CULTURE
When I left the Army and entered into private medical practice, I was far from home. My military obligation had taken me south of the Mason-Dixon line for the first time in my life and the culture I would live and work in for the next twenty-plus years was quite different than where I had grown up.
The city I settled in was a medium-sized burg in the southeast US. It was the state capital and home to the state university. There were three hospitals in town, and I was granted privileges to practice at each; two were smaller community hospitals — one Catholic and one Baptist. One was a larger teaching hospital that had formerly been a public/county hospital.
The Catholic and the former county hospital had cultures with which I was fairly familiar. The Baptist hospital, however, while well run, was culturally alien to me. Whether it was true or not, I never knew. Still, the hospital had a reputation for being the last in town to accept black patients and also (this part I know is true) was one of the last facilities in the country to accept Medicare payments after the Medicare act was passed in 1965.
What really surprised me was how loyal many of my patients were to the Baptist hospital. Many of them insisted on going to “The Baptist” when they needed hospitalization or outpatient care. I guess I shouldn’t have been very shocked about this, given that the entire community was, and remains so today, a very conservative place. My patients were simply asking for care from those who shared their cultural values.
Many years later, I became chief of staff at the larger teaching hospital and held that position when the Baptist hospital and the hospital where I was chief were merged to create a new multi-hospital healthcare system. One of our biggest challenges in successfully effectuating this merger was to bring the two distinct cultures of these facilities together into one. The medical staffs were quite distinct, with a lot of town-gown conflicts, since the teaching hospital was affiliated with the local medical school and the Baptist hospital was staffed primarily by private practitioners who had graduated from the older of the state’s two medical schools and considered the local school to be an unwelcome interloper to the community. Specific services offered by the two organizations were also often in conflict, with the Baptist hospital obviously prohibiting abortions which were allowed at the former county facility. Conflicts even arose as to whether or not we would serve alcohol at the new joint board retreats. To summarize, merging the back-office functions of these two organizations was relatively easy compared to trying to change the cultures of two very different places.
What I learned from that process is, I think, somewhat applicable to what we as a country are now trying to do with entrenched organizational cultures within areas like law enforcement. Don’t get me wrong; I strongly believe the criminal justice system needs a cultural makeover. That being said, I’m not sure that a top-down, mandated, and externally imposed culture change can happen in a short period of time. As I learned with the merger of the two hospitals long ago, it is sometimes better to push for things like culture change through a bottom-up approach and a lead by example approach. We were ultimately able to bring the cultures of the two hospitals together successfully. Still, it took many years, and in some cases, it took many retirements of those in positions of leadership and authority.
I also learned from this experience that care and compassion are two cultural traits that are literally impossible to mandate. We should remember this as well-intentioned legislation begins to roll out regarding law enforcement policies and procedures. All the rules and regulations in the world cannot change a dominant culture, and this can only come when what’s in the hearts and minds of those within the culture begin to change. I hope that we have the time and the wisdom to bring about this much-needed cultural change.
Many, understandably, want change to occur immediately. I sympathize with this desire. What I lack, however, is the conviction that we can accomplish this rapidly. Hopefully, there are those with more experience than I who can make this happen and do so quickly. The possible consequences of simply letting things play out over time are too dangerous. We must be patient but also continue to push hard for needed changes. Striking the right balance will be difficult but necessary to avoid disaster.
