How to Tell if a Hospital’s Culture is a Good Fit for You was originally published on Hospital Recruiting.
Job interviews are like speed dates that result in marriage.
Both sides spend the interview trying to develop enough insight to make an informed decision. Everyone shows off his/her best attributes while tactfully unveiling the other person’s worst. The dance ends with both parties asking themselves the same question: Do I want to spend my life with this person?
Or, if you work in medicine: Do I want to spend a few years with this person?
Healthcare providers talk openly about their jobs. We walk into interviews knowing the tangible things a job may offer—things like pay, schedules, or benefits. By the time we walk through the interview door, we know the market and where a potential employer fits into the landscape.
The intangibles, however, aren’t as accessible. These are the unspoken aspects of a new job that take time to be decoded. Tangibles may get us through the door but it’s the intangibles that make us want to stay.
In a life partner, those features are collectively called personality. In a job, they’re called culture.
Stories and traditions are the fabric of organizational culture. It’s the terminology and environment of the workplace. The way people address one another. How rules are enforced or how independent people are. It’s the attitude and the vibe of a workplace.
Culture is the unmeasurable experience of being there day to day.
Fortunately, unmeasurable doesn’t mean undiscoverable. You can gain insight into the culture of a prospective workplace before you sign a contract by implementing the following strategies.
Know what you want before the interview
“If you don’t know where you are going, any road will get you there.”
– Lewis Carroll
Envision your perfect job well before you start the search. Imagine it in as much detail as you are able.
If you don’t know what you want, you’re going to have a much harder time knowing what questions to ask and the implications of the answers you receive.
Be unapologetically honest with yourself. You are envisioning the ideal job for you, not negotiating one in real life—so be deliberate and conscientious when you answer the question:
What does my dream job look like?
How often and hard do you really want to work? What kind of patients do you hate seeing? What age of co-workers do you most identify with?
Is creativity important to you? Make sure it’s included. Do you want to go back to school for photography and need a job that’s flexible enough to support that dream? Be sure your new job allows you to do this.
Or, maybe you need a specific job title now to get your dream job tomorrow.
Being honest with yourself in the early stages of the job search is critical. The job you want exists but it won’t be handed to you; you will need to craft it from the jobs available to you— but you’ll have to know what you’re looking for to make it a reality.
Example scenario: I interviewed at an academic medical center that was trying to promote a “research-oriented culture.” This meant that I’d be assigned to a research team that meets at least monthly to ensure that everyone was constantly publishing. This was in addition to mandatory weekly didactics and bi-weekly journal clubs.
I knew that I wanted to travel and needed a significant amount of freedom. I also knew I did not want to be required to attend meetings every week, regardless of the need to meet. That culture was too structured; too constant and too rigid. I knew early that I wouldn’t fit in well and didn’t take the job, despite my desire to work in academic medicine.
The Value of Job Shadowing
If it’s possible, spend time observing the unit you’re applying for.
When we’re entering medicine, we shadow to gain insight and exposure to the field and possibly to gain letters of recommendation.
Shadowing a prospective workplace is slightly different. You’ve already gained the medical knowledge; what you’re observing are the interpersonal interactions, learning how employees treat each other and the patients. You want to leave with a sense of the climate, urgency and professionalism. Through observing, you see how (or if) people solve problems and what kind of problems they face.
Observing your prospective team in action lets you determine whether you can see yourself as a member.
Most importantly, shadowing lets you meet the patients. Hospitals have different proportions of similar patients. Providers generally know what types of patients they like working with. The demographics cared for, the types of medical problems typically seen, the acuity of patients—shadowing for even one shift could save months of working with patients you aren’t comfortable with.
Locums positions can provide a similar opportunity for physicians and APPs. Short term contracts may be available at the organization you’re considering joining. If these are available, you can work in the organization on a temporary basis before making any major commitment. This is a particularly attractive option if you’re looking at moving to a new region where the facility itself may not be as important as figuring out whether you want a new locale.
Example scenario: We were considering a move to a different part of the state. I found out that a hospital in the new region was hiring locums so I took a four month contract with the locums company.
In those months, I learned everything I needed to know about the culture of that facility—from work ethic and professionalism to the quality of care.
I also learned about schools, crime, places to live, recreation, family life—basically, anything I needed to know to make the decision to move. I did all of this with no real commitment and while being paid to be there.
I also learned about the patients served in that area and whether I would be a good fit for that patient population. The experience taught me the value of a locums position when considering a lifestyle change.
Evaluate the processes you have been exposed to
You will have been given samples of a company’s culture by the time you interview.
How did the company contact you? Personally or through form letters?
Were you forced to make an online profile, upload a resume, then manually enter the same information from your resume onto your profile and then watch a short video about the company’s mission before you were allowed to click “submit”?
And after all that, were you forced to endure back-and-forth emails with a recruiter who didn’t really understand your questions?
That experience speaks volumes.
Or, were they personal? When you were called and invited to the interview, did they greet you at the door of the facility?
