Volume 8, June 2024

In today’s complex world, an organization’s culture is far from static, singular, or uniform, though it is often talked about as if it has these qualities. In our view, organizational culture encompasses a variety of dynamic tensions arising from multiple sources. You can see this, for example, in:

  • the clash between old ways of working and future aspirations
  • the interactions between different roles or identity groups and subcultures within an organization
  • the pull between cultural polarities in our identities and needs.

Cultural tensions can challenge organizations when they lie beneath the surface of awareness or discussion and present barriers to evolution and success. However, these same tensions can be turned into opportunities if organizations can surface these differences, acknowledge their place in the organization, and help foster healthy conversations about the cultural commitments and behaviors the organization needs to be successful.

This issue of Fieldnotes explores three cultural tensions we see in our work:

  1. Continuity and change in family businesses
  2. The orientation of a healthcare system’s culture towards patients or staff
  3. Productivity and pace in the workplace

Many businesses with a long history and track record attribute their success to the power of their organization’s culture, which has been cultivated for success over generations. Equally natural is the tension that arises when new ideas and practices (often advanced by rising, new generations) challenge older, established norms.

This tension is particularly pronounced in multi-generational family-owned businesses, where the founding culture in its original articulation may fall out of sync with evolving generational, societal, industrial, and economic environments. This is well illustrated in the case of Mechanized Solutions, a 40-year-old engineering firm in New England, where the founder’s children were set to take over leadership. CFAR helped the family assess the company’s culture, revealing that some specific traditions, like walking the production floor, had lost effectiveness as the company grew from a few dozen to hundreds. While the practice itself was no longer effective, deeper discovery work uncovered that the core values behind the original tradition remained relevant. By developing new practices aligned with these core values, the family translated tension into an evolution of the culture of the business, strengthened their bond with employees, ensuring a smooth leadership transition and positioning the company for continued success.



Traditionally, leaders of healthcare organizations articulate their vision and motivate their people by emphasizing that patients come first, a worthy focus. At this year’s American College of Healthcare Executives (ACHE) Congress on Healthcare Leadership, some organizations discussed the value of challenging this long-standing assumption.

One executive at an urban academic medical center is reframing their strategy for quality by taking an employee-first approach, contrasting the patients-first tradition. The idea draws from research and experience that taking care of their workforce will better enable them to do what they signed up to do: take great care of patients. While this reframing does not mean patients are not important (quite the contrary), cultural resistance is expected from leadership colleagues and, potentially, tenured employees in patient-facing roles. Though it may seem counterintuitive to a traditional patient-first mindset, if leaders prioritize healthcare workers in a quality strategy, it means putting processes and structures in place that enable workers to prioritize patient care rather than Healthcare workers focusing on their own ability to navigate the complexity and politics of the organization. This mindset shift has been highly effective in other industries, and we are optimistic it can take hold in healthcare. Even more powerful would be a shared vision across the entire leadership team of putting their people first, anchoring a strategy with structures and processes in place to enable their workers to provide excellent patient care.


As our world continues to adapt to change and implement new ways of working, we’ve given some thought to the tensions around productivity in our work at CFAR — reflecting on how we manage tasks, time, and the needs of our day-to-day lives.

Author and Georgetown Professor Cal Newport’s book Slow Productivity explores three key components to reduce busyness, be more productive, and experience “Accomplishment Without Burnout” as its subtitle says:
1. Do fewer things, but do them well
2. Work at a natural pace
3. Obsess over quality

These components sound reasonable on paper when considering the reality of our work. We all intend to do our best work, but actively living these and balancing the frantic activity of the “daily grind” is challenging! So, how can we shift our mindsets to slow down and be more productive? How can we balance this tension?

One concept Newport outlines (among many) is that of a pull workflow. This workflow requires unlearning habits we’re all guilty of, for example, accepting more work getting “pushed” onto our plates before we have time to focus on it. In a pull-based workflow, we aim to put incoming tasks in a “holding tank” and work only on our prioritized “active” list of tasks until we are ready to move on to or “pull” in the next one. Using the tools that Newport shares in Slow Productivity can help ease the tension of busyness in our work lives and pull us towards meaningful productivity.

What cultural tensions are you navigating in your work?