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Compliance Versus Culture in Onboarding—An Ongoing Dilemma in Healthcare


Thu Feb 28 2019

Compliance Versus Culture in Onboarding—An Ongoing Dilemma in Healthcare

When we sit down as talent development professionals to design or redesign onboarding for new employees, we often face a dilemma around what to emphasize in our programs: compliance or culture?

As a former English teacher, current author, and perennial word-freak, I always like to do linguistic research before embarking on any project. Here’s what I found out from searching my old friend, the thesaurus.


The thesaurus details a long list of compliance synonyms, most of which have negative connotations—conformity, acquiescence, complaisance, concession, deference, docility, obedience, passivity, resignation, submission, yielding—the list goes on. The very word compliance can make our bodies tighten, our teeth clench, and our eyes roll back in our heads. It’s no wonder compliance training gets a bad name as being dry, dull, tedious, difficult, and, yes, even painful at times.

What about culture? Culture, on the other hand, usually has a positive connotation. Its synonyms in the thesaurus include ability, art, civilization, accomplishment, achievement, enlightenment, erudition. In organizations, it connotes connections, bonds, the glue that holds people together. With glowing terms like these, who wouldn’t want to be involved in culture training?

Linguistically, culture beats compliance, hands down.

And yet, organizationally, we often see just the opposite: a heavy reliance on compliance training for new employees. There are so many boxes to check, forms to sign, regulations to meet, and agencies to please, it’s easy to understand why compliance can dominate a brand-new employee’s first days. This emphasis, while keeping the doors open and the authorities at bay, conveys the initial impression that compliance, with all its connotations, is the essence of this new family the employee has joined.

Meanwhile, culture waits its turn on the onboarding stage, eager to engage, connect, energize, contextualize, personalize, and instill passion in those same new hires. Culture, as compliance, has its naysayers, with many believing that training on an organization’s culture is too fluffy, ambiguous, and a colossal time-waster. (After all, they’ll figure it out after a while from those conversations at the water cooler or in the cafeteria.)


But, let’s get back to us talent development professionals at the drawing table, faced with our dilemma of what to emphasize in onboarding, culture or compliance. Exacerbating the dilemma is that in today’s healthcare environment, we are faced with high stakes and limited resources.

First, the high stakes. The research on the impact of onboarding is abundant and unequivocal: Do it right and your organization will reap the rewards in terms of patient/customer satisfaction, employee engagement, recruitment/retention, quality, and productivity. Miss the mark with your onboarding and you could face fines, penalties (including jail time), decreased revenue, bad public relations, lost market share, poor morale, and, in some cases, closure.

Last but not least, the limited resources. Having worked in healthcare for the past 32 years, I know that facing limited resources is a fact of life that isn’t likely to get better anytime soon. There’s increasing pressure to get new hires at the bedside or their workstations quickly. Every hour spent in training is a cost that is frequently referred to as “non-productive time” on productivity reports. And the pressure for speed to competence—just how quickly new employees can gain all the abilities, knowledge, and skills that enable them to be safe and effective in their jobs—has never been more intense.

The dilemma described above is a true story faced by University Health System in San Antonio as it successfully transformed its onboarding to include both compliance and culture. Come hear how this eight-time ATD BEST Award winner went mano a mano with compliance vs. culture and came out a winner for the employees and the organization.

Want to learn more? Join me at the ATD 2019 International Conference & Exposition for the session, Compliance vs. Culture, Which Is More Vital to Onboarding?


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