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Culture audits: a tool for change.

The culture audit, which has five phases--needs awareness, diagnosis, planning, action, and evaluation--is a critical tool for easing cultural transformation in healthcare organizations. The objective of the audit--usually conducted by outsiders--is to help leaders better understand the current culture and adapt the culture to enhance organizational performance. Most leaders contract with an outsider to facilitate the needs exploration process, often with the guidelines of an advisory team of managers and staff. During the diagnosis phase, the audit team chooses the data-gathering methods, collects and analyzes the data, and develops a model of the culture. The third phase of the culture audit involves planning interventions. Once leaders have a clear picture of their organization's culture, they must ascertain whether the culture will enhance or impede the changes demanded by healthcare reform and an increasingly competitive environment. During the action phase, the culture begins to move toward its desired future. This transition generally requires change in all the organization's systems, including technology, structure, rewards, decision making, budgeting, and managing. Finally, the organization assesses the impact of its culture on its performance. Using the original diagnosis as a baseline and the organization performance goals, the evaluation process maps the changing culture against the benchmark beginning and the goals.