Shaping culture: A practical framework for teams
Culture profoundly shapes organizational, team and individual performance. It can propel organizations toward excellence — or hold them back in risk and stagnation. Too often, however, employees view culture as something distant, external, or imposed from above.
They forget an essential truth: we are the culture. Each of us, through our daily words and actions, builds — or breaks — the culture we live in.
When I share this with teams, I see both hope and humility. Hope, because people realize they do have agency to improve the culture they long to see. Humility, because many feel uncertain about how to begin. Culture can seem abstract, intangible. To make it real and actionable, we developed a practical tool to help teams shape culture together.
Step 1: Envision the ideal future
We begin with appreciative inquiry. Teams are asked to imagine themselves two years in the future, on a truly extraordinary day — one where collaboration, safety, innovation, joy and excellence all flourish. We then ask them to describe what that day looks and feels like in vivid detail.
Step 2: Define the behaviors
Next, we translate that vision into concrete behaviors. What would people be doing on this amazing day? How would they interact? What words would they use? What habits and practices would be visible?
Step 3: Shape the behaviors through the Six R’s
Finally, we explore practical interventions that can bring those behaviors to life, guided by the Six R’s Framework for Shaping Culture:
1. Relationships
Strong cultures are built on strong relationships. They deepen when we listen more than we speak, ask humble questions and balance task talk with relational talk. A simple question about someone’s family, values or hobbies can strengthen connection and trust.
2. Role Modeling
Behaviors are contagious. If we want respect, collaboration or empathy, we must first
demonstrate those behaviors ourselves. Leaders and peers alike set the tone.
3. Rhetoric
Words matter. They can uplift or diminish. Language that conveys power with rather than power over fosters respect and hope. Choose words that affirm, inspire and connect.
4. Rituals
Rituals make values tangible. Think of how faith traditions, sports or operating room teams use rituals to create meaning and consistency. For example, our transformation team begins meetings with uplifting music, a well-being reflection and an inspiring story before reviewing performance.
5. Recognition
What we recognize, we repeat. Recognition must be intentional. We created an “Illuminator Award” for individuals who elevate, connect and uplift others. Anyone can nominate someone — no vetting, no gatekeeping. Over time, we hope everyone is recognized as an illuminator.
6. Rewards
Rewards, often formal through HR, should also align with the culture we want. They should be both monetary and non-monetary and signal clearly what behaviors matter most. In our team, we believe change moves at the speed of trust, and trust grows when we act with rather than to others.
Moving from abstraction to action
We are testing and refining this framework in our organization, and early feedback has been overwhelmingly positive. Clinicians and staff tell us it gives them both agency and a clear set of actions to influence culture — not just lofty aspirations, but real tools.
Culture is not beyond our control. It lives in every interaction, every choice, every word. By applying the 6 R’s — Relationships, Role Modeling, Rhetoric, Rituals, Recognition and Rewards — we can all help build a culture that uplifts, connects and empowers.
Together, let’s shape a culture worthy of the people we serve and the people we work
alongside.
Peter Pronovost, MD, PhD, is Chief Quality & Clinical Transformation Officer and President, Veale Healthcare Transformation Institute at University Hospitals in Cleveland, Ohio.
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