HCA South Atlantic Division Leadership Day

Building a Culture of
Ownership in Healthcare
HCA South Atlantic Division
December 5, 2018
Joe Tye, CEO and Head Coach
Values Coach Inc.
Copyright © 2018, Values Coach Inc.
1:00-3:00

For a copy of these slides and the special
report Key Success Factors for Positive
Culture Change:
Text 66866
Type message valuescoach

“Joy in work – or the lack there of – not only
impacts individual staff engagement and
satisfaction, but also patient experience,
quality of care, patient safety, and
organizational performance.”
Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for
Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for
Healthcare Improvement; 2017.

You cannot hold people
accountable for joy!

Toxic emotional negativity
is the ultimate killjoy!

The Old Criteria...
 Trust
 Pride
 Camaraderie

 Values
 Innovation
 Financial Growth
 Leadership Effectiveness
 Maximizing Human Potential
 Trust

My take...
Effective leaders maximize human potential
by...

My take...
by helping people live their values...

My take...
by helping people live their values, creating
a culture where trust and innovation can
flourish...

My take...
by helping people live their values, creating
a culture where trust and innovation can
flourish, resulting in financial growth.

Management is
a job description

Management
expects compliance
28

Leadership
seeks commitment
29

Management is
transactional
30

Leadership is
transformational
31

Guiding insight #1
Culture does not change unless
and until people change.

Guiding insight #2
People will not change unless
given tools and structure, and
inspired to use them.

Guiding insight #3
The best way to help people be
better employees is to first help
them be better parents, better
citizens, better humans.

“I got a whole new team and didn’t
have to change the people because
they changed themselves.”
Paul Utemark, (then) CEO
Fillmore County Hospital
Geneva, Nebraska

You tell him that we
love our culture and he
had better not come in
here and mess it up.

“FCH will remain committed
to The Twelve Core Values
in the years to come. These
values are visible on a daily
basis in our hallways and
observable in conversations
with patients, families, and
co-workers.”

Your cultural DNA should transcend
any particular individual or position
on the organization chart –
including the CEO

Who would you rather work with?

Who would you rather live with?

The work that you
choose to do, and the
attitude with which you
choose to do that
work, are the hammer
and chisel that carve
the statue that is you.
Self Made Man by
Bobbie Carlyle

There is an invisible barrier on the
potential of your organization

You cannot “empower” someone
who is being disempowered by
their own negative self-talk.

Companies that study employee
engagement* consistently find:
~ 25% fully engaged
~ 60% not engaged
~ 15% aggressively disengaged
* e.g. Gallup, Avatar, Press Ganey, Modern Survey, Values Coach

No one has tell an
owner to mow the lawn

Renters don’t care what
the neighbors think

Squatters trash the place,
and get paid for doing it

Disengaged employees, especially
disengaged managers, are a
quality defect.
Jim Clifton: The Coming Jobs War

When Sally and I were in the market for a
second home in Arizona my criteria were:
 Spectacular back yard
 Low to zero maintenance
 Affordable

And this was our primary
residence, the house where we
lived for 20 years and raised our
two children >>>>>

Lesson #1
Things aren’t always
what they seem.

Lesson #2
What you really want
might be closer than
you think.

Lesson #3
You must be willing to
jettison old baggage
to move forward.

Lesson #4
There is almost
always a way to
create a win-win.

Instructions for Live Polling
Text 22333
Type message JOETYE362

80% yes 70% no
Which hospital has higher
patient satisfaction?

80% yes 70% no
Which hospital has greater
employee loyalty?

80% yes 70% no
Which hospital has higher
nursing turnover?

80% yes 70% no
Which hospital has
healthier financials?

80% yes 70% no
Which hospital has had
the most bad press?

80% yes 70% no
Which hospital is a 10-time
100 Best Places to Work?

80% yes 70% no
Which hospital is part of a system
that treats culture as fluff?

VCI-17 Culture Assessment Survey
results from leadership team at a
large multi-facility healthcare system
in New York State

Powered by
What percent of total paid hours in your organization are wasted on toxic
emotional negativity (e.g. disrespect, bullying, spreading rumors)?
~18%

$1,065,000,000 annual SWB
X
18%
=
>>>>>>>>>>>>>>>>>

What could that system do to
improve patient care quality and
satisfaction, operations, and
community health with an extra
$525,000 worth of help every
single day 365 days per year?

And that does not include indirect
impact on patient satisfaction,
productivity, morale, and every
other dimension of the operation!

A word about the
assumptions we make.

What do you get when you
break the word “assume”
into its constituent parts?

The journey from
Accountability
to a culture of
Ownership

Accountability
Doing what you are supposed to do
because someone else expects it of you.
It springs from the extrinsic motivation
of reward and punishment.

Ownership
Doing what needs to be done because
you expect it of yourself. Ownership
springs from the intrinsic motivation of
personal pride.

35,472,692 views142,966 – avg 5 stars

Just when you thought United’s PR
catastrophe couldn’t get any worse

The problem with
this place is that
no one ever holds
me accountable.

Son, you’ll be proud
of your old Dad...
Today the boss held
me accountable.

No one ever won
a DAISY Award
by being held
accountable!

“In the long run... accountability
encourages a culture of evasion,
denial, and finger pointing.”
Richard Farson and Ralph Keyes:
The Innovation Paradox

We don’t talk
about colleagues
behind their
backs.

Invisible
Architecture
“Invisible Architecture” is a
trademark of Values Coach Inc.

