Annotated Edition

The Florence

Prescription

Building a Culture of Ownership

on a Foundation of Values

Independent Hospital Network Leadership Summit

January 13, 2012

Joe Tye, CEO and Head CoachValues Coach Inc.

Copyright © 2012, Values Coach

Inc.

If your raft is in class 5

whitewater and the

guide hollers out for

everyone to grab a

paddle…

What do you do to

the person who

says…

Your

Hospita

l

Healthcare Reform

In the stormy seas of

healthcare reform, it is

everyone’s job to grab an oar

and paddle!

Question #1

When did the

healthcare

crisis begin?

Question #2

When will the

healthcare

crisis end?

14

This story…

15

Has a happy

ending!

The Chinese symbol for crisis

means danger + opportunity

“Brick walls are not

there to stop you, they

are there to make you

prove how much you

want something.”

Randy Pausch: The Last Lecture

Whether it’s the best of times

or the worst of times depends

upon what we choose to see

19

What would you think of this ship and

its leadership if 25 of the 100 rowers did

most of the work while 60 of them

coasted by and 15 of them were actually

rowing backward?

Companies that study

employee engagement*

consistently find:

~ 25% fully engaged

~ 60% not engaged

~ 15% aggressively

disengaged

* e.g. Gallup, HR Solutions, Press Ganey

Engaged: Spark Plugs

22

Not Engaged: Zombies

23

Disengaged: Vampires

24

Shift Your Bell Curve

Employee

disengagement

negatively effects

clinical quality,

productivity, patient

satisfaction, and

marketing image.

But what’s

even more

tragic...

It has a life-diminishing

impact on the

disengaged.

“Disengagement [is]

one of the chief causes

of underachievement

and depression.”Edward M. Hallowell, M.D. in HBR, 12-10

The journey from mere

Accountabilit

y 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.

Do you know people

who seem to think that

this is the official

uniform where they

work?

Or that this is the

official job description?

You cannot hold people

“accountable” for the

things that really

matter.

What’s wrong

with this

picture?

Not My

Job!

Nobody ever

changes the oil in a

rental car!

Ownership

Doing what needs to be

done because you expect it

of yourself. Ownership

springs from the intrinsic

motivation of pride.

In a culture of ownership,

every job description

includes first and foremost

being a caregiver, last but

not least being a janitor, and

in between being willing to

do whatever else needs to

be done.

42

Cultural ownership is of the heart, not

of the wallet… No one ever walked off

the job of a Habitat project in a pay

dispute!

When baggage handlers at United

broke Dave Carrolls’s Taylor guitar,

they refused to reimburse him for

the damage. When he said that he

was going to write a song about it,

they told him to go ahead. He did –

to date, more than 16 million

people have viewed “United Breaks

Guitars.”

18,339,829 views

78,545– avg 5 stars

As of 01-13-11, 12:15am

“We have hundreds if not thousands of examples…” 787,839

The Taylor Guitar Company made

their own video: how to pack up

your Taylor guitar so United won’t

break it!

How do you spell public

relations black eye?

48

All it would

have taken to

prevent this PR

black eye is one

person taking

ownership for

the problem.

Unfortunately, because

that did not happen,

every United employee

has been painted with

that brush.

49

The real losers in

this picture are the

good people who

work at United.

United does not

have broken

people; United has

a broken culture.

A word about the

assumptions we

make.

What do you get

when you break the

word “assume” into

its constituent

parts?

Faulty Assumption #1

You can’t teach people

values – if they didn’t

learn in kindergarten,

it’s too late.

Culture is a given –

especially in the short

term you cannot

transform it.

Faulty Assumption #2

You can “empower”

people without them

having doing the work

of self-empowerment.

Faulty Assumption #3

If you can’t measure it,

it’s not worth doing.*

Faulty Assumption #4

* The left brain counts

but the right brain matters.

Invisible

Architectur

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

When it comes to employee

and patient satisfaction, the

blueprint that can’t be seen is

more important than bricks

and

mortar.

Invisible architecture

is to the soul of your

organization what

physical architecture

is to its body.

Core Values are

the Foundation

Core values

define what you

stand for and

what

you won’t

stand for

65

Zappos Family Core Values1. Deliver WOW Through Service

2. Embrace and Drive Change

3. Create Fun and A Little Weirdness

4. Be Adventurous, Creative, and Open-Minded

5. Pursue Growth and Learning

6. Build Open and Honest Relationships With

Communication

7. Build a Positive Team and Family Spirit

8. Do More With Less

9. Be Passionate and Determined

10. Be Humble

Source: Zappos website

1. Deliver Wow Through Service

He goes above and beyond the average level of

service to create an emotional

impact on the receiver

and give them a positive

story they can take with

them the rest of their

lives.

