Leaders go first: Creating and sustaining a culture of high performance.

The culture of a healthcare organization plays a critically important role in determining whether strategic plans will be executed effectively and organizational goals will be achieved. A culture of high performance serves as a foundation that supports the implementation of healthcare strategies and enables health leaders to evaluate, select, optimize, and sustain a full portfolio of improvement initiatives linked directly to top priorities and mandates. This article argues that a culture of high performance should become an integral part of all strategic planning and, further, that a strong and explicit leadership commitment, beginning with the board and CEO and extending throughout all leadership levels, is required to implement a successful culture transformation. Proven methods for developing a culture of high performance in practice are described, addressing key areas such as alignment, accountability, standard behaviours and practices, leader development, discipline, and consistency.