A toxic or neglected culture in your practice can lead to burnout, turnover, lost revenue, and preventable mistakes that impact patient care. Just like an undiagnosed illness, culture problems start small but can spread rapidly—hurting your team, your patients, and your bottom line, noted Hayley G. Boling, MBA, COE, CEO of Boling Vision Center, INSIGHT Surgery Center, INFOCUS Optical Lab, and HGB Consulting, in her presentation at the 2025 ASCRS meeting, “The Culture Cure: Heal Your Practice With Team Retention, Patient Trust & Profitability.”

“But there’s good news!” she said. “No matter how far off course your culture feels—it’s not too late to start the cure. All it takes is intentionality, leadership buy-in, and the courage to begin.”

First, Recognize What Toxic Culture Looks and Feels Like

Ms. Boling, who is also a certified practitioner for various culture tools, processes, and surveys, began by first looking at what toxic culture looks and feels like in a health care setting. For example, she said, some of the team and leadership symptoms may include high turnover, retention issues, or “quiet quitting”; cliques or fractured team dynamics; and low trust in leadership. Other symptoms she noted include inconsistent accountability, double standards, the perception of "untouchables" among the team; misalignment between stated values and tolerated behaviors; and reactive leadership. 

The emotional and mental climate in a toxic culture she said can include feelings of low morale; burnout and disengagement; "cruise control" or "clock-in, clock-out" mentality; fear of speaking up; and resistance to feedback. Other feelings, she said, include feeling unseen, unheard, or unappreciated; feeling like it is us vs them; persistent negativity, drama, gossip; and resistance to change. 

Ms. Boling also discussed the operational and clinical impact of working in a toxic culture. “This can include "dropped balls"; mistakes and rework; an environment where toxic high performers are tolerated; compliance issues, preventable errors, and "near misses"; absenteeism, silence; and reduced productivity and inconsistent performance,” she said. 

When there is a toxic or neglected culture in a practice, patients too will also notice and feel that. This is evident, she said, when staff stress is visible to patients, when there is staff disengagement towards patients, and when there is inconsistent quality of care and service experiences. Ms. Boling also pointed out that in this type of environment there is also typically an increase in patient complaints, low satisfaction scores, and poor communication and errors in care. 

“Your culture is only as strong as the worst behavior you’re currently allowing. When you don’t address it, you endorse it. What you permit, you promote. Your practice’s financial health and patient trust depend on a strong culture,” said Ms. Boling. OP 

Now that the symptoms of a toxic or neglected practice culture have been identified, be on the lookout for “8 Steps to Heal Your Practice From a Toxic Culture – Part 2,” that provides practices with an 8-phase roadmap for a clear, tactical path to culture transformation. Ms. Boling also shares Boling Vision Center’s success story implementing these steps.