Eggs, bacon and pancakes arranged in a smiley face

Over the past several weeks, I have engaged with several health care non-profits and in all cases the conversation turns inwards: organizational culture. It reminded me that culture is one of the main reasons why most organizations (public and private sector) fall short on implementing or sustaining innovation.

Most of us have all heard the phrase coined by Peter Drucker “culture will eat strategy for breakfast!” There are countless publications on organizational development and like many of you, I too have seen organizations who embraced change and innovation and flourished…and organizations who fell short of their goals, sometimes the result of a design flaw in their strategy, but most often because “culture ate our strategy!”

Why does this happen? Well, change is hard. But here are some “well knowns” in the business community that apply to the health care sector:

  • People are loyal to culture, not to strategy
  • Culture is more efficient than strategy
  • A brittle culture can doom even a great organization
  • When strategy and culture collide, culture will win
  • Culture provides an emotional safe zone and offers resilience in hard times
  • Culture will have a significant impact on your bottom line

Think about innovative companies like Southwest Airlines, Apple, Starbucks, Ebay, Amazon, the list goes on. What’s sets them apart from their competitors? It’s the culture of their organization.

“So how do we change that?” you ask? My response: you gotta add the Secret Sauce.

I used to think that the Secret Sauce that makes great and sustainable organizations was one thing, like one ingredient. I’m not so sure now. Ketchup is made up of several ingredients, right? BBQ sauce is made up of several ingredients, right? I’ve been thinking that the ingredients that make up the Secret Sauce of great organizations. Here are a few ingredients:

  • Leadership
  • A clear sense of mission and vision
  • The right staff skill mix
  • The right “personalities” for the job (AKA “goodness of fit”)
  • Clear roles/expectations
  • Effective communication
  • Ability to be nimble/flexible
  • Oh, and did I say Leadership?

These are just a few of the ingredients that, if bottled up and added to your organization, have the potential to change the flavor and culture of your organization!

So you can have all the pieces in place to advance a paradigm shift or implement a new program, but if you don’t have the Secret Sauce to add, as we say in Texas: “it ain’t likely gonna happen.”

Now you won’t find this kind of stuff in clinical journals…but you will find it in reputable publications like the Harvard Business Review!

Final thoughts: corporate culture is as tough as nails, as stubborn as a mule, and resilient, and these are not bad traits at all! As well thought out as any strategy may be, it’s an organization’s culture that will drive that strategy to where it needs to go and give your organization that competitive edge in today’s environment. This applies, maybe even more so, to the heath care sector as we continue to push health care transformation and reform to achieve improved health outcomes, engaged participants in their health care, and cost containment.


Rick Ybarra serves as program officer for the Hogg Foundation for Mental Health and leads the foundation’s Integrated Health Care Initiative. With over 25 years of clinical and administrative experience in both private and public sector behavioral health, Ybarra’s policy and program experience extends to county, state and national efforts promoting reforms, public policies and clinical practice to improve effective service delivery and health equity for racial/ethnic populations. Ybarra joined the foundation in 2007. For more on Ybarra, see his bio or follow his blog on health care reform.