It can be tough to move the needle on workplace culture, especially when communication has broken down and trust is strained. The stakes are even higher when someone’s life is on the line.
But what happens when a heart failure unit asks for help with its culture?
The University of South Florida and Tampa General Hospital collaborated to find out.
New research, published in the New England Journal of Medicine Catalyst Innovations in Care Delivery, suggests one promising approach: Give employees a meaningful role in creating the solution.
A case study at Tampa General Hospital’s Heart Failure Center of Excellence found marked improvements in communication, teamwork and employee perceptions after staff members worked together to establish their own expectations for workplace behavior.
The study, published in August 2026, was co-authored by David Howard, associate professor of management; Paul Spector, professor of management and TGH organizational behavior science consultant; and TGH president and CEO, John Couris.
“It was amazing to see this world-class team of people take on the challenge of improving their culture and accomplish it in front of me,” said Spector.
The effort began in late 2021, when the Heart Failure Center approached hospital leadership with concerns about communication, coordination, and trust.
The center provides complex and life-saving care across multiple disciplines, and seamless care coordination is critical. Unit leaders saw that miscommunication was compromising patient safety and clinical outcomes, and took steps to improve their teams.
The first step was surveying employees. They asked workers to describe their team, workplace culture, communication and trust. Honest feedback on how things could be better was encouraged.
The responses were eye-opening. The problem wasn’t just miscommunication.
The intervention team saw four major pain points: difficulties in communicating across disciplines, poor coordination among members of the team, concerns about accountability and leadership, and unprofessional comments.
The survey also reflected an important difference in how the unit’s culture was perceived across roles.
At the outset, 76% of physicians, surgeons, and advanced practice providers surveyed had a positive perception toward their team. In contrast, leadership and assistant team members, including coordinators and those managing day-to-day patient care, had more negative views.
Back row, from left: Dr. Benjamin D. Mackie, Dr. Guilherme Oliveira, Dr. Debbie Rinde-Hoffman.
Front row, from left: Paul Spector, John Couris, David Howard. Photo by Daniel Wallace,
Tampa General Hospital
Staff then participated in three half-day retreats where they developed shared rules for communication and behavior.
The first retreat focused on team-building exercises. They discussed the survey results and developed a set of engagement rules to lay out expectations of how team members should interact within the workplace.
The effort worked. By the second retreat, employees said they felt more comfortable with their coworkers. Three-quarters of attendees acknowledged things had improved since the first retreat.
They discussed progress, celebrated successes, and mapped out expectations for their “rules of engagement” agreement.
“The difference in tone between the first and second retreats was remarkable,” said Spector. “At the first retreat, there was obvious tension, while at the second, the team was very relaxed and kidding around with one another.”
Nearly a year after the first retreat, employees completed a follow-up survey, refining the rules they deemed important in how to work with each other.
In the follow-up survey, positive descriptions of the team rose from 42% to 59%, while negative descriptions declined from 47% to 29%. Instances of poor communication fell from 58% to 23%, and positive assessments of communication jumped from 2% to 27%.
Reports of poor leadership and management and mentions of harsh and unprofessional comments dropped from double digits to single digits.
The intervention team considered the results a win.
“The buy-in and engagement from the entire heart failure team — from the most senior leaders to individual contributors — was critical to the success,” said Howard.
The outcomes point to a practical lesson for organizations: Change may gain traction when the people closest to workplace challenges have a voice in defining both the problems and the solutions. ROI