Using Deliberate Practice to Change Culture

American health care providers face an environment of rapid change and find themselves constantly reacting to shifts in client needs, staffing and regulatory frameworks. To respond quickly, many providers are building more responsive cultures which emphasize collaboration, accountability and trust.

One mid-sized, community health care provider that provides a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs and family planning services to low-income families was seeking innovative approaches to leadership training that could help them adapt quickly to the changing environment.

Leaders were expected to play a key role in modeling collaboration, accountability and trust for other employees and for each other. Modeling the right culture was seen as especially important during difficult or crucial conversations.


Although leaders had participated in workshops on crucial conversations, accountability and coaching there was an identified gap in their ability to apply what they had learned to difficult or crucial conversations with direct reports and peers. Many leaders found these conversations to be uncomfortable or anxiety-provoking and were hesitant to engage in them. Others struggled with how to model collaboration, accountability and trust during those conversations.

The health care provider was seeking a solution that would bridge the gap between knowledge and skill – especially in the context of crucial conversations such as:

  • Performance management conversations with direct reports
  • Project management conversations with peers

After an in-depth discovery process that included multi-level interviews and surveys, Practica Learning designed a deliberate practice activity that included four crucial conversation scenarios:

  1. A coaching conversation in which a direct report has been late and has had multiple unplanned absences.
  2. A peer-coaching conversation in which the peer has failed to complete deliverables on time.
  3. A coaching conversation with a direct report whose results have been slipping.
  4. A coaching conversation in which a direct report has had repeated arguments with a colleague.



Areas of Improvement

By the end of the course, participants demonstrated significant, consistent improvement in five skills considered critical to building a culture of collaboration, accountability and trust:



Net Promoter Score

At the end of the course, participants were asked how likely they would be to recommend the course to a friend or colleague. Eighty-three per cent of participants would recommend the course:



Client internal survey results:

Employee surveys conducted after the program showed the following encouraging results:

94% of participants agreed that their crucial conversations skills improved

74% of participants agreed their skill level with trust improved

76% of participants agreed their skill level with accountability improved

97% of participants agreed there was value in continuing with Practica Learning

Participant Feedback

Participants were asked to provide feedback at the end of the course. Here are a number of verbatims:

  • “This was REALLY great. I’ve learned so much today. I found the scenarios so apropos to my reality. It was a very realistic and the feedback was helpful.”
  • “I’ve had 11 years here with countless training courses. This has been the best practice ever.”
  • “Getting feedback from the Roleplayers was extremely valuable!”
  • “This is far superior to any training that’s ever been done. It’s a supreme method to work on obstacles and challenges. I think that all managers should go through this, and it should be mandatory for all first-time managers. The feedback is invaluable.”



In times of rapid change, American health care providers are finding that they need lean, flexible leadership cultures based on foundations of collaboration, accountability and trust. Traditional blended learning solutions may not bring about the desired behavioral changes. To change the culture, leaders need to practice and change the day-to-day crucial conversations they have with peers and direct reports. Deliberate practice has proved to be an effective method to bring about the kind of measurable, demonstrated behavioral changes in difficult conversations that are required to change organizational culture.


To learn more about us and how we can help your employees become more effective communicators through deliberate, experiential practice, please contact us.
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