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The ability to deliver consistent high-quality care requires effective leadership, a culture of safety, good teamwork, consistent processes of care, and the ability to learn and improve. Leadership is the essential component that ties all these factors together, and is the differentiator between extraordinary care teams and those that are average. As culture and care delivery live at a clinical unit level, we will provide a practical framework that can be applied there or more broadly within a healthcare system.


A Department or Unit is Made Up of Culture and Learning


High-performing units or departments have two integral components: “culture” and “learning,” and they have a particular relationship to each other in that, learning is built on and dependent on culture. Culture is the foundation out of which learning grows.


Learning, or more precisely a “learning system,” is the combined effort of individuals working collaboratively toward a common set of goals, and in the process constantly and consistently reflecting on activities to learn and improve. Ultimately, learning is dependent on the relationships that individuals have with each other, and the best relationships are those in which defects or improvement opportunities can comfortably be made visible. Those relationships are shaped and determined by the milieu, or culture, in which the individuals work, determined in part by organizational factors such as leadership behaviors, how the individuals are chosen or hired, paid, encouraged (or discouraged), by the agreed upon behaviors of the many individuals in that learning system, and by the attitude in the organization toward errors and human failure. Combined together, culture becomes “the way we do things around here.”1


The components of culture are as follows:


  1. Leaders and psychological safety

  2. Teams and team behaviors including effective communication

  3. An environment of organizational fairness, also described as a culture perceived as being just and with appropriate accountability.

  4. Negotiation and the ability to constructively manage conflicts


The components of learning are as follows:


  1. Reliable processes

  2. Continuous learning

  3. Measurement and improvement skills

  4. Transparency


All eight components must be healthy to achieve stellar performance and the eight components are interdependent. Leadership, psychological safety, and negotiation are at the base of the structure. They are essential to building effective teamwork and to creating an environment of fairness. The learning system is built above these, and reliable process perches on top, slightly askew and at risk of teeter-tottering should any of the other components become unstable (Figure 5-1). A brief description of each is as follows.

Figure 5-1

A framework for excellence.

Graphic Jump Location

Leaders refer to positions at multiple levels in healthcare environments, including the administrative leaders who head organizations, who tend to have the title “CXO” where the X may refer to executive, ...

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