Invisible Architecture™
is more important than
bricks & mortar

Invisible architecture is the
soul of your organization the
way physical architecture is
its body.

The Blueprint
Behind the
Blueprint™

Core values define who
you are, what you stand
for, and what you won’t
stand for.

“Identifying the core values that define your
organization is one of the most important
functions of leadership. The success or
failure of this process can literally make or
break an organization.”
Ken Blanchard: The Heart of a Leader

The problems with generic
values statements >>>>>

Problem #1
They do little to differentiate
you from everyone else who
has the same posted values

Problem #2
They establish minimal
expectations

Integrity
Compassion
Accountability
Respect
Excellence

Problem #3
They are unlikely to inspire
team members (who likely
don’t know them anyway)

Organizational values determine strategies
but personal values shape culture.

171
“People who are clearest about their
personal vision and values are
significantly more committed to
their organizations.”
James Kouzes and Barry Posner: A Leader's Legacy

“If people could understand their core
values, they would save years of doubt,
confusion, and misplaced energy as they
try to find direction for their lives.”
Laurie Beth Jones: Jesus CEO

I WISHI’D
WATCHEDMORE
TELEVISION
No one on their
deathbed ever
says

Culture is the personality
and the character of the
organization.

Same
business
Different
cultures

People shop at Wal-Mart
because they don’t have
to dress up like they do
for the Dollar Store.

Describe your culture
in just 6 words.

Southwest Airlines Core Values
Servant’s Heart, Warrior
Spirit, Fun-Loving Attitude

Netflix Culture Code
We employ only fully
formed adults

Cypress Semiconductor Motto
The Marine Corps
of Silicon Valley

193
From managers sitting in
the same room at one
large medical center’s
leadership retreat

194
We love patients and
each other

195
We are ALWAYS
here for you

196
Multiple priorities,
limited resources,
great expectations

197
We’re entitled,
hating it,
and staying

198
Disjointed departments
working against each
other

199
Negativity reigns while
circling the drain

200
I’ve been here
longer – you leave

201
Beatings will
continue until
morale improves

The Florence Challenge
Emotionally Positive
Self Empowered
Fully Engaged

The Culture Mapping
Schematic Wheel

There is no right-or-wrong pathway
through the Culture Mapping
Schematic...
All 693 potential pathways
will yield great ideas!

218
Workplace attitude is
determined by what
you expect and what
you tolerate...

219
And what you tolerate
will dominate over
what you expect!

Burnout
Disengagement
Compassion fatigue
Bullying
Incivility
Disrespect
Dropout
Suicide

Toxic Emotional Negativity
The healthcare
crisis within

You cannot be a negative,
bitter, sarcastic pickle
sucker in the break
room…
This place
sucks

May I help you? I
have the time.
NOT!

You cannot be a negative,
bitter, sarcastic pickle
sucker at work…
My job sucks

I wish she
would stay
at work!

227
“It is a leadership responsibility to
create a workplace environment
where toxic emotional negativity
is not tolerated.”

228
The simple promise that
will change your life...

229
And transform your
organization…

The Pickle Challenge
has taken on a life
of its own!

Why this matters
more now than ever
>>>>>>>>>

“Hospitals face unprecedented
turnover and attrition rates.”
Study by Leaders for Today

“A large majority of CNOs say the
nurse shortage at their organizations is
moderate to severe, and most say this
problem will become increasingly
worse over the next five years.”
Worsening Shortages and Growing Consequences: CNO Survey on Nurse
Supply and Demand, a white paper by the Center for Advancement of
Healthcare Professionals, B.E. Smith, and AMN Healthcare

“CNOs see shortages negatively affecting
some of the most important aspects of
healthcare: patient satisfaction, quality
care, and staff morale.”
Worsening Shortages and Growing Consequences: CNO Survey on Nurse
Supply and Demand, a white paper by the Center for Advancement of
Healthcare Professionals, B.E. Smith, and AMN Healthcare

“Millennials value company culture
more than any other generation that’s
come before them.”
Larry Alton: “How Millennials Are Reshaping What’s Important In
Corporate Culture” in Forbes, June 20, 2017

As if the challenges we know
about now weren’t sufficiently
daunting >>>>>

Lighten up, baby!
This is supposed
to be joy!

A mini case study
on positive culture
change>>>

Culture of Ownership Classroom

100+ MMH mangers’ responses to describing
their culture in just one word – October, 2018

Patient satisfaction
Patient satisfaction from
record low to record high
Emergency Department from
bottom 10% to top 10%

RN Turnover
32% reduction overall
43% reduction for new nurses
in first 2 years of employment

Other staffing expense
Significant reductions in overtime
and $2.5 million annual reduction
in contract labor expenses

Quality measures
22% reduction in CLABSI
38% reduction in ventilator
related events
64% reduction in CAUTI

More than one
million dollars in
annual energy
cost savings

Annual Cultural
Productivity Benefit
>$12,000,000

First hospital to earn the
INSPIRED Award for Values
and Culture Excellence

But remember...
Culture changes one person,
one attitude, one leadership
example at a time

Building a Culture
of Ownership

You can’t always
choose who you
have on the bus!

You can’t just throw
all the “wrong” people
off the bus!

It begins with a
shared vision...

A leader is someone who
takes you to a place to
which you didn’t know
you wanted to go.
– Joel Barker

A leader is someone
who helps you become
the person you didn’t
realize you could be.
– Joe Tye

285
There is a 100% probability
that by leading with values,
you will change your own
life in a positive way.

286
There is a 100% probability
that by leading with values,
you will change your culture
in a positive way.

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