One of the key pillars of high performing organizations is a strong, pervasive culture. A shared culture binds individual group members and practices into a cohesive whole and allows the group to function at a higher level.

Building a common culture must be an active process. Otherwise, inertia will foster continuation of the status quo.  Developing a common culture does not have to be the insurmountable task that many seem to think that it is. We offer the following suggestions based on our experience with culture development engagements.

Define “culture.” Many individuals have difficulty defining culture. We use a simple definition of “shared expectations that drive behavioral norms.” This definition makes it easier for group members to understand the concept and contribute to the development process.

Define the group vision. As we mentioned in a recent article, developing and sharing a detailed group vision not only defines strategic objectives through which to attain the vision but also begins to define cultural elements demonstrated by the vision.

Prompt the discussion. Group members likely have not specifically thought about what desired group culture elements might be. Specific questions can prompt individual thought and subsequent group discussion. Key questions might include the following:

  • What attributes of a group make you proud to be a part of it? We often ask this question during the vision development interview process. The question starts making abstract concepts more concrete and often focuses group culture element consideration.
  • What does it mean to be a group physician? The answers to this question directly reflect perceptions of the group’s culture – either current or the desired future state – and likely represents another area that individual group members had not specifically thought about.
  • What behavioral norms are essential to drive the group’s culture? Nothing like getting to the heart of the matter – ask the question directly to get a targeted response.
  • How will we address group members who are non-compliant? Holding fellow members accountable is a necessary element of an effective group. Enforcing compliance is difficult.  Openly discussing and collaboratively developing mechanisms to promote adherence to group norms and address recalcitrance promotes transparency and elevates collegiality.
  • What skill set (including knowledge base) must physician leaders possess to guide this effort and how do they gain those skills? Leadership characteristics and behaviors are often overlooked during culture discussions. Not uncommonly, discussions focus on the group at large and do not consider the impact that leadership has on group culture. Directly addressing this area ensures a more comprehensive approach to desired group dynamics.

Instilling a shared group culture is not insurmountable. Actively pursuing the outlined approach makes culture discussions more concrete and has successfully moved groups toward their preferred culture.


Terrence R. McWilliams, MD, FAAFP

Chief Clinical Officer and Managing Director, Employed Provider Networks