The hiring experience is your first impression of the organization. If it’s clunky, they will never have a second chance to make it.
Case study with good processes: I was working locums in a different state. Credentialing took about two months. A month before my first shift, I received a manila envelope with detailed instructions telling me when and where to show up with a diagram telling me where to park.
When I arrived, a representative from the medical staff office was waiting for me in the main entrance, knew my name, and greeted me warmly. She took me through a personal tour of the facility that ended in the quality department.
When I arrived, my identification, parking tags, computer, and gym access were ready to go. They walked me through the quality metrics and focused on which processes in the ED those metrics correlate to. The CEO arrived during the meeting and introduced himself. He already knew me by name, where I came from, and what I was doing there. He then welcomed me to join him during their weekly medical staff meetings—he explained they were voluntary, breakfast would be provided, and he would love it if I could attend a few.
I was then escorted to my first shift where the medical director was waiting for me. I logged in to the EMR and began a training shift. The entire experience was seamless, totally integrated and welcoming.
Case study with not so good processes: One facility took roughly eight months to credential its providers. There was no clear interview process (either you didn’t interview or would have an informal interview with an available member of leadership). Credentialing paperwork wasn’t clear, and when it was completed, providers weren’t notified. Not only were providers not notified, but their information wasn’t forwarded on to other relevant departments (like IT or parking). It was essentially up to the providers to call and constantly remind the hospital of their application.
There was no orientation process and no on-boarding for providers.
A provider would know everything he/she needed about this organization’s culture by simply looking at their hiring process!
Learn how people advance
“If you don’t design your own life plan, chances are you’ll fall into someone else’s plan. And guess what they have planned for you? Not much.”
– Jim Rohn
Think of career advancement as the continuation of your hiring process.
Advancement could mean new skills, education or projects. It could also refer to job titles and hierarchy. Whatever form of advancement is important to you, how do employees achieve it?
For example, are the doctors sent to an annual leadership course to become better team managers? Are nurses trained in quality improvement training to oversee critical processes?
Through what mechanism does an Assistant VP become a VP? Is it time, productivity, or does someone else have to quit to make room?
Learning how people advance is a great window into the structure, performance evaluation, and culture of an organization—but if you don’t know where you want to wind up, it will be hard to judge the answer.
Case study: I interviewed at a faith-based organization. I learned during the interview that unless I was a member of this faith, I would not be able to ascend beyond the position I was interviewing. In other words, I would have the same job in ten years that I was currently interviewing for.
Although I can respect their values, the impossibility of career growth made that organization a poor fit for me.
Questions to Ask to Reveal Work Culture
It’s your job and your time—ask relevant questions during an interview to get a sense of the culture. There are plenty of sample lists online, but a few examples are:
“What’s the best part about working in this environment that I won’t be able to see from just a walk around the office?”
“What are the most common complaints employees make about your culture?”
“How often does the staff meet?”
“When and how do people like to give and receive feedback?”
“What’s one thing you would change about the company if you could?”
“What was the department’s biggest challenge last year and what did you learn from it?”
These questions ask for examples of the culture without directly asking “What’s your culture like?” They require the interviewer to show (not tell) you the climate of the organization..
Case study: I interviewed a physician who had an interest in international medicine. This meant that she would have to leave the department for weeks at a time, several times per year. She asked for specific information about scheduling practices, whether other people have international interests, and whether they have been able to achieve their goals. She also asked what the perception of the other members of the group is regarding those with international interests.
By asking about examples and details, she gleaned much more information than asking “Would I be able to work in international medicine?”
Do your research
Don’t be shy to tap your network if it includes potential co-workers. Contact them to learn about life at the company. This is especially true for ex-employees, if they are in your network. Be willing to take people with direct experience of the organization to lunch and explore their decisions to stay or leave.
There are also plenty of indirect, online resources that let you learn about a company before you sign the contract:
Sites like Glassdoor, Indeed or Kununu provide reviews of companies, written by current and past employees. Read through these as you would any review—you’re looking for an overall sense of the organization; don’t let one review (good or bad) color your impression of the entire organization.
Also, sites like HealthGrades, Medicare.Gov or LeapFrog provide quality, safety and patient experience data. These sites don’t use employee reviews, but they do give you an indirect sense of how the company performs. If the hospital has high grades on multiple platforms, there’s a good chance it’s a high performing organization.
Case Study: The website of the hospital itself is also telling. I interviewed at a hospital that did not have a working website. When I interviewed there, it was clear—the website wasn’t the only thing that was untended.
I interviewed at another facility that didn’t include emergency providers in its online directory of medical staff. For an institution where the overwhelming majority of inpatients come through the ED, this oversight spoke volumes.
Other facilities have streamlined, clear, relevant, patient-friendly websites. These sites give you the sense that the organization enjoys seeing patients, wants to empower them, and is grateful for its providers.
There’s no reason to settle for a culture that doesn’t support you.