Organizational culture: the critical link between strategy and results.

The U.S. Department of Veterans Affairs (VA) is undertaking a massive reorganization to transform itself into a more efficient, patient-focused healthcare system. It has developed a new strategy and structure. But if it is to achieve the rapid, sustainable transformation needed to succeed in today's environment, it must also change its culture. The rigid, functionally focused, command-and-control culture that has long been a hallmark of VA must be replaced by one that values speed, flexibility, and the processes for delivering high-quality, cost-effective patient care. Such a change will not come easily. In addition to the normal hurdles, several barriers are unique to VA. They include ingrained bureaucratic traditions and behaviors, constraints imposed by the federal government, close scrutiny by powerful service organizations, and a Civil Service employee base that makes the hiring, promoting, and removing of employees a slow, unwieldy, and procedurally complex exercise. In a climate that does not encourage change, successful transformation must be well orchestrated. To drive the change, the leadership must be mobilized as a team, new work processes must be developed, and a full range of human resource processes must be established.