Tone at the Top and its Relationship to Change Management

Change Management

“Tone at the top”

Tone at the top is accounting language that was developed to evaluate and address the business ethics of an organization.  It’s smart language because when something bad happens inside an organization, the definition differentiates the actions of a rogue employee vs. the modus operandi of an organization’s leaders.  

The gist of “tone at the top” can be found in parts of its definition (1):

  1. Whatever tone management sets will have a trickle-down effect on employees of the company.
  2. Employees pay close attention to the behavior and actions of their bosses, and follow their lead.
  3. In short, employees do what they witness their bosses doing. 

I got to thinking about “tone at the top” because I was thinking about why change seems to be such a challenge within the healthcare industry. I was thinking about the need for change because so much of the information that’s presented in healthcare publications, at healthcare events, and in healthcare educational settings, speaks to the need for change (lots of change).  I tied “tone at the top” to change because an organization’s appetite for change can easily be tied back to the tone set by an organization’s management. 

Obviously, it’d be way off base to suggest that management’s willingness or unwillingness to change in any way, shape, or form correlates to ethical or unethical behavior.  However, I think it’s certainly reasonable to say that the tone management sets has a lot to do with how willing employees are to: a) look for opportunities to change b) create and sell cases for change (up, across, and down) c) make difficult decisions necessary to orchestrate change and d) own the ups and downs of managing change. Like the definition suggests, employees will pay close attention to the behavior and actions of their bosses, and follow their lead. 

I See Styles of Change Management from a Good Vantage Point

I’m connected to the healthcare industry because I’m a partner in a business that's selling financial services to healthcare providers. One of the neat things about selling is that it gives me access to C-level/Director level personnel.  In every introduction I have the real privilege of hearing and seeing different management styles throughout multiple organizations. It’s fascinating (from my vantage point) to see the wide spectrum of management styles: slow and deliberate to fast and ever changing – and everything in between.

It’s worth noting that the Management Teams with fast and ever changing management styles almost always point to such a style of management with pride. They tout the progress they’ve made all throughout their organization and boast about running way ahead of current issues (they’ve already solved the industry’s current hot list of problems and moved onto where they want to go next). It’s also worth noting that – true to theme of tone at the top – management styles almost always seem to permeate the ranks of each organization (there’s consistency in the delivery of information, the decision making process, and execution of change management).   

Moving On

Management Teams should recognize that the current punch list of change related items (like crossing over to electronic medical records or ICD-10) is simply a current events list driven by an external environment.  The question for Management Teams is: without the external environment, what does change look like inside your organization? In addition to reactively tackling the many projects that are in the pipeline, Management Teams should evaluate their organization’s ability to change and evaluate the following:

  • Who has authority to make changes within the organization? (Who has management responsibility for a line, and doesn’t?)
  • How many decision makers need to approve changes?
  • How many layers up does a decision have to go before it can be authorized?
  • What are the [positive/negative] consequences to managers who don’t make change? (Is status quo safer than the risks associated with change?)
  • How are managers recognized and rewarded for orchestrating change?
  • What is the organization’s track record for successfully implementing change? (What does an organizational resume for the last year look like?)

Saying back what’s being said by industry experts, there’s an overall need for effective change management in the healthcare industry – a culture of change that not only manages a changing external environment, but also constantly drives change to better one’s organization.

(1)    Association of Certified Fraud Examiners “Tone at the Top: How Management Can Prevent Fraud in the Workplace” Tone at the Top: - Association of Certified Fraud Examiners 30 Oct. 2012


Click here to see how other healthcare providers have made a change.

A Case for Change


Topics: change management