Confluence..a geography, an organization, a concept, a culture

Culture shifts at Confluence Health with engagement, satisfaction, and alignment with goal of improved service.

Confluence Health is a physician led healthcare organization centered in North Central Washington, formed as an affiliation between Central Washington Hospital and the physician owned Wenatchee Valley Medical Group in 2014.  The organization’s location centers in North Central Washington State, at the Confluence of the Columbia River and Wenatchee River, covering 12,000 square miles of geography.  There are currently 270 physicians, 150 Advanced Practice Clinicians, and over 3000 staff.    

For 70 years, these two organizations had been friendly competitors, and although separated geographically by several miles, the separation in previous decades was in identity and culture.  With the formation of Confluence Health, it became apparent that a large culture shift was occurring, affecting physician and staff engagement, satisfaction, and alignment.  Many long term employees and physicians have perceived and felt a loss of identity, abandonment of previous organizational values, loss of control of the many changes that have occurred with organizational change, and the perception of lack of involvement in decisions effecting daily practice.  This has effected the engagement, satisfaction, and alignment of many physicians and staff.   A Press-Ganey physician survey completed within the organization in 2016 gave a 53% engagement rank, and a 42% alignment rank.  Physician turn-over of 11% in 2016 was seen as a red flag to recruitment and retention. Engagement, alignment, and satisfaction are now one of the top organizational goals, addressed at every department, every service line, every leadership meeting, and every board meeting.  The why, what, and how to improve these key performance indicators have become both a challenge, and an opportunity.

Transparent communication strategies, cascading communication at all levels, daily huddles within the organization, and engaging every employee in the conversation of engagement and satisfaction has been developed.  Setting lofty organizational goals around engagement and satisfaction with every manager and leadership held responsible and accountable for those goals has been performed.  The formation of a provider specific bi-weekly Physician Connection newsletter specifically addressing topics pertinent to physicians, and also the development of “Collegial Connections” meet-up groups led by physicians each month with varying topics such as burnout, resilience, gratitude, mindfulness, etc.  The Physician Satisfaction and Support Committee and been re-invigorated.  A handbook specifically for Physician Partners was developed.  Collaboration with county medical societies sponsoring joint speaker meetings with topics including “Burnout Proof Lives”, and “Finding the Joy in Medicine” have occurred recently both in response to, and to educate, mitigate, and prevent burnout and lack of engagement, satisfaction, and alignment.  A Women’s Physician group supported by the organization has spread to women physicians both within and outside of the organization, with activities designed at networking, developing relationships, building teams, and work-life balance.

And yet the work continues…

We have found at Confluence Health that the concept of “Confluence” pertains to not only our organization, our geography, but our culture.



Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) Survey


Cultural Change in the Transforming Health Care Industry

Participant comments on Confluence..a geography, an organization, a concept, a culture

  1. Julie, undoubtedly a long and arduous journey. It appears your organization has adapted and reacted appropriately to control the damage. I am curious though, prior to the integration, was there a rigorous cultural assessment of the two organizations before formation of the IDS? If so, what did that look like and what were the findings? Any particular lessons learned?

    1. Thank you Neil. The culture of the leadership groups felt they were aligned. However, the impact to the thousands of employees was not appreciated until post-affiliation. Lessons learned….discuss as much at every level prior to changes (discuss as much is legally allowed during the exploratory phases for example), set up “listening circles”, or “town halls” for discussion and questions, and evaluate/measure physician and employees satisfaction, engagement, prior to affiliation, with specific attention to how an affiliation or merger would change their alignment, etc. All of that has happened to a great deal post-affiliation.

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