30 - Culture Building: Creating a Cohesive and Inclusive Environment

Description: Background :
The team at the newly established Ambulatory Surgery Center within the urban health care system is composed of registered nurses, surgical technologists, perioperative leaders, and support staff, all of whom come from diverse clinical and non-clinical backgrounds. Some team members possess extensive institutional knowledge, while others are new to the healthcare field, presenting both opportunities and challenges. This diversity necessitates intentional culture-building to ensure alignment, safety, and effective teamwork in the fast-paced surgical environment.

Planning:
Leadership initiated a proactive planning process that reviewed best practices, internal organizational models, and literature on team culture and psychological safety. This process led to the co-creation of a Cultural Contract, a foundational document that defines shared values, behaviors, and expectations. Three key frameworks shaped the plan:
- The Human Connection Triad (empathy, curiosity, and respect)
- Psychological Safety (based on Edmondson’s framework)
- The "3 Cs" Framework (Collaboration, Coordination, Cooperation)

Additionally, two recognition programs were launched:
- Great Catch—recognizing staff who prevent safety issues
- Culture Creator of the Week—celebrating staff who exemplify the Cultural Contract

Assessment:
Cultural assessment was integrated into both informal and formal feedback mechanisms. These included real-time check-ins, anonymous pulse surveys, shared governance input, and recognition trends. Staff input helped shape continuous updates to the Cultural Contract, making it a living document. The number and quality of safety reports, the frequency of Culture Creator nominations, and engagement in group discussions were used as qualitative metrics to evaluate psychological safety and inclusion.

Implementation:
The rollout was participatory, with staff involved in refining the contract and participating in department-level dialogue sessions. Psychological safety was operationalized through norms such as "assume good intent," "invite all voices," and "celebrate speaking up." The 3 Cs—Collaboration, Coordination, and Cooperation—were used to guide daily work. Leaders modeled vulnerability and transparency, while peer facilitators led microculture sessions across sub-teams.

Outcomes:
While long-term metrics are still being collected, early indicators show:
- Greater engagement in recognition programs
- Reduced interpersonal conflict
- Increased psychological safety during debriefings
- Anecdotal improvements in communication and teamwork

Staff have expressed increased trust, ownership of team dynamics, and a deeper sense of belonging.

Implications for Perioperative Nursing:
In perioperative environments, where safety, speed, and precision are critical, team cohesion is essential. This cultural initiative has shown early success in fostering collaboration, safety reporting, and interdisciplinary unity. Psychological safety has enhanced the willingness to speak up, while the Cultural Contract serves as a stabilizing and guiding force. As a model, this approach is scalable and adaptable to other perioperative settings, reinforcing AORN's commitment to just culture, DEI principles, and frontline-driven innovation.