Conversations about workplace culture tend to drive me crazy because so often they are rooted in platitudes about teamwork and collaboration. Conversations about culture change are even more maddening. We've all been on the receiving end of a well-meaning lecture about what our organizations stand for, only to return to our desks, file away the related handouts and watch those around us backslide to business as usual, and maybe even join them.

This issue's story on value-based purchasing, however, gives me some hope. The reimbursement program's emphasis on HCAHPS scores will provoke some meaningful discussions about organizational culture and how it shapes the patient experience. Leaders would be wise to listen to Susan

Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Mass General, who advises "hiring people that have the right aptitude to care about patients ... whether they're delivering the food tray, they're a security guard, or the chief of your service."

So, in addition to assessing the clinical competence of every current and potential physician and nurse, administrators need to look for emotional competence. Leaders also need to recast staff in every department as caregivers, because we know that the patient experience begins when he or she turns into the parking lot and ends after the last bill is paid. The usual pep rallies about improving culture and the short-lived bursts of goodwill that follow won't be enough to earn incentive payments.

Trustees should borrow Edgman-Levitan's lens when evaluating boardroom interactions and, most importantly, when seeking new trustee candidates. That concern for patients deserves a place at the top of every competency list.