re going to do something and then a couple of months later nothing has changed, you’re done. And luckily, the fellows were able to really make some rapid improvements in a very short period of time. Basically, fellows came up with ideas and said, ‘I want to do this,’ and off they went.”

Over time, there were deeper-rooted projects too. The fellows identified curriculum needs and explored new avenues for collaboration. They invited outside speakers to present on the topic of leadership. They started a process to redesign their work space to allow for greater peer collaboration. They engaged the faculty within the division in a similar process of culture introspection and dialogue.

They made culture a core component of their new fellow recruiting process.
As they took new jobs, senior fellows passed on their “champion” role to more junior fellows so that the process could repeat.

Though their story is still evolving, there are a number of early signals that the work is having a real impact. Faculty members across the division have commented on “what’s different with the cardiology fellows?!” Repeated surveys of the fellows over this same time validated the progress. The percentage of fellows whose rating of the program is “very positive,” the highest rating category on the 5-point scale, was up nearly 20 points to 80% overall, whereas the national average is 52%.

In general terms, when you follow these heuristics, they prime an important thought process about what matters most (i.e., the “criteria”), and therefore, what process makes the most sense in the situation. Is it – Making a quick decision? Getting it right? Bringing others along? Or creating a development opportunity? The answer is situational.

You’ll also note that applying this framework helps to address the “who question” but does so by walking backward from an analysis of the situation and criteria. When groups enter the dialogue focused on who gets to make the decision, it has a way of priming unhelpful notions of turf and positional power. In contrast, focusing the dialogue on how the decision should be made has a way of opening up the right questions at the right time about roles, expertise, access to information, key influencers, and so on. In other words, clarifying process usually helps to sort out questions about who best to involve and how.

Creating the space for dialogue

Learning the framework is one thing and practicing it is something entirely different. An important aspect of getting it into daily practice is creating the space for routine dialogue. In my experience, the best way to learn the framework is to use it to analyze some specific decision examples from the past. The facilitator might ask the group: Describe a decision that wasn’t as effective as you would like, either because there was confusion, it was too slow, people didn’t support it, etc. What process was used and what process might have worked better?

It’s not uncommon in these discussions to unearth divergent descriptions of what happened and why, even down to some of the very basics. The boss thought he had delegated it. The group thought it was going to be a democratic process. Two executives each thought the other ultimately had made the decision. In each case, a better word for thought would be assumed. But making fun of the past isn’t the point. The key insights from these past examples should lead the group directly into a productive planning discussion about how future decisions will be made more effectively.

Giving people a set of questions they can use as prompts for productive dialogue is a second exercise that can help a lot. Well, not quite “giving” them. The group needs to articulate–for themselves–the questions they feel would improve decision making and then commit to using them in daily practice. Again, simple is good, and the closer in number to 7±2, the more likely people can hold them in their minds and call on them in the moment.

Here are some examples of good questions that can add depth to the thought process and dialogue about decisions:

  • Have the right people been consulted and/or involved?
  • On what data is the decision being made?
  • At what level of the organization should the decision be made?
  • Is there a policy or guidelines to reference? If not, will this decision create one?
  • Does the decision reflect and reinforce our values as an organization?
  • Have we closed the loop by communicating the ‘how-what-why’ after a decision was made?
  • How will we measure the impact of the decision over time?

Whether people perceive that it is safe (or not) to use the questions is everything, and has a lot to do with how leaders behave. Key signals from leadership that others will look for include (i) whether leaders demonstrate humility and ask others to challenge their assumptions and thinking and (ii) how leaders respond to the first few “challenges” that come their way.

Embedding the new behaviors

One yardstick for judging the success of a program architected on these principles is the extent to which new habits and routines emerge in place of the old ones. And killing the old ones dead won’t be easy. And so in closing, I’ll leave you with a few reflections about how to translate program learning into habits that embed deep and stick around.

Use a campaign of reminders. Keeping the program learnings and commitments top-of-mind for people is a big first hurdle. Artifacts such as posters, business cards, or decision making “playbooks” can help, particularly if they provide a quick reference to the stickiest parts of the program, such as “the questions.”

Meetings are another place for new routines and reminders. Meetings can start with a quick clarifier on what decisions will be made or discussed and how; they can be wrapped up by asking: Are we clear on what was decided – or – What next steps are needed for us to move to a decision?

Stay on top of the bad old habits. It can help a lot when groups talk about their biggest “watch-outs” and how they will raise awareness to the early signals that, “folks, we’re doing it again.” This is also where having a parallel track that supports individual awareness and growth is extremely important. In truth, this topic is deserving of its own blown-up article, and there are some really interesting ways to integrate things like personality assessment, feedback, and one-on-one coaching. But for now, let’s all agree (and then move on) that all the best programs can succumb to the re-emergence of the bad old habits, particularly when they re-emerge from the key influencers in the group.

Scaling the program from top to bottom. The long-term success of any one team, department, or division to shift its decision making behavior will be capped to a certain extent by whether the organization as a whole can make a similar shift over time, starting most immediately where there are strong interdependencies. This is most salient up and down the hierarchy, where executives need to role model the new behaviors and engage their direct reports in a process of “cascading” the key program elements down to their direct reports, and their direct reports, and so on. The key role for program facilitators here is to support this process and get everyone in the organization speaking the new language.

Levi Nieminen, PhD is the Director of Research and a Senior Consultant with Denison Consulting

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