How Quiet Choices Shape Your Culture
You’ve probably been there: You roll out a new mission statement with fanfare, plaster your values in the lobby, maybe even host a team-building retreat with breaking news that “This Year, We’re Committed to Accountability.” Yet, months later, little seems to change. The feeling in the clinic, the side glances in meetings, the unspoken norms—they all seem at odds with what you thought you were building.
The truth is your real culture isn’t built on what you announce. It’s shaped—slowly, indelibly—by who you hire and what you permit every single day.
That’s the lesson behind the phrase, “What we permit, we promote.” And it’s never more true than in the high-stakes, people-centric world of O&P. So, let’s get practical—and honest—about what kind of culture your quiet choices are really creating.
The Invisible Hand of Leadership: Your Culture is Showing
Everyone I talk to is juggling a thousand things—billing deadlines, compliance checks, staffing issues, and never-ending requests from patients and payors. But the real driver of change (or inertia) is more subtle: it’s how you handle the messy, unspoken moments.
Did you let that “super-producer” admin bulldoze the weekly meeting because he always gets results? Did you sidestep the uncomfortable conversation when a staff member missed a deadline—for the third time? Did you stay silent when another team member’s negativity sank the energy in the lab?
You may tell yourself, “It’s not a big deal. I’ll address it later, when things calm down.” The problem in, your silence in the moment sends the signal of approval. In those moments, you are setting the real standard. And your team is watching.
As I wrote in my blog, “The Rhythm of Business,” the central melody of your organization isn’t in your manuals—it’s in your daily acts. If someone’s out of rhythm, out of sync, and nothing is said, that’s the new “normal.” Over time, small dissonances become the soundtrack of your team.
The Patient Impact: Culture Isn’t Internal Only
In clinic business, these choices ripple beyond your office walls. When disengagement or corner-cutting goes unchallenged, that culture echoes in patient care. Suddenly, the patient who needed a little extra empathy gets shortchanged. The documentation gets sloppy. Innovation stalls because it’s easier to play it safe.
In “Where Are You Going?” I talk about getting the right people on the bus—but even your best people can lose their spark if the silent rules nudge them toward disengagement or cynicism. Are you empowering them to bring their best, or teaching them to “keep their head down and don’t rock the boat?”
Silence is Not Neutral
Sometimes, leaders worry that confronting issues will damage fragile trust, hurt feelings, or slow things down. But the damage of silence is far greater.
Failing to address behaviors teaches two lessons: to the person in question, “This is okay,” and to everyone else, “We don’t really mean what we say about our values.” The cost? Erosion of trust, rising turnover, and a slide toward mediocrity.
If you want to change the story of your workplace, as I urge in “To Make a Change at Work, Tell Yourself a Different Story,” you must first confront the unspoken stories that are already running the show—the ones that say, “Nothing ever changes around here,” or, “Accountability is just talk.”
Practical Steps: Audit, Model, Repeat
So what does intentional culture stewardship look like—especially for busy O&P leaders?
Start with these four moves that I talked about in “Why Process Matters” and “When You Are the Target”:
Audit your tolerations: Ask yourself, What am I permitting that would never make it into our official values? Make a list. You’ll be surprised.
Observe your team’s real dynamics: Who speaks most in meetings? Who checks out? Are silences moments of thought—or fear?
Model the standard loudly and early: Be the first to admit where things aren’t working. Ask for tough feedback. Celebrate when someone voices a concern or tries to break the status quo for the better.
Address issues, every time—especially the little ones: Don’t wait for a crisis. Every small correction is a deposit in your team’s trust account.
Remember, as with lean processes and patient satisfaction, consistency is your friend: “When You Are the Target” reminds us that transparency and data, paired with genuine listening, build the kind of culture where improvement is the default—not the exception.
Bottom Line: Raise Your Awareness, Change Your Culture
Building an intentional culture means never outsourcing your values to a poster or a policy. It means recognizing that the gap between what you promote and what you permit is where the real culture forms.
Start today by raising your awareness—one interaction, one tough conversation, one small correction at a time. Your culture isn’t what you wrote last year; it’s what you permit every day. Make sure that’s building the practice, the patient care, and the team you truly want.