Silence Isn’t Golden

Much has been written about what leaders need to do in order to affect lasting and meaningful change in an organization’s culture. We know that leaders need to be clear about expectations, fully explain the ‘why’ behind the change, engage the hearts and minds of all employees, give frequent updates on progress, offer recognition along the way, etc. There’s no shortage of instructions on what leaders need to do.

I’d like to talk about the things leaders sometimes don’t do.

I’ve worked for many organizations that were trying to undergo a culture change. There were committees and cross-functional teams and retreats and kick-offs and balloons and all kinds of hoopla celebrating the new direction the company was taking. And there were plenty of dedicated people truly invested in seeing it happen. But many of them lacked something: the ability to speak up, call someone out, confront, correct. They were conflict-avoidant. And the changes they hoped for didn’t stick.

It’s hard to confront someone when he makes a comment that was acceptable yesterday but isn’t today under the new culture change initiative. But you must. Everyone is watching. Everyone wants to know if this is for real or just another flash in the pan that fizzles out like the other programs that have come and gone.

When the executive leadership team stands up in front of everyone and talks about the new plan and how wonderful things are going to be but doesn’t hold others or themselves accountable, they lose the confidence and trust of the whole team.

It isn’t enough to compile a list of behavioral standards to follow. It has to be okay for people, regardless of their job title or position within the company, to – respectfully – call others out when they say or do something that isn’t part of the new direction.

An old boss of mine had a framed saying on his wall right next to his desk. It said, “What you permit, you promote.” If he saw something he knew didn’t support the culture of the organization, he said something. He was always kind about it, but he didn’t let it go. It’s those little things, those daily interactions that shape culture and he knew it. He took a stand and made it okay for everyone else to do it, too.

If you’re naturally conflict-avoidant (like I am), you might want to take a lesson from people you know who can gently, respectfully hold people accountable for their behavior. Notice their tone, the words they choose, the focus on the behavior not the person, and suggestions for how the situation might be handled differently. Notice how much they realize the importance of saying something.

What you permit, you promote. Silence isn’t golden, it’s permission.



A few weeks ago, I got a phone call from an administrative assistant in one of our imaging offices. She asked about the courtesy van that the hospital provides to those who are in need of transportation but are unable to afford cab or bus fare.  A patient who had been in the day before said she had no way to get home but had used that service previously and found it very helpful. This administrative assistant didn’t have the voucher she needed and starting hunting one down.

The hospital had recently changed its policy about which departments were authorized to give these vouchers out to patients. Apparently, people were taking advantage of them. Funny, I thought the whole idea of the program was for people to take advantage of it…

She called another department – one that was authorized – and asked if she could have a voucher for patient who was here and needed to get home. The director responded with, “I don’t know, will I get in trouble if I give this to you?”

She had been in a meeting where the senior leadership team was ranting about how much money it costs us every time someone uses this service. She got the message loud and clear that anyone caught giving the service to someone who didn’t really need it would be in a whole lot of trouble. It was clear that managing the budget was more important than meeting a patient’s needs.

I had to ask myself, what kind of a hospital is this? What do we truly value? The buck kept being passed until someone decided that helping this patient get home was more important than potentially getting yelled at by an executive.

Thankfully, this all happened behind the scenes; the patient had no idea there was such a scramble to find a simple voucher, but as I was listening to this story it became crystal clear to me that we have sent our employees the wrong message. All this talk about patient experience and putting the patient first… it’s just talk.

Until employees – all employees – are empowered to take action that helps patients, you do not have a patient-centered organization.

Your patient experience efforts will go nowhere. And your patients will go elsewhere.