Every now and you read something and it sparks an insight that has been just out of reach. It may be an article in a journal, a blog post, or sometimes a book in an entirely different field. As is often the case, it is in the moments when we are not actively seeking these insights that they spring up to meet us. In this case, a book about business and finance led me to some thoughts and discoveries about building successful healthcare clinics and organizations.

I recently read Enough: True Measures of Money, Business, and Life by John C. Bogle, the founder of the Vanguard Group. Though this book covers Vanguard’s history and John Bogle’s philosophy on investing and finance, it does offer insights into problems in our current economic environment and how to build great organizations. This got me thinking about great healthcare organizations I have seen, worked with/for, and been affiliated with. It also made me realize why those organizations stood above their counterparts.

Great Organizations

When you think of a great organization, what comes to mind? I tend to think about a team, company, or nonprofit that is bound together by a higher purpose; a mission of some kind. I also think of a place where staff and personnel enjoy being. Recent business books like Leader’s Eat Last by Simon Sinek or Radical Candor by Kim Scott all speak to this idea that a great organization is built around a great culture. I personally believe that a great culture is made up of two things: people & purpose.


The culture of an organization results from the purpose influencing the people. When I talk about culture of a company or clinic, I am talking about the overall environment; how it feels to work there, buy from there, etc. This feeling is a result of the organization’s people.

At a very basic level, an organization’s culture stems from emotional roots. People are emotional creatures and how we feel impacts the decisions we make, how those decisions are received by others, and other people’s response to those actions.  For this reason, I find it amusing when organizations talk about “improving the culture” by changing systems, processes, and protocols rather than addressing the “touchy-feely” piece that is the culture. Once the human —or emotional— side of the equation is sorted out, the processes and systems tend to fall into place.


How supervisors manage, how decisions are made, and how that affects staff members steers and forms the culture. These factors should be driven by the organization’s purpose; its mission, vision, and values. Many confuse an organization’s mission statement with its purpose. However, mission statements are often fancy business speak meant to purvey some ideal or attribute that the company thinks will make it look good to the public. These organizations typically operate from an entirely different set of principles than those reflected by the mission statement.

For example, I was recently speaking with an owner of a physical therapy and personal injury clinic in the metro Atlanta area. I wanted to get a sense of the owner’s values, reason for being in that business, and motivation to make changes at their clinic. I asked the question, “What brought you to the personal injury space?” I expected to hear some reasons around their skills and clinical expertise and how that fit with an opportunity in the market. What they told me was, “There’s more money in personal injury than in regular outpatient.” That is a valid reason. I mean, we’re all in business to turn a profit, right. However, after probing a bit deeper, the only answers this clinic owner provided was about money, volume, and revenue. The mission statement for the clinic was something like “dedicated to individualized care for each patient.”

Whether this clinic owner meant to or not, he projected that the purpose driving his business decisions related only to metrics and revenue; a far cry from “individualized patient care”. That’s not a very compelling reason that will cause employees, clinicians, or prospective patients to get excited about. As I’ve written about here, a higher purpose plays a critical role in compelling prospective patients and/or staff/employees to want  to do business with us or help us succeed. But simply stating a purpose is not the same as acting from it. Statements need to be backed up by decisions and actions.


Great organizations center around one thing: people. The people who work for that organization and the people who buy from that organization both play a role. Directors, supervisors, and staff members make decisions that directly impacts the culture of that organizations. Those decisions should be consistent with and grounded in the purpose or mission of that organizations.

So how do you go about doing that? By focusing on the people. I think this quote by John Bogle makes the point very well:

“Tell me, please, if you can, how to value friendship, cooperation, dedication, and spirit. Categorically, the firm that ignores the intangible qualities that the human beings who are our colleagues bring to their careers will never build a great workforce or a great organization.” (Bogle, 2008)

Ultimately, the people who work in our clinics and organizations make decisions. Those decisions impact both the quality & impact of the healthcare services provided; whether that be physical therapy, occupational therapy, or some other discipline or treatment. If we want great organizations, we need to focus on culture.

Building Great Healthcare Organizations

So how do we go about creating a great culture in our clinics and organizations?

I’ve written about here, that healthcare is about one thing: people. It’s about a person skilled in delivering treatment, serving and healing another person, who is on a unique journey to recovery. Metrics, number, and productivity demands come second to the human experience of receiving (and providing) healthcare services.

So how do you take this into account when designing the process of care? By focusing on the patient and the patient’s experience/outcomes rather than financial numbers and metrics. To again quote Bogle:

“…the human concerns of the caregiver and the human needs of the patient have been overwhelmed by the financial interests of commerce.” (Bogle, 2008, p.125)

It’s very easy —especially when running a healthcare clinic or organization— to focus almost exclusively on the metrics & financials. However, that misplaces the focus of the organization. Healthcare organizations exist to provide life-changing services and treatments. They exist to help their patients overcome dysfunctions & limitations. While the numbers do need to work out for us to keep the lights on, the main focus of every decision made in our clinics and organizations should be the well-being and experiences of our patients.

Process of Care

One final note on building great healthcare organizations: Great organizations are rooted in a great culture, made up of people & purpose. Those people —ideally— base their daily decisions on the purpose of that organization. Since healthcare is about people, it logically follows that great healthcare organizations focus their purpose on the patient.

That leads us to an important point: Clinics & organizations should design the process of care to allow human connection and relationship.

This may be as simple as allowing clinicians extra administrative time to spend reviewing medical records or even something as simple (and less costly) as training receptionists and office staff how to make the most out of a patient phone call.

Patient ExperienceAre we simply using a phone call to gather the data necessary to check the boxes on an assessment form, or are we using that call as an opportunity to hear/listen to that patient’s story?

Are we using that call to let the patient know that we care about them as an individual and not just how much their insurance company will pay?

How we gather data is arguably as important -if not more important- than what data we actually gather on these phone calls. That ultimately trickles down to the front-line clinicians who will treat that patient.


At the end of the day, healthcare leaders need to recognize that healthcare ultimately revolves around people: both clinicians and patients. Organizations should strive to build and promote a culture that focuses on the patients they serve and empower their staff and clinicians to make decisions in line with that objective. That means at times, letting the metrics take a back seat to the people.

What are you doing to build a great environment in your clinic or organization? Is culture an important piece of that puzzle for you? Share any additional resources that you found helpful in the comments below!

For more informational reads, check out our Blog to see all the articles we’ve published to date. Click here to head over to our resources section and check out our variety of clinical and professional resources aimed at increasing your knowledge and skills. If you’d like to make some changes in your clinic or health center, and would like some help, check out our consulting and advisement services or contact us to see how we can help you break out of the norm and provide a truly impactful patient experience.

Rafael E. Salazar II, MHS, OTR/L is the president and CEO of Rehab U Practice Solutions. He has experience in a variety of rehab settings, working with patients recovering from a variety of injuries and surgeries. He worked as the lead clinician in an outpatient specialty clinic at his local VA Medical center. He also has experience as an adjunct faculty instructor at Augusta University’s Occupational Therapy Program, as a Licensed Board Member on the GA State OT Board, has served on several committees for the national OT Board (NBCOT), and as a consultant working for the State of Georgia’s DBHDD. He is also on the Board of Directors for NBCOT. He works to help healthcare clinics and organizations deliver uniquely impactful patient experiences by improving service delivery through training & advisement.

Read his full bio Here. Read about Rehab U Here.


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[1] Bogle, J. C. (2008). Enough True Measures of Money, Business, and Life. John Wiley & Sons. Find it here.