Is your practice culture well-defined?

Unlike in years past, this summer I went on vacation--in the respect that I actually left town at least--albeit with some work in tow. It wasn't getting up early to write a few mornings that was much of a big deal. What did take a surprising amount of energy, however, was the dynamic of co-vacationing with another family.

These are people I really, really like. Conflict wasn't an issue. But combining two family cultures under one roof for a week? It was definitely eye-opening. Even though we were at the beach, we had a household to run. There were meals to cook, activities to plan, messes to clean, children to tame, supplies to replenish and so on. Inevitably, there was a lot of turn-taking and give-and-take.

Fortunately, although we may have had some different family idiosyncrasies, our core values are similar enough that we merged successfully.

We've all been in situations, however--oftentimes at work--where the attitude and behavior of one or two people don't gel with the rest. There might be the coworker who routinely sits back and always waits for others to contribute ideas, the one who hardly gives anyone else a chance to speak, the person who overreacts to problems, the other who doesn't seem to take the job seriously.

It doesn't take much of a mismatch to sour the spirit of the entire team. And that's why hiring for cultural fit is so important. In fact, I spoke to a physician owner of a small family practice recently who said the group made all hiring decisions by committee.

"We take three months, sometimes six, to see if somebody's going to work out, and everybody on the team gets an opinion on that. If there are one or two team members that say, 'I don't feel good about this person then we don't hire them,'" explained Edward Bujold, M.D., who leads Family Medical Care Center in rural North Carolina. "It's like a football team. If anyone doesn't buy into the vision, have the skills it takes to do what we do or just plain doesn't want to do it, then they need to leave the organization."

I respect that philosophy and have heard similar explanations from other practices. "Not everyone can work here," was the phrase used by the office manager I shadowed for a day last winter. And that group was fairly large--yet I still got the vibe that it functioned very much like a family--if family members had to behave professionally, that is.

I have to wonder, though. How does a group prevent having to vote people off the island? Surely, even after 12 weeks or so, any departure must be disruptive.

If you haven't done so already, take some time as a group to define your practice's culture. Brainstorm as a group what you value about the way your team runs, put it in writing and post it prominently. Key words such as courtesy, communication, effort, priorities and accountability come to mind. Tell your story, both as an exercise to build team pride, but to inform candidates of the mores they'd be expected to share. It can take time to catch on to these nuances if they remain "unspoken" rules, which isn't really fair to a newcomer, so talk about them.

What do you think? Is your practice's culture well-defined? How do you help potential candidates get a feel for whether they'll fit in? In what areas to mismatches most occur? What are the best ways to help an employee with a very different (or no) work background assimilate to and feel welcome in your practice? - Deb (@PracticeMgt)