• Series: A Thriving Practice Culture

    Part 1: Give Your Team Permission to Change

    Family physician Mark Greenawald, MD, FAAFP, of Carilion Clinic Family and Community Medicine in Virginia, believes that a thriving practice culture—a workplace that is respectful, uplifting, and fulfilling—is the product of choice rather than chance. In other words: If you want it, you have to help create it. In this three-part series, Greenawald offers some practical tips for how to get started.

    Staying Open to Allow Change

    Physicians don’t have to “own” culture change for change to occur. But as leaders within the practice, they do need to be open to allowing change. “Physicians often don’t understand that there’s a power differential,” says Greenawald. “Staff may notice some of these practice culture issues but be afraid to say so.”

    Opening a dialogue about your practice culture with staff is a good starting point. You can use Greenawald’s 5 STARRS instrument as a guide. By initiating this conversation, you legitimize the team’s concerns and feedback. You’ll also lead the way for others to speak up, be engaged, and offer ideas.

    That’s not to say that the ensuing conversation will be easy. The key to having a healthy, authentic conversation with staff is to accept and honor their perspectives and input. “Physicians have to have the willingness to seek feedback, listen to it, thank people for giving that feedback, and then take appropriate action, without getting defensive,” says Greenawald.

    Remember that you don’t have to solve every problem yourself. Once your team has identified an area of potential improvement, give staff the authority to take action. In Greenawald’s practice, when they realized a need to foster social connections among staff, one of the licensed practical nurses (LPNs) stepped up as social chair and is now the team’s leader for staff social activities. “It was a gift that we had someone step up by default,” says Greenawald. If that doesn’t happen in your practice, don’t just let an issue persist. Ask for help directly from a staff member who has shown an interest in the problem or exhibits the qualities you seek. 


    More from Greenawald

    Written by AAFP editorial staff.

    Mark H. Greenawald, MD, FAAFP, is Vice Chair for Academic Affairs and Professional Development, Carilion Clinic Department of Family and Community Medicine, and an associate professor of family and community medicine at the Virginia Tech Carilion School of Medicine, Roanoke, Virginia. He is on faculty at Carilion Clinic’s family medicine residency program, chairs the Carilion Clinic physician well-being committee, and serves as the director for the American Academy of Family Physician’s (AAFP’s) Chief Resident Leadership Development Program.