Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website
FORUM - Translating research into quality health care for Veterans

» Back to Table of Contents

A Conversation with VHA National Center for Organization Development's Linda Belton

FORUM recently sat down with Linda Belton, Director, Organizational Health, VHA National Center for Organization Development, to discuss her views on culture change and organizational transformation in VHA.

NCOD is an internal consulting service to VA leaders and staff in support of workforce engagement and satisfaction to enhance Veteran outcomes. Practitioners in organizational development integrate service, training, and research in ways that positively affect culture. The mission of Organizational Health is to help create an environment where employees want to work and Veterans want to receive care . If we had a motto it would be "All Things Connected." Acting as conveners, we bring together diverse programmatic efforts within VA under the organizational health umbrella.

A primary strategy is data-driven assessment through on-site consultation or online tools, including the All Employee Survey (AES), 360/180 degree, change management, and team and Servant Leadership assessments. With that information in hand, NCOD staff help individuals and work groups fashion practical plans. We then support those plans through executive coaching, leadership development, team building, facilitation, transition briefings, change management, enhancement of psychological safety, and AES action planning. (Psychological safety is the ability to give input, feedback, disagree, etc., without fear of reprisal.)

NCOD's Civility, Respect and Engagement in the Workplace (CREW) program offers an excellent example of the significant impact that culture change can have in VHA. As we know, patient-centered care is best delivered by an engaged, empowered workforce. With that in mind, NCOD launched CREW in 2005 to address AES findings of low civility, which appeared to affect outcomes adversely. NCOD's data provide a business case for civility: less sick leave, fewer Equal Employment Opportunity complaints and grievances; lower ICU mortality rates and lengths of stay; higher patient and employee satisfaction; enhanced psychological safety; and reductions in work-related injuries.1 CREW is rooted in relationship and team building via regular, facilitated work group meetings. Post-CREW data demonstrate statistically significant improvement in civility scores. More than 1,200 work groups have now participated in CREW. In 2011, The Joint Commission recognized CREW as a best practice.

Another excellent example is Organizational Health's endorsement of "Servant Leadership" as a framework for achieving transformational change. Leadership is critical to shaping and sustaining culture. In fact, NCOD data illustrate a spillover effect from leaders' behaviors to employees' perceptions of their workplace and Veterans' perceptions of their care.2

Servant Leadership is a philosophy that distinguishes "serving to lead" from "leading to serve." It values characteristics such as putting people first, integrity, humility, building teams and communities, leading change effectively, exercising stewardship, sharing power, and establishing a culture of accountability.

To help VA leaders grow as Servant Leaders, NCOD designed a 360-degree assessment to gauge Servant Leader skills. The VA Servant Leader 360 is behaviorally based, developmental, and action-oriented. Participants receive an electronic report and a consultation session with NCOD. Interested readers may contact

Over the next several years, we can expect a "permanent whitewater" of change, reflecting shifts in legislative direction, Veteran demand, and culture. NCOD will continue to support change efforts in VA. Perhaps the biggest challenge is not any one event or issue but rather the way in which we approach change itself. Culture change doesn't happen by caveat, policy, or training; it happens in the "interstitial spaces." I believe the real challenge of managing culture change (and where NCOD can be most helpful) lies in the following:

  • Patience. Culture change won't be accomplished by next quarter or next year. It takes time to assimilate change into all levels of the organization. True culture change is woven into the fabric of the organization.
  • Persistence and focus. Avoid the "flavor of the month" phenomenon. Juggling too many culture change efforts risks diluting the change that's really important. Set the direction and maintain "true north."
  • Draw the connections. We sometimes see conflicting priorities that, if understood in the larger systems context, may not be conflicting at all. Helping employees connect the dots between programs and initiatives, between culture change and VA's mission, brings us back to the common denominator: the Veteran.
  • Leadership. Culture change cannot be delegated; it must be led. Alignment, consistent messaging, and authentic modeling are all key components of culture change.
  • Make it real. How can change be made meaningful to every employee? Does every employee know what he or she will do differently to support the change? If we help employees find their own answers to these questions, we create a personal connection to change and the organization's mission. That's when change becomes transformation and transformation becomes culture.
  1. VHA Office of Public Health, Occupational Health Division (2012).
  2. National Center for Organization Development: Executive Teams Assessments and AES, 2011; AES and SHEP 2008-2012.