Becoming World Class, with Class

Jeffrey E Thompson,  Pediatric Intensivist and Neonatologist, Gundersen Health System

Conventional wisdom and thousands of business books spend an endless amount of time talking about the keys to outgrowing, out profiting and out maneuvering your competition. Many will use this ‘wisdom’ to attempt to crush those in their path resulting in occasional , usually short term, success. But there is another way. There is another way to be successful not just for the short-term but for the long-term. Not just successful for you personally or even your organisation but bring along your staff, your community and your region. Organisations and leaders focused on values-based, not ego-based leadership can attract rising stars, find amazing partners and build momentum to last well into the future.

Conventional wisdom and thousands of business books spend an endless amount of time talking about the keys to out-growing, out-profiting, and out-maneuvering your competition. Many will use this ‘wisdom’ to attempt to crush those in their path, resulting in occasional, usually short-term, success. But there is another way. There is another way to be successful—not only for the short-term but for the long-term. And not just for you personally, or even just for your organisation—instead, the kind of successful that brings along your staff, your community, and your region. Organisations and leaders focused on values-based, not ego-based, leadership can attract rising stars, find amazing partners, and build momentum to last well into the future.

Our approach was developed in the midst of enormous competition. The Mayo Clinic, maybe the best known healthcare brand in the world, was our closest adversary.  It is nearly 10 times our size and was originally just over 100 km away. We thought that was a problem until they moved a major branch less than 10 blocks away. In addition, large insurance giants like United Healthcare, a hundred times our size, looked to expand in our region and impart their version of healthcare. In addition, if we were to recruit the brightest and the best, we had to recruit from across the country to a small market area without the glitter and excitement of a big city or medical school. These were a pressing collection of challenges.

The key to succeeding for the long term was not complicated, it was just hard.

We made a decision to compete not for size and profit but for the long-term health and wellbeing of the community. We believed we could deliver ever-increasing quality of care and have strong finances and improve the health and wellbeing of the community. The key word is ‘and’. Not this goal or that goal, but all of them. In addition, we were sure we would find partners from across the region that would help us deliver on that promise.

To build an organisation that serves the whole community, we had to start with a strategic plan that declared the purpose of the organisation to be something more than just taking care of sick people. We decided that our purpose would be to improve the health and well-being of our patients and our communities. We would focus all our efforts on that solitary purpose. We put the entire plan for this billion-dollar organisation responsible for hundreds of thousands of lives on a single sheet of paper (Figure 1).

 This outwardly focused purpose is the first thing people read when they are recruited into our organisation and connects to how they will be evaluated. It helps build a focus on others. Our mission focuses on distinguishing through excellence. We are not going to be satisfied with beating our mediocre peers or our own mediocre past. And we certainly are not going to just be focused on crushing the competition or just getting bigger; rather, we are going to deliver on our responsibilities to those who trust us. Our vision proclaims the extent to which we will go to deliver on our promise to improve the health of our communities. We aim to deliver on our promise so well that we will be nationally recognised. Finally, our commitment is to never rest on our laurels, to always strive to be better today than yesterday. Greatness is not an accident, it is intentional. You have to aim for it and drive for it.

It seems obvious, but implementation of the values statement is critical if you're going to accomplish these lofty goals. Too many organisations have clear values on their Web site or on the wall of their building, but do not have the courage or discipline to live those values.

It is a package. The purpose tells us why we exist, the mission tells us where we are going, the vision convey show far we will go, the commitment asserts our relentless drive to do better, and the values tell us how we will behave on the journey.

Present this package to the brightest and the best when they interview with you, and you have a good start at building an extraordinary team. Use daily as the basis of your decision making and priority setting, and you have the start of a greatorganisation. Living your values becomes a strategic advantage. Then reinforce the message at orientation, during staff training, and at performance evaluations. This plan gives staff a clear path forward for day-to-day work, as well as the freedom to innovate.

The strategic plan applies to every person, and everyone knows it applies to every person. No exceptions. We all have the same purpose, work toward the same mission, intend to accomplish the same vision, and are committed to continuous improvement. And most importantly we're going to do it with the same values. We all know how we will behave, how we will be treated, and how we will prioritise our decisions.

We purposely built this type of culture to be able to implement the next part of the strategic plan. These  strategies needed an outwardly focused, values-driven staff to compete. Our focus on superior quality and safety intentionally includes “through the eyes of patients and caregivers”. Our mission and vision require that we achieve national-level excellence—that we measure up to the best data available. But that means nothing if our patients and their families do not believe that they receive the best possible care. Likewise, our goal for patient experience is to genuinely understand what patients and their families need, not just what we think they need.

Our third strategy is to make our organisation a great place to work—a great place, but not an easy place. We expect very high performance in an environment that has clear expectations for behaviour—where all must embrace a passion for caring and a spirit of improvement. Many would consider this a very hard place to work. It's a hard place because the purpose is outwardly focused, not on ourselves or monetary goals. The mission is to be excellent, not just to survive but to be excellent in multiple categories—to be so good that we can be nationally competitive. Finally, we have adopted a set of values that we will not compromise. If you want to play outside the values, it means that you will be playing outside the organisation.

