A strong culture within a spine practice can make or break the experience for both patients and staff. From camaraderie to transparency, six spine surgeons discuss the signs of a healthy practice culture.
Note: Responses were lightly edited for clarity.
Question: Culture is increasingly critical to the success of a spine practice. What are the clearest signs that a practice has built a strong, healthy culture?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: A hallmark of a healthy culture, is if the people that work there joke and enjoy being around each other, and they will do that little bit extra for the patients. That’s the sign of a very strong culture. The other thing is that when you are able to share a joke or share a smile or just share something joyous, that’s a sign of healthy culture. Sometimes people will come in early to get work done, but that’s not always a sign of healthy culture. In fact, it might be a sign there’s a problem that they’re not getting enough time to get their work done or they’re not being efficient. But I would say that if a healthy culture is predominant at a practice, or even at a hospital, people go a little extra for one another.
In my practice, my front office staff will sometimes break the ice with patients because they know the patients are nervous. I’d be nervous going to the neurosurgeon’s office, and I’m a neurosurgeon. But if [staff are] joking around with them and setting them at ease, they realize why they’re doing it. You can really get that feeling that these folks work with you honestly.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): I think that a strong, healthy spine practice culture is best demonstrated in how decisions are made when no one is watching.
There is this element of “psychological safety,” where team members can speak up about inefficiencies, complications, or workflow failures without fear. And there is a clear connection between stated values and the daily operations, particularly around scheduling, staffing, and resource use.
Also, we see that healthy cultures also invest in measurement and learning, not just productivity. So still improving how the practice is tracking outcomes, costs, and workflow with the intent to improve (and not punish). Finally, they prioritize surgeon and team sustainability as we know how disruptive under-staffing and constant turnover can be.
Brian McHugh, MD. McHugh Neurosurgery (New York City): In a strong spine practice, culture shows up in outcomes before it ever shows up on a mission statement. You see it in how consistently teams communicate, how aligned clinical and administrative staff are around shared goals, and how comfortable people feel raising concerns early rather than after problems arise. There is a clear sense of shared ownership across the practice, rather than siloed decision-making or reactive problem-solving.
Healthy cultures are also reflected in patient experience, including smoother care coordination, clearer expectations and fewer breakdowns across the continuum of care. Over time, those same practices tend to see better clinical outcomes, lower staff turnover and more sustainable financial performance. Importantly, strong cultures tend to be intentional, reinforced through leadership behavior, transparency and accountability rather than informal norms alone. When a team understands how their role connects to patient care and practice success, culture becomes a strategic advantage rather than a “soft” concept.
Robert Norton, MD. Florida Spine Associates (Boca Raton): I believe a strong and healthy work culture is critical to the success of a growing spine practice. As overhead rises and the general practice of medicine becomes more and more burdensome, it’s imperative to establish a positive and motivated culture within the workplace. We at Florida Spine Associates appreciate this and have taken steps to ensure improved productivity and higher patient satisfaction scores. Every interaction a patient has, from the phone operator scheduling an appointment to the checkout desk after the visit, plays an important role with the patient experience. I believe the clearest signs of a healthy office culture are employees that express their excitement to come to work.
How do we motivate employees to give it their all and be the best that they can be? It starts from the top up. As the physician or administrator, you serve as a role model for how the day will go. Having positive energy and working hard will be reciprocated. Well defined KPIs are important motivators if they are set to reasonable, obtainable hurdles for bonuses when appropriate. Saying thank you and appreciating the staff goes a long way to establish a positive culture. Have team huddles to ensure everyone is rowing in the same direction with clear expectations of job duties. Staff appreciate events such as catered lunches, holiday parties and or team bonding experiences outside of the office play a crucial role in unifying the practice for a healthy culture.
The greatest litmus test is the patient themselves going out of their way to tell you how they feel about the staff and general culture of the practice. When the patients have a good experience you can take comfort in knowing you are doing a good job in establishing a strong, healthy culture within the practice.
Gbolahan Okubadejo, MD. The Institute for Comprehensive Spine Care (New York City): The clearest signs that a practice is strong and healthy involve focus on the patient experience, along with energy and motivation displayed with the staff. A healthy practice has to prioritize the patient experience with streamlining the process that the patient goes through once within the office. Close attention to make sure the patient’s needs and expectations are met with enthusiasm, joy and individual pride should be the biggest emphasis. With consistent energy and enthusiasm comes growth. Innovation is also critical. A strong practice keeps up with evolving technology with emphasis on innovation. This combination will lead to more efficiency. Overall, this will set a precedent for a strong, healthy culture.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): The most important part of a great work culture at a spine practice is to always put the patient’s interest and well-being first. It starts with the physician and permeates to every member of the practice.
The second sign is teamwork and mutual respect. Successful teams have clear delineation of duties for each member, while having the ability to help each other during busy times.
Finally, a successful spine practice team promotes the financial well-being of the practice itself. There are many external factors in the current healthcare system that apply a lot of financial pressures on practicing spine surgery and medicine in general. It takes a team of dedicated workers to be able to counteract it and thrive in the current environment.
Vijay Yanamadala, MD. Hartford (Conn.) Healthcare: The clearest indicators of a healthy spine practice culture extend far beyond clinical outcomes — they’re visible in daily interactions and decision-making patterns:
Mutual respect among surgeons – Healthy practices foster genuine collegiality where surgeons consult each other on complex cases, openly discuss different approaches without ego, and welcome constructive feedback. There’s no hierarchy of condescension — junior partners feel comfortable challenging senior surgeons’ recommendations, and experience is valued alongside fresh perspectives.
Respect for advanced practice providers – Surgeons who treat APPs as essential clinical partners rather than subordinates create stronger practices. This means involving them in decision-making, supporting their professional development, and recognizing their unique contributions to patient care. When APPs have autonomy appropriate to their training and feel genuinely valued, patient care improves measurably.
Appreciation and empowerment of all staff – From surgical coordinators to medical assistants to front desk staff, every team member should feel their role is critical to patient outcomes. This means soliciting input on workflow improvements, celebrating contributions publicly, investing in training and development, and ensuring fair compensation. Staff who feel empowered to solve problems and speak up about concerns create a safety net that catches errors before they reach patients.
Clinical decision-making alignment – When the entire team genuinely embraces conservative care first, and surgery is viewed as one tool rather than the default solution. You see this when physicians openly discuss cases where they didn’t operate and why, without defensiveness.
The family member standard – Perhaps the most telling sign: would you treat your own parent, spouse, or child the same way you’re treating this patient? This isn’t just about clinical care. It’s about returning phone calls promptly, explaining options patiently, acknowledging fears and concerns, and never recommending a procedure you wouldn’t want for your own family. When this standard becomes cultural rather than aspirational, patients sense it immediately.
Transparency in outcomes – Practices should regularly review complication rates, patient-reported outcomes, and revision rates and use this data to improve rather than hide it. When surgeons can admit complications openly and learn collectively.
Patient communication patterns – When patients routinely understand why surgery might not be recommended, and when “no surgery needed” conversations happen without patients feeling dismissed. Time spent on education, not just procedural consent.
Peer accountability – Colleagues feel comfortable questioning each other’s surgical indications in a constructive way. The absence of financial pressure to operate on marginal cases.
Staff longevity – Low turnover among clinical and administrative staff signals that people want to stay. They’re treated well, feel valued, and respect the integrity they witness daily. High turnover is often the first visible sign of cultural dysfunction.
These elements are interconnected. Respect flows downward and creates psychological safety that flows upward, enabling everyone to contribute to better patient care.
