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.

Nurse executives: career derailment, success, and dilemmas.

Nurse executives are facing the complexity of orchestrating their leadership roles within a sea of turbulence. The realities of organizational change pose both threats and opportunities for career success or derailment. Understanding the realities is critical to success.

Reward systems: options and opportunities.

Reward systems encompass a wide range of options and opportunities. Just as there are a multitude of ways to design new care delivery systems, there are also many ways to design new pay systems. This article gives you an overview of some of the options.

Failure. Making it a positive experience.

It is naive to think that all failures can be viewed as positive. Failure hurts. It can create the lowest of the lows and anxieties that you did not know existed. It is not fatal, however, nor is it contagious. Most of all, it is not permanent. Failure is an event. It can be judged by how we view it and how others tell us to view it. We do not have to accept others' opinions about the event. We do have to decide how we will interpret it and manage it. It is the way we cope with failure that shapes us, not the failure itself. The real strength of character comes from knowing that we will survive, that survival will ensure a better life, and that we can learn to manage both our successes and failures.