How do we Create Culture?

A new clinic asked me this question recently, before they had hired a single member of staff, and I could tell they weren't looking for a slogan. They already had their core values worked out. What they didn't know was how to get an entire team living them once the hiring actually started, and my answer surprised them because it wasn't about workshops or away days or any of the machinery most practices reach for when the word culture gets raised in a meeting.

It isn't a mission statement laminated and screwed to the wall in reception, admired by nobody and read by fewer, gathering the same dust as the pot plant beneath it. It isn't a list of values sitting in a folder on a shared drive that someone wrote once during a strategy session and nobody has opened since, filed away like a warranty card for an appliance everyone has forgotten they own. Those things feel like culture because they look like the artefacts other organisations produce when they talk about culture, and so we copy the artefact and assume the substance will follow, but it never does, because the artefact was never the point.

Culture is shared values, held by people who already held them before they walked through your door. You don't install values into someone through onboarding. You don't talk a person into believing something they don't already believe, no matter how good the induction pack is or how many times you repeat the phrase patient first during a team meeting. Beliefs are formed long before someone arrives at your practice, shaped by every workplace they have passed through and every experience that taught them what good care looks like and what corners are acceptable to cut when nobody is watching, and by the time they are sitting across from you in an interview, those beliefs are largely set.

The first thing I told them was to slow down before they wrote a single job advertisement. Get brutally clear on what you actually believe as a clinic, not what sounds good on a website or in a brand deck, but what you will actually defend on a hard Tuesday when a patient is upset and a staff member is stretched thin. Most owners skip this step because it feels slower than just filling the roster, and then they spend the next two years hiring against values they never properly named, wondering why the team feels scattered even though every individual on it seems competent enough on paper.

This is the part practice owners find hardest to accept, because it means culture isn't something you build after the fact through better communication or a stronger set of policies. It means culture is decided at the point of hire, in the ten or fifteen minutes where you're deciding whether this person shares what your team already believes about how patients should be treated and how colleagues should speak to one another under pressure, and if you get that decision wrong, no amount of coaching afterwards will fully correct it. You can manage behaviour. You can enforce a standard. What you cannot do with any real reliability is change what someone fundamentally believes about their work, and every practice owner who has spent months trying to turn around a mismatched hire eventually learns this the expensive way.

I think of Jessica Kriegel's TEDx talk on this often, where she makes the case that culture is not built through tasks and to do lists but through belief, and that the gap between a team that has to do something and a team that wants to do something comes down entirely to what that team believes about the value of the work in front of them. She describes the shift from managing people through more oversight and more check ins to shaping the experiences that let people arrive at a belief for themselves, because belief drives action in a way that instruction never quite manages, and action sustained over time is what eventually produces results. It is a useful reframe for healthcare, where the temptation to manage through more policy and more meetings is constant, and where the actual lever, the belief someone already carries about what good patient care looks like, gets overlooked in favour of the parts we can more easily measure and file.

So when that new clinic asked me how you create culture, what I meant was this. Stop treating culture as something you produce after the team is assembled, through better meetings or a values refresh or a new set of posters for the tea room. Start treating it as something you protect at the point of selection, by being honest with yourself about what your practice actually believes, not what you wish it believed or what would look good in a job advertisement, and then hiring only the people who already hold those same beliefs before they ever accept the role. It is slower. It means turning away candidates who look competent on paper but don't share the underlying values your team has spent years building. But it is the only version of culture that survives contact with a busy Tuesday, because it was never dependent on a document in the first place. It was dependent on the people, and it always will be.

If your team's culture feels like it keeps slipping no matter how many values statements you write, the fix usually isn't another document. It's a harder look at who you're bringing through the door, and CouperMed can help you build that filter properly, from the interview questions through to the reference checks that actually test for belief rather than competence alone.