Our financial strategy is not to make a set amount of money. Our plan is to make care more affordable for patients, employers, and our communities.  Again, this strategy has a values-based, outward focus. We look at finances and facilities as tools. Important tools, valuable tools, but just tools—never the prime goal. Our staff is well compensated, and savings, facilities and technology all are well funded, but never to the detriment of serving the broader mission. The final major strategy is growth. We included growth as a strategy not to dominate the world or crush the competition. Rather, growth is beneficial when it supports our mission and other strategies, never growth for growth’s sake.

The plan is simple, but hard. The culture is crucial. One of the key tools to build a culture to serve this plan was the medical staff compact (Figure 2). We made it clear that the organisation would meet its responsibilities, that it was committed to providing an environment that would achieve excellence through recruiting great colleagues and by providing clear communication, strong education programmes, competitive compensation, and thoughtful change management. Just as the organisation has responsibilities, individuals have responsibilities on their side of the agreement. All medical staff are to lead quality and service, demonstrate integrity at the highest levels, treat all people with respect, and understand that things will steadily change in their job. Part of the work is to help make that change for you and your staff.

We started using the compact with medical staff, but eventually the approach included all leadership and all staff positions.

This simple but consistent approach was a critical part of moving our strategic plan forward and developing a culture that would serve a higher purpose. Another important factor in building a culture that can compete at a high level is understanding the big difference between a leaders’ lines of responsibility on an organisational chart and their actual breadth of influence. Outstanding leadership and strong, responsible behaviour can cast a bright light across a broad swath of the organisation—far beyond the leader’s immediate peers or staff. Likewise, bad behaviour can cast a shadow across an equally broad swath and result in poor outcomes, worse service, remarkably less efficient work, and attrition of valuable next-generation stars and leaders.

The more influence your leaders have, the more important it is for them to be people builders, not just rules police. They need to understand that their job is to serve, not just manage. They need to be shown how to get close enough to the work so they understand the complexity of the challenges that staff face and the moral imperative of strong outcomes being delivered in a supportive culture. This is so important that we expected leaders to set aside time early in the day, every day (e.g., 8-9am), to physically walk to their areas of responsibility to talk with the staff, to make sure they have the right tools and adequate staffing, and to get a better understanding of the work.

As we evaluate our leaders, we must understand the difference between doing things and accomplishing something of substance. If all we, as leaders, do is hold our staff accountable, to follow rules or checkboxes, the most talented staff become disillusioned, disengaged, and will not help you build forward. Holding staff accountable is always looking backward; being responsible for the success of your staff is looking forward. To deliver on excellence, young leaders will need to find a balance between the two. This is consistent with our theme that leadership is a responsibility to serve, not a license to rule.

To build leaders, you need to be intentional and disciplined. A key tool we learned from General Electric was the nine-box matrix (Figure 3).

Our senior-most leadership group would gather, and each would score the performance and potential of all their managers, supervisors, and directors. It was a chance for each to present the young leaders for whom they were responsible, to talk about how they viewed them, and to discuss their plans for development. It was also an opportunity to get feedback from other senior leaders about how they saw the young leaders’ performance and potential from a different point of interaction. The nine-box sessions had two important values. First, leaders gained clearer and broader views of their staff, and second, it set a tone of everyone being responsible for the growth and development of every young leader in the organisation.

You have to be completely clear about what you expect from leaders and give them the tools to deliver it to the staff. Assuming that mid- or even upper-level leaders are all on board is a mistake. Make expectations, lines of communication, and performance as transparent as possible. This will build a culture and an ever-increasing level of performance from all staff.

Maureen Bisognano from IHI said  “You cannot give what you do not have. If the staff do not feel cared for they can't care, to embrace you have to been embraced, to respect you have to been respected. Do not be stunned by your staff’s lack of care, connection or respect if they have not through their eyes been cared for, connected with and respected.”

I would argue that this applies not only to the frontline staff but across all levels in your organisation.

To compete against the best, you have to aim to be the best. That starts with developing the best environment for your staff. To attract and retain the best young leaders, you have to know and be clear about why you're here (the purpose) where you're going (the mission, vision, and commitment) and what values will guide the culture in which they will be immersed. It takes courage to set bold goals and clear standards for all. It takes discipline to follow through on both systems and people building. And it takes durability to stay with your plan despite constant pressure to compromise your values in the interest of short-term gains.

The path is not complicated, it is just very hard.

--Issue 37--

Author Bio

Jeffrey E Thompson

Jeffrey E Thompson, MD, is executive advisor and chief executive officer emeritus at Gundersen Health System. Dr. Thompson is a trained pediatric intensivist and neonatologist, and served as Gundersen’s chief executive officer from 2001 to 2015. After completing his professional training in 1984, Dr. Thompson came to Gundersen with a desire to care for patients and to teach. He was asked to serve on Gundersen’s boards beginning in 1992 and was chairman of the board from 2001 to 2014.

Author “Lead True, Live your values, Build your people, Inspire your community”

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