When new managers take over respiratory care departments, they can expect to be faced with many challenges. One of the biggest of these is dealing with an established departmental and organizational culture: the way work and authority are organized; the way people are rewarded and controlled. It also encompasses features such as customs, taboos, company slogans, heroes, and social rituals.1 In this editorial, I will be discussing departmental culture—specifically the culture of a respiratory care department.

New Managers Beware

Each department has its own rules and ways in which people are encouraged to behave. Often, those who do not behave as expected are frowned upon and usually end up leaving. They are viewed as being unfit for the established culture. This is because an established culture is resistant to change, and those within it dislike those who try to bring change—which many people hate.

So as a new manager dealing with an established negative culture, how does one change the culture and establish a new one? Any new person who enters the department will be viewed as an outsider. New managers can expect insubordination and lack of respect and trust from his subordinates. They often are misled by employees either to be ridiculed or simply to make their job really difficult. This can be frustrating to new managers, since they are dealing not only with running a new department but also with the human resources part of the job. Problems can range from scheduling conflicts, to constant call-offs, to people not completing the assigned tasks.

Miguel A. Bustillos, MBA, BSRT, RCP, RRT

Miguel A. Bustillos, MBA, BSRT, RCP, RRT

Personal Experience

When I took over my first department, it was a very stressful time for me. I had little idea how to run a respiratory care department, and most of my management education came from my previous experience in retail management. That was very good experience when it came down to handling people problems, however. Respiratory therapy schools did not have leadership classes then, although now they do offer Masters of Sciences in Respiratory Care Leadership. Although I was positive, it seemed like the world was coming to an end when I was suddenly dealing with multiple call-offs and employees telling me that they were not completing their tasks as assigned. This was their culture. They were used to telling their old manager that they were not going to complete an assignment or disliked an assignment, and the old manager would change assignments or miss important meetings to take over assignments to cover the shift. None of the employees were ever disciplined. Meanwhile, the CEO and upper management perceived this as a well-oiled respiratory department. At first, when I tried to implement changes, I was often bypassed by the staff, and issues were taken straight to the CEO. This was frustrating to me, since I had to explain every decision I had made to the CEO after the incident. It was a horrible time. I needed to change the culture ASAP!

So how did I end up changing the culture? Any time a change of culture is needed, a few things must happen. One of the best ways to deal with culture change is to use all of your available resources. These include the use of new slogans, social rituals, and departmental heroes. Changing departmental culture requires time, commitment, planning, and proper execution. It is not going to happen overnight. Also, I needed to keep in mind that before I began to change the culture, I had to understand the culture. In addition, I needed to have total support at the executive level. This meant that I had to present the problem and the solution to the current crisis to my CEO. Bringing the CEO a problem without a proposed solution would show poor management skills. After presenting my case to the CEO, I decided to implement my plan and look for future changes in behavior. The first tool I used was the performance review. Every employee was informed that a good performance review and a merit increase depended on certain behaviors and expectations. A memo was sent out to every employee in the department, and each one of them was made to sign a receipt. In addition, training programs and orientations were scheduled, and testing was instituted to ensure that each employee was able to perform their assigned duties. With proper orientation and training, no one could tell me they were unable to take an assignment. New positions were created to reward those who showed leadership skills. And those who wanted more responsibility were given more responsibility.

All of these ideas were extremely successful, but the use of implied (informal) leaders in the department made all the difference. It is amazing how implied leaders can help shape a department. I highly recommend using them. The use of implied leaders was instrumental in ensuring that the rest of the team attended departmental social rituals, and this was key in making the whole process work. In these rituals, proper behaviors were rewarded, and the consequences of below-standards performance (although no individuals were singled out) were addressed by the rest of the group, and the whole team brainstormed on possible solutions. Team members were allowed to work independently, but high measurable standards were set. Those who failed to meet with the requirements were properly warned and, if necessary, terminated. Banners were placed all around the hospital emphasizing the importance of teamwork, customer service, and punctuality. Gift cards and certificates of appreciation were given to all employees who had perfect attendance every 3 months. In addition, they were entered into the employee-of-the-year award contest. The contest winner received a large check, dinner, and a plaque naming them the employee-of-the-year.

After all of these policies and rules were implemented, we noticed a total change in the culture. Call-offs significantly decreased and tasks were being completed as assigned. I have not heard a negative word from anyone since the program was instituted. Now, keep in mind that I did not run the department like a dictatorship. In fact, I listened and encouraged my team members to make their own decisions on how each task was going to be completed. This freedom made them feel good about themselves. Of course, I was also not a pushover; things had to be done. As we all know, a manager who is too hard or too soft loses control of his team. Effective managers must be respectful but also should know when they must confront their employees professionally when necessary. Confrontations are usually things we try to avoid; unfortunately, they are often necessary. The bad apples need to be discarded and the good ones picked and pruned.

Tips for Change

When faced with an unruly culture, you must institute changes to ensure your success and that of your department. Use all of your available resources to ensure the change of your departmental culture. If you are a new manager, do not get discouraged; this happens to most of us. Get your CEO to be your greatest cheerleader. Reward those who enrich your culture, and confront those who must be confronted. Use your implied leaders, because they are your biggest allies. I recommend using implied leaders versus formal leaders, because formal leaders can sometimes be looked upon negatively. If you are faced with a situation like the one I just described, I suggest you get help. Do not expect changes to occur immediately, it is a slow process. In the end, all of your hard work will pay off and you will have a department that will be the envy of all. Good luck.

Miguel A. Bustillos, MBA, BSRT, RCP, RRT, is professor of health care management, California University of Management and Sciences, Falls Church, Va. For further information, contact [email protected].

  1. Nelson D, Quick J. Organizational Behavior. Mason, Ohio: Thomson South-Western; 2006.