ATD Blog

Compliance Versus Culture in Onboarding—An Ongoing Dilemma in Healthcare

Thursday, February 28, 2019

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?

About the Author

Jacque Burandt, MEd, president of Award-Winning Results in San Antonio, Texas, is passionate about transforming organizations through people development, creating top performers and leaders at all levels of the organization and enhancing organizational and individual visibility, prestige, and pride through achieving awards and recognition for her clients' great work. Her award-winning clients include Texas Health Resources, Alamo Colleges, and University Health System.

A proven expert in creating an award-winning culture, Jacque led the team at University Health System (UHS), San Antonio, Texas, to win eight ATD BEST Awards and ATD's first Innovation in Talent Development Award. UHS has won more BEST Awards than any other nonprofit organization in the world. She served as chairperson of ATD's Public Policy Committee, authored five case studies for ATD's Skills Gap Series, and co-chaired the Strategic Planning Committee for Workforce Solutions Alamo. She serves on ATD's Awards Strategy Committee.

Jacque and her UHS team also won four Chief Learning Officer Learning Elite Awards, including Editor's Choice for Best Midsize Company in 2016 and five Chief Learning Officer Learning in Practice Awards.

Jacque designs and delivers highly interactive workshops to build crucial skills. Audiences consistently find her motivating, energizing, and entertaining. Her dynamic presentations are custom tailored to each audience, giving attendees the insights, skills, and strategies to take their performance to the next level.

Sign In to Post a Comment
I work in healthcare. Specifically in behavioral healthcare. I lead, among other things, the development of cultural responsiveness training. I encourage our contracted provider agencies to consider the C3: Culture, Compliance and Competency. When doing so, line up a trail that always points back to improved quality of services for the individual patient. If we understand the ways these are interconnected, and support improved outcomes, it's easier to get people on board for the long haul.
Well said! Thanks.
Sorry! Something went wrong on our end. Please try again later.
Sorry! Something went wrong on our end. Please try again later.
Could you give me a general description/explanation of what one of these skills workshops was? Were the crucial skills job or company specific, or a combination with soft skills or?
HI, Tom,
Thanks for your interest in my post I'm not sure I understand your question. I am referring to a one and a half day live, instructor led program accompanied by eLearning modules that University Health System offers to all new employees. Are you interested in the competencies covered, such as the patient experience? Please give me some guidance on what you need and I'm happy to reply.
Sorry! Something went wrong on our end. Please try again later.
Sorry! Something went wrong on our end. Please try again later.
Sorry! Something went wrong on our end. Please try again later.