IT Department of a Large Hospital System: Leveraging Culture as a Strategic Business Driver


In an effort to be proactive regarding the organization’s culture, each year, the IT department of a large hospital system conducted an employee engagement survey. Launched in September with results announced in November, the survey of roughly 1,000 staff members served as a temperature gauge for the department. This process provided management with insight into the organization’s culture and how well things were progressing with their change efforts.


The Need

The associate director of the department monitored the results of the annual survey over the course of several years and noticed that the data remained the same. There appeared to be no progress in key areas.

What she found was that the employee engagement survey gave leadership a sense of how the staff were experiencing the IT department, but it did not help leadership understand what was working and what was not working.

Also, the survey did not reveal whether the department’s strategy was clear to all staff, how staff was working cross-functionally, whether leaders were aligned, or how well the department was listening to feedback from customers throughout the health system.

In response to this lack of helpful information, leadership started looking for ways to improve their understanding of such things as the state of their leadership development activities and executive team communication. They wanted to know more about the department’s culture and how that culture is being propagated.

In 2018, reacting to healthcare reform and developments in the digital space, the IT department committed itself to exploring two important areas:

  • The implications of culture on team performance and engagement, and
  • How to leverage culture as a strategic driver for business.

Leadership’s perspective and involvement needed to be at the center of this cultural intervention strategy.


The Intervention

To help them with their internal examination, the IT department engaged gothamCulture.

First Session: Awareness of Current Environment

The first activity was to deploy the Denison Organizational Culture Survey with directors and above to determine what their perception was regarding how the department was functioning and how work gets done.

This first session was illustrative of the department’s issues. Participants were divided into groups and asked to use BrainflakesTM to build a model of what they felt the current culture was. All the models were different. And none were a positive reflection of the culture.

For example, one group created a cohesive model but broke it apart to symbolize the disjointed nature of the department.

Another group built a rollercoaster. A few groups built tall, individual structures.

What this exercise validated was that the department was very siloed.

The organizational structure was largely responsible for the silos. There was a CIO with 15 direct reports. All the direct reports had teams that reported to them, and they actually called those teams “towers.”

It was clear that, although staff in the department were performing, they were performing in spite of themselves.

Second Session: Understanding Culture

In the second session, the group of leaders were brought back together to dig a little bit deeper. After explaining the results of the Denison Organizational Culture Survey of over 80 participants, gothamCulture identified two key areas that needed to be prioritized to have the greatest impact on both performance and engagement:

  • Mission alignment – Seek agreement on answers to the following questions: What does the department do? Who does it do it for? How does it do it?
  • Consistency in terms of workflow – Help address the following question: Do our systems, processes, and behaviors drive efficiency, reliability, and results?

The outcome of the second session was a commitment to work together as a group and to invest equally in making the identified necessary changes.

Third Session: Planning for Action

The third session involved action planning relating to the two key areas of mission and consistency. gothamCulture broke the participants out into their “towers” and asked them to work on a project together. There was a lot of frustration with the process and little forward progress.

This was largely because they were still working in towers and not as a cohesive team. Each team still had vastly different priorities. Team goals were simply not aligned to the department’s goals. The participants were asked to do something that they already knew they did not do well.

The session was rescued by the formation of a Culture Champions group. This group was formed by nominations and was tasked with taking an even deeper dive into the department’s culture. The idea was that a group of 10 leaders could accomplish more than a group of more than 80 people.

Before the next session could take place, a system-wide review involving a large outside consulting group was conducted to search for money-saving opportunities. This was an all-hands-on-deck initiative that required everyone’s attention. Consequently, the culture sessions were put on pause.

Fourth Session: Storytelling

The next large-group session was held several months later. It was a well-received session that featured Michael Margolis, the founder of Storied, who facilitated a discussion on storytelling. The idea was that culture could be transformed through stories.

It was a time of rapid change within the hospital system. There was a lot of cost-cutting and layoffs, and people were feeling vulnerable. Fortunately, the Culture Champions continued to meet and discuss the culture action plan.

By this time, there was some networking and relationship building at the directors and above level. It was clear that there were pockets of comradery and trust being developed that was never there before. People were starting to “get it.”

After the storytelling session, gothamCulture asked the participants to reflect on all the prior sessions and identify positive and negative experiences. Everyone worked cross-functionally on this project.

That activity reflected a major breakdown of silos and was an important bonding experience for the participants. It was an emotional and celebratory event. For the first time, they really embraced each other as leaders and as people. They left the session looking forward to the next one. Someone even stated that they needed to meet more frequently.


The Impact

On March 1, 2020, the health system admitted their first patient with COVID-19. Due to government-mandated lockdowns, the sessions halted, and the group began to work remotely.

Largely because of the progress made during the sessions facilitated by gothamCulture, the IT department worked together internally, and together with other departments, to rise to the occasion to do things like rapidly set up an external emergency facility to treat COVID-19 patients.

Overall, the leadership team demonstrated a secure bond and the ability to work collaboratively to get things done.

Today, they are working towards the mission of the entire health system and not just their department silos.

A year after the first COVID-19 patient was admitted, the IT department held a session during which they reflected on everything that had taken place throughout the year. It was a non-mandatory, after-hours event which 180 people attended. The event was so moving that people stayed around for nearly an hour after the event ended to share stories with each other.

About gothamCulture

gothamCulture is a management consulting firm that draws on our associate’s comprehensive expertise and experience in the areas of culture, leadership, and people strategy to provide innovative solutions and client-service excellence. Our work is guided by our deeply held shared values, including a commitment to each other and our clients, unwavering integrity, the maniacal pursuit of excellence, relatable expertise, and authentic community. For more information, visit