"At Seattle Children's Hospital (SCH) we began the quest to understand our culture in 2003, when we engaged the Bard Group, a consulting organization specializing in physician and hospital relations, to help uncover the unwritten 'simple rules' that informally define the way things get done at Seattle Children's. After a series of interviews and discussions with faculty physicians and administrative leaders throughout the organization, we uncovered the simple rules at the heart of the culture. The top seven unwritten simple rules identified at Seattle Children's are as follows: 

• You're only accountable to your boss or silo-not the institution. 
• Value peace: avoid confrontation. Challenging an issue is a personal attack. 
• Don't set priorities-everything is a priority. 
• New ideas must be fully developed to be considered. 
• "Plan-do" is more valued than "check-act." 
• Get buy-in for all decisions-participation is required for commitment. 
• Add new initiatives without reorganizing the systems and processes upon which they are based. 

Question: What are the implications of these simple rules on the ability to implement and sustain a change initiative? 

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