Looking forward – January 2020

David B. Hoyt, MD, FACS

Most of you know that if you hold a word up in front of a mirror, and read from left to right, it will appear to be spelled backward, but if you read it from right to left, you find the true meaning. Likewise, sometimes musicians will record a track so that if it is played backward, listeners will hear a different message than if it’s played normally. That is called backmasking. It, too, is a deliberate process. The same purposeful technique should be applied in turning around an organization’s culture. In this column, we describe how the American College of Surgeons (ACS) turned what was erutluc into a culture that better aligns with our mission.

Why culture change is necessary

Many organizations, businesses, and institutions have sought to eliminate counterproductive behaviors that were previously ignored, especially if these behaviors were exhibited by high-ranking or top-performing employees. In today’s workplace one-upmanship, pilfering resources from others, and belittling comments are recognized as not just inappropriate but toxic.

We now recognize that hiring and retaining talented employees requires leaders to establish a diverse culture in which respect is demonstrated for each employee’s background, talents, skills, and leadership style. People, regardless of profession or trade, want to work in environments that support our productivity, encourage collaboration, and embrace our unique abilities. As leaders of health care facilities, professional associations, and teams, surgeons must be laser-focused on what will matter and how we want to define the culture to deliver value-based, patient-centric care. We must commit to doing the time-consuming work of defining the culture we aspire to lead and defining the values we can use as our guiding principles to make decisions many times each day.

Defining our culture

Approximately seven years ago, the ACS partnered with GE Healthcare Partners to evaluate how we all worked. This process allowed us to reflect on who we were as an organization, where we were, and where we wanted to go. It was about having someone hold up that mirror so we could gain a different perspective. One of the gaps we identified was that the College had never truly defined its culture. We had a mission statement, but we had yet to express our Values—the centerpiece of any culture.

The Executive Leadership Team agreed to commit to protecting time to do what initially sounded easier than it was. We spent many meetings as a leadership group and months working with our staff in focus groups to see this project through. We knew we wanted a place where intelligent, collaborative, and caring people could come together and do what they do best each day. With this goal in mind, we defined our Values as Professionalism, Excellence, Innovation, Introspection, and Inclusion. Learn more about our Values on the ACS website. But establishing our organizational standards was just the first step in transforming our culture.

Values in action

Values are brought to life by the people in an organization. We introduced the ACS Values to existing staff and educated them about the importance of demonstrating their alignment with these principles. We revised our performance review process to make working in ways that are reflective of our cultural mores a significant component of each employee’s overall evaluation. This strategy reinforced that demonstrating our Values was a key responsibility for all ACS staff and leaders—one that is every bit as important as completing one’s work.

For new hires, it starts with the interview process. We have guides for hiring managers to use to assess whether candidates are a good cultural fit. It would be unrealistic to assume that everyone we hire knows what we want our organization to be, so we train to it. An organization’s commitment to the culture and its aspirational qualities means that it must be willing to teach its employees what that looks like. Training that is ongoing and continually builds on cultural expectations is promoted and embraced.

At the ACS, we offer training on our Values as part of the onboarding process. We also have each staff member take a DiSC (Dominance, influence, Steadiness, and Conscientiousness) and EQi (Emotional Intelligence) assessment. These assessments provide our employees with the opportunity to learn more about who they are and what is important to them and creates an opportunity to begin to understand that other contributors to our organization have different styles and priorities. Training in these areas encourages staff to engage in some Introspection and to appreciate the importance of Inclusion—listening to and appreciating the different perspectives and skills of other team members as they innovate, create, and produce the programs and services ACS members need to thrive in today’s health care environment.

Ongoing professional and personal development

The programs we offer are reflective of our commitment to our mission of improving the care of the surgical patient and safeguarding standards of care in an optimal and ethical practice environment. They are in line with our Values and the culture we aspire to sustain and evolve each day.

The College offers a robust set of training programs to ensure all staff can grow and develop intellectually in support of our commitment to Excellence. The Executive Leadership Team participates in ULead—four days of annual team training on key topics that align with our mission and strategic priorities. UConnect is offered 10 times a year for an hour to support the professional development of supervisors and covers topics such as becoming a manager and coaching conversations. UImprove is a multiday course that is offered to our staff to introduce how our organization has embraced Performance Improvement and Change Management techniques. ULive courses support our staff’s overall well-being, educating the team on topics such as ergonomics, managing finances, and mental health. ULearn classes are available to all staff on key topics each year, such as leading to engage, avoiding “the drama triangle” in the workplace, working and managing to individual strengths, and thinking outwardly, about the big picture.

In addition, we established a group known as Power of 8 to support our women leaders. The group meets monthly to reflect on individual challenges and success, creates an accountability framework for personal development, and contributes to each member’s professional development. This initiative provides a forum for building a greater network within the organization.

Finally, we offer tuition reimbursement, individual coaching, and support for off-site training courses and educational opportunities. Our commitment to the development of our staff is critical to the health and leadership of our organization.

The programs we offer are reflective of our commitment to our mission of improving the care of the surgical patient and safeguarding standards of care in an optimal and ethical practice environment. They are in line with our Values and the culture we aspire to sustain and evolve each day.

Culture change is no small undertaking, but we believe the benefits are evident in the programs and services we provide to College Fellows and members. This column may have offered you some ideas about how to improve the culture in your institution or practice. And maybe you have implemented some strategies that we have overlooked. If you would like to offer some suggestions or learn more about the ACS’ culture, contact Michelle McGovern, Director of Human Resources and Operations, at mmcgovern@facs.org.


If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at lookingforward@facs.org.

Tagged as: , ,

Notify of
Inline Feedbacks
View all comments


Bulletin of the American College of Surgeons
633 N. Saint Clair St.
Chicago, IL 60611


Download the Bulletin App

Apple Store
Get it on Google Play
Amazon store