1. Getting Your Culture Right for Healthcare Transformation

2. Panel Members Reginald W. Coopwood, MD, FACS – President and Chief Executive Officer Regional Medical Center, Memphis TN Lisa E. Harris, MD – Chief Executive Officer and Medical Director Wishard Health Services, Indianapolis IN Anna Roth, RN – Chief Executive Officer Contra Costa Regional Medical Center, Martinez CA 2

3. Breakout Session Objectives Learn a simple framework for understanding culture and the importance of getting it right for organizational transformation Compare your organization’s culture to a healthcare industry benchmark Learn about ways that leaders can change culture to support organizational transformation 3

4. Corporate Values Communication Respect Integrity Excellence Do these look familiar? They were Enron’s (espoused) Corporate Values! 4

5. Culture is Often Hidden Norms, Behaviors & Artifacts Personal Values & Attitudes Cultural Values & Assumptions Visible & Tangible Less Visible but Talked About Not Visible and Rarely Questioned 5

6. What is Culture? Culture is the shared set of beliefs, values, and behaviors that have contributed to the organization’s success in the marketplace over time. It is a powerful yet invisible force that fosters cohesion, reinforces organizational identity, and pervades every aspect of how the business is run. “It is the way we do things around here.” 6

7. Some Examples of Culture (Positive) The vision of the organization is widely shared and it provides meaning and direction to the work of staff. There is clear agreement on the right way and wrong way to do things. Different parts of the organization often cooperate to create change. Authority is delegated so that people can act on their own. 7

8. Why is Culture Important “Any competitor can duplicate our putting satellite TV’s in every seat, any competitor can duplicate our larger overhead bin space, any competitor can duplicate our extra leg room, any competitor can duplicate our roomier leather seats, but NO competitor can duplicate the culture and leadership we’ve created that delivers the JetBlue experience to our customers.” David Neeleman, CEO, JetBlue Airways 8

9. Changing Perceptions of Business Culture 9 Behaviorally based, measurable, and manageable via deliberate leadership. Result of thoughtful leadership, values orientation, and involvement of the entire organization in a focused direction. Have strategic impact that must be managed to preserve business value and ensure success. Intangible, esoteric, and difficult to manage. Just happens. Luxury when there is time From…To…

10. Why Address Culture Now? The Opportunity: Never Waste a Crisis - Great leaders know that significant opportunity lies in a world turned upside down. Dr. Saj-nicole Joni chief executive of Cambridge International Group The Approach: Culture will have a significant impact on the organization’s ability to effectively transform itself 10

11. A Framework for Understanding Culture Translating the demands of the business environment into action Defining a meaningful long-term direction for the Company Building human capability, ownership, and responsibility Defining the values and systems that are the basis of a strong culture 11 © Denison Consulting, LLC. All Rights Reserved

12. Does Culture Matter? – Links to Performance Innovation & Customer Satisfaction Stable Performance Over Time Profitability ROI, ROE Operating Performance Quality Employee Satisfaction Growth Market Share 12 © Denison Consulting, LLC. All Rights Reserved

13. Composite for US Healthcare Organizations 13 Percentile is the composite score as a percentage benchmarked against the average of other organizations. © Denison Consulting, LLC. All Rights Reserved

14. Dynamic Tension Dynamic Tension: Linking the purpose, direction, and goals of the organization (top - down) to a shared sense of responsibility, ownership and commitment with all employees (bottom - up). 14 © Denison Consulting, LLC. All Rights Reserved

15. Dynamic Tension Dynamic Tension: Successful organizations learn how to cope with the dual problems of external adaptation (stimulate progress) and internal integration (preserve the core). 15 © Denison Consulting, LLC. All Rights Reserved

16. Changing the Culture Example – HealthPlus of Michigan* Core Business – provider of HMO and point-of-service health plans Employees – 400 Opportunity – Stability in the industry in 1997 provided chance to focus on internal infrastructure and monitor/measure an environment that could be continuously improved Results: – Below the 25 percentile for most all of the culture traits – Chose to focus on Mission first – strengthening the vision, developed a strategy, communicated it to staff, and set individual performance goals for staff tied to the company plan – Suffered a setback in 2001 from the pressures of intense competition – Continued the process with focus on specific areas such as Core Values and Capability Development – By 2007, company was scoring higher than 85% of all benchmarked companies * Published by Denison Consulting, Volume 3, Issue 2, 2009 16

17. Changing the Culture Example – University of Maryland Medical Center* Core Business – Healthcare facility, 700 beds, 1,000 attending physicians, 300,000 patients per year Employees – 6,600 Opportunity – Poor financial and operating performance in late 1990’s led senior leadership team to believe that culture change was needed Results: – Initially received low results on culture and leadership surveys – Goal – help leaders develop the skills and relationships needed to make culture stronger and healthier – Implemented a comprehensive leadership development program – Organization needed to learn a new level of empowerment – authentic and truthful conversations with viewpoints respected by senior leaders – Culture survey scores increased on 11 of 12 traits and net income increased 150% * Published in the Organization Development Journal; Winter 2007, page 63 17

18. Creating a Master Plan for Change Gain a full understanding of the current reality – what aspects of culture need to be strengthened to improve the success of the organization Determine the best place to start, typically Mission and Involvement – Mission – shared vision for the organization of the future, with ambitious but realistic goals, that motivates staff and gives meaning and direction to their work – Involvement – Accomplishing the shared goals and objectives in the organization through information sharing, cooperation, and empowerment Design the right programs and interventions to improve the culture Broaden the ownership of the transformation to all internal and external stakeholders Execute the plan and monitor results 18

19. Your Assignment – Analyze Your Organization 19 © Denison Consulting, LLC. All Rights Reserved

20. 20 How did you go bankrupt? Two ways. Gradually, then suddenly. Ernest Hemingway The Sun Also Rises

21. Getting Your Culture Right for Healthcare Transformation