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The other day, in a meeting with a client in a congested urban city on the West Coast, I noticed that the first 10 minutes were taken up with parking.  Everyone shared, in some cases bragged, about where they found a parking space.

I was amazed, but apparently this “here is where I parked, what about you?” exchange is a ritual every time meetings were held at this particular location, which was frequently.

At another client’s shop, gas prices took top billing.  The talk here was about the high cost of gasoline – at every octane level – and where the cheapest prices could be found.  There is a smart phone app, but apparently this is a conversation that is part of the meeting culture for this leadership team.

In Texas, not surprisingly, the pre-meeting chit chat seems to focus on football.  Even in the middle of the blazing summer, with baseball season in full throttle, meetings seem to begin with a conversation about every imaginable football issue, from the draft – how the GM screwed it up again – to the health of the quarterback, a team star who has yet to win the game that really matters.

In other organizations, in other cities, they have different pre-meeting rituals, from talking about another company issue, a weekend festival, the big concert, the weather, or even some juicy gossip about their competitors down the street.  Regardless of the subject matter, it seems to be part of the meeting routine for many organizations.

These routines, and ones similar, are part of any organization’s culture.  They are not the defining part of the culture, at least I hope not, but they are a strand which, when combined with many others, defines who the organization is and what it stands for.

The amazing thing to me is that many times, the turnaround CEOs who come to change the culture, miss the real importance of these strands altogether.

I have worked as a healthcare consultant and as CEO for many years and rarely have I heard the casual pre-meeting conversation focus on the quality of care and the safety of the patients under our care. I know it must happen, but in my career, I have not witnessed it.

I think we get tripped up by the notion that improving quality and safety is such a complex problem.  There are many people who argue that it is this complexity that thwarts our efforts, hence our inability to make dramatic improvements to protect our patients.  We can’t seem to get our hands around it so, therefore, we do not talk about it that much, especially in public.

To be fair, I know there must be some great organizations, large and small, which do obsess about these issues — always talking about them — but I doubt seriously they are anywhere near the majority of health systems and hospitals.

At the end of the day, though, I have always believed that the organizations that are obsessed with improving quality and protecting the safety of patients, whose CEO is an endless drum-beater for this cause, are the ones not with better quality numbers, for they can be managed,  but the ones who, day in and day out, actually deliver better, safer care.

I could be wrong…