The Bystander Effect in Organizational Culture: Cleveland Clinic

The Bystander Effect in OrganizationalI recently read Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way, by Dr. James Merlino. The book describes the Cleveland Clinic‘s transformation from a technically excellent but non-empathic health care system to an institution known for its patient-centeredness. Key to that transformation was engaging the employees in a mission of providing an excellent patient experience.

Dr. Merlino insists throughout his book on the importance of imbuing the organizational culture in every employee, from physicians to administrators to the people who work in the cafeteria and the parking garage. He writes:

Successful implementation . . . requires that everyone, regardless of role, is held accountable. A healthcare organization must not have two standards, one for doctors and one for everyone else . . . Leveling the organization by calling everyone a caregiver resets our purpose and, at a very basic level, reminds people why they come to work each day.

At some level, the reason why this consistent application of the patient-centered culture is so critical is because of the bystander effect. Normally this phenomenon is called upon to describe inaction in situations where people assume others will help. But I would argue that a failure to live into organizational culture is a parallel occurrence stemming from the same psychological process. When someone thinks, “Not my job” with respect to patient care, they are really thinking, “Someone else will do it, so I don’t need to.”

A common tactic for fighting the bystander effect is to call people out individually and ask for their response. Instilling an organizational culture across all roles, saying to every employee “Yes, you do need to work on providing the best possible patient experience,” in effect points the finger of accountability at everyone. Culture becomes the enforcer.

The right recipe for a culture in support of an excellent patient experience.
The right recipe for a culture in support of an excellent patient experience. Visual note-taking by Collective Next.