Cultural Realignment After COVID-19: Signs Your Organization Needs Help

Added on May 27, 2020

By Martin Wright, Partner, Strategic Consulting

For many health care systems, the COVID-19 pandemic has revealed opportunities to improve aspects of organizational culture that leaders may not have been attuned to previously. Although the impact of the pandemic on day-to-day operations has varied across organizations, the crisis has universally highlighted strengths and weaknesses around such cultural considerations as communication practices, support for caregivers’ well-being, process reliability, and system resilience.

The need to adapt quickly to meet the changing care and workforce demands introduced by the pandemic required organizations to pressure-test their cultures, providing leaders with the unique opportunity to see how workplace attitudes and behaviors can be assets and liabilities, not only during a crisis but also under normal operating conditions. The challenge leaders face moving forward is in determining how to move forward with this knowledge. Should they try to rebuild the pre-COVID culture, or should they design and nurture a new one? The answer depends on what they experienced and learned in the midst of the pandemic.  

In working with colleagues and partner organizations around the country, we have identified six signs that may indicate your culture needs to be reinvigorated.

1) Caregivers felt unsafe due to a real or perceived lack of resources and equipment during the pandemic.

2) The organization furloughed and/or cut compensation for a portion of your workforce.

3) The organization faced staffing shortages and/or redeployed staff outside of their typical work environment.

4) Employees and medical staff perceived a disconnect between the communication from leaders and what happens at the bedside.

5) A perceived lack of transparency about risks, protections, and work status diminished trust in leadership.

6) Employees, medical staff, and leaders are exhibiting signs of emotional exhaustion and depersonalization in their work.

Even if only one or two of these signs are present, that is sufficient to warrant further cultural review. Creating an organizational culture that can rise to meet extreme challenges requires deliberately constructing an environment that helps all staff bring their best selves to work every day. The guidance in the table below supports this objective by describing actions that leaders can take in the wake of COVID-19 to reduce variability and help ensure alignment and engagement across the workforce.

Because this pandemic has affected different organizations in different ways, there is no one-size-fits-all approach to cultural realignment. Some organizations experienced a major surge of COVID-19–positive patients, some saw many COVID patients but did not have a surge, and some didn’t see many COVID patients yet may have had to furlough employees due to cancellations of elective procedures. Although many of the recommendations apply to all settings, some reflect the specific needs of staff as they related to each of these scenarios.


Leadership Strategies

Concern for Safety, Lack of Resources

  • Conduct a “lessons learned” review to understand what could have been done differently and what went well during the COVID-19 pandemic or surge.
  • Understand your response tendency in stressful situations to mitigate additional staff concerns.

Furloughed Staff/Cut Compensation

  • Increase leaders’ skills in managing conflict to help address situations that may arise.
  • Develop daily standard work for leaders relative to building engagement and accountability.
  • Adopt universal relationship skills to help build trust.


Staffing Shortages and Redeploying Staff

Experienced surge of COVID patients:

  • Continue higher capacity of staff to accommodate relief for staff who need time off.
  • Determine the potential for a ramp-down of agency staff and the need to bring on a new agency to relieve core staff.
  • Incorporate new staffing demands from the ramp-up of elective procedures.
  • Maintain early and active partnerships with shared governance councils and, if applicable, union representatives.


    Received many COVID patients, but no surge:

  • Develop a multidisciplinary team to review financial improvement opportunities across the enterprise while keeping safety, quality, experience, and engagement top of mind.
  • Develop a complex staffing and skill mix strategy that balances ramp-up plans between financial drivers and safety/risk management.
  • Evaluate a surge plan and ramp-up of resource needs, particularly a reliance on float pool and agency staff, for key limited resources in areas such as pulmonary and critical care.


    Received few COVID patients:

  • Determine long-term financial implications and the potential for labor reduction or position elimination.
  • Balance the impact of furloughs and potential layoffs on safety, quality, and patient experience.
  • Evaluate care model redesign opportunities to minimize the impact of absent employees.

Disconnected Communication/Lack of Trust

  • Ensure the message leaders deliver is aligned with the organizational mission by putting safety first in decision-making, supporting those who speak up for safety, and starting every meeting with a safety message.
  • Deploy local learning systems such as learning boards.
  • Host a virtual daily check-in to anticipate problems before they arise.
  • Conduct a success factor review to understand what went well.
  • Improve leaders’ skills in facilitating difficult conversations.
  • Define daily standard work for leaders relative to building engagement and accountability.

Signs of Emotional Exhaustion and Depersonalization

  • Conduct a culture and engagement survey to assess the level of resilience among team members.
  • Provide personal well-being solutions for leaders, physicians, and staff.
  • Recognize evidence of compassion fatigue, emotional distress, and other precursors to disengagement and burnout.
  • Provide leaders tools for spotting precursors to burnout in their teams.
  • Understand and eliminate the stigma of employee assistance programs and support solutions.


Significant events such as the COVID-19 pandemic shine a light on the strengths and weaknesses of organizational culture and provide leaders with an opportunity to look critically at what is working and what should be improved. Now is the time to act on the lessons learned by equipping leaders with the skills needed to nurture a highly engaged, motivated workforce committed to the delivery of safe, high-quality health care.


Visit our dedicated COVID-19 webpage for additional resources.