Before I get started, let me define what I’m talking about. All workplaces have a culture that is uniquely theirs. Since I have worked primarily as a musician and an ER nurse, I’ll use my experience to try and illustrate this concept. Recording studios are a great example – particularly before the internet when information was a little harder to come by. The ones that were very successful and stayed in business would develop their own way of doing things based on successful practice. Where to put the microphones, how and when to “ride” the faders on a console, the way clients were to be treated, when and how to use compression and EQ, etc.
Likewise in the ER there are standardized “best practices,” but each individual site would have their own way of doing things in terms of how they meet these guidelines. For example, does nursing place intraosseous devices or does medicine? Does nursing administer Alteplase to acute stroke patients in the ER or in CT immediately upon interpretation of the scan by neurology? Do they reconstitute at the bedside or wait for pharmacy to do it? What does the relationship between medicine and nursing feel like?
All of these things generally start with an individual, someone who is a “game changer” – they come up with a better way of doing things, and because they are totally engaged, tenacious, and focused on improving practice, their coworkers notice and begin emulating their methods and behavior.
This is how culture changes.
This is what we should all strive for. We won’t always make it, but as long as the consistent intent to improve is there, things will change.
Try it. You probably have more influence than you think.