Source: Zappos website

The Values Behaviors Outcomes Continuum

68

Trust is an outcome that is

earned…

By the behaviors of honesty,

reliability, humility, and

stewardship, which are founded

on…

The value of integrity. 69

What are the

core values of

your

organization?70

Why were those specific

values chosen and what

do they say about who

you are and how you do

your business?

71

Which value do nurses

feel is more important

to executive

leadership?

72

Compassion

73

OR…74

Productivity

75

This is a false dichotomy. No

organization can be optimally

compassionate if it is not also

optimally productive.

The first person ever to

calculate cost per patient day

was… 76

OR

AND77

Most organizations, no matter

what industry they are in,

claim integrity as a value,

either explicitly or implicitly.

But in almost all of them (most

likely including yours) there

is… 78

An Integrity Gap

79

Because almost every organization

has a rumor mill… And what does

it say about your commitment to

integrity, respect,

and dignity if your

culture tolerates

people spreading

rumors? 80

The root of the word

integrity is “integer”

– one unified whole

The incredible

invisible man

81

The guiding insights

behind our work at Values

Coach…

82

Values are

Personal

and…

Values are

Skills

Nobody learns

everything they

need to know in

kindergarten!

88

Why should you

care about the

personal values of

your people?

89

“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

90

Participants say it’s like

graduate school for life (or like

graduate school for the seven

habits).

92

These universal values

transcend political

opinion, religious belief

(or non-belief), ethnic

heritage,

and social class. 93

After all, who

wants to be a

phony?

Core Action Value #1

is Authenticity

94

Don’t we all need to live

with integrity, awareness,

courage, perseverance,

and faith?

The first six Core Action Values lay

a solid foundation of character

strength 95

Don’t we all need the

power of purpose, vision,

focus, enthusiasm, and

service?

The second six Core Action Values

help us do our work and make a

difference 96

Don’t people who live

their values inspire and

influence others?

Core Action Value

#12 is Leadership

97

The business case

for values

training…

Is not really about

business

A Classic Win-Win!

The individual wins:

“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 CEO101

102

The organization wins:

“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

It’s not that you do or

don’t practice values –

it’s where you fall on

the continuum.

103

And if you are not

moving forward, then

you are sliding

backward.

104

105

In Stage 4 decline “people

cannot easily articulate

what the company stands

for; core values have

eroded to the point of

irrelevance.” Jim Collins: How the Mighty Fall

106

Why it

matters now

more than

ever before…

107

Values and

value-based

purchasing.

108

People will sustain

personal change only

to the extent that they

are motivated by

deeply held core

values.

109

Recruitingandretention

is not one word.

Use the “Honey and

Glue” formula to find

and keep great people.110

You recruit with the

“honey” of left-brain

features such as pay and

benefits… 111

You retain with the “glue”

of right-brain qualities

reflected in values and

culture. 112

Values and Employee Loyalty

Source: Roger Herman, et al: Impending Crisis: Too Many Jobs, Too Few People (page 139) 113

When a critical mass

of people connect

with and act upon

their core values,

they will have a

positive impact on…

Corporate culture is

the superstructure

Culture is morally neutral.

Enron had a powerful

culture.

Culture is to the

organization what

personality and

character are to the

individual.

“I came to see, in my

decade at IBM, that

culture isn’t just one

aspect of the game –

it is the game.”

Culture eats

strategy for lunch!

Corporate culture didn’t

even make the top ten list of

CEO concerns in the 2010

ACHE survey on issues

facing the industry.

Who has the

power to change

the culture of

your

organization?

124

Anyone can have an influence on

the culture of the organization

simply by raising expectations of

how we treat our patients and how

we treat each other.

125

Shawneen Buckley of Saint Francis Hospital

and Health Center in Poughkeepsie, New

York

You do not need an architectural

degree to design the Invisible

Architecture of your organization!

126

Culture doesn’t change

unless people change,

and that is

emotional

work!

Emotional attitude

is the interior décor

As with finishing off a

building, the outward

reflection of

corporate culture is…

If I were to

become a hospital

CEO today…

This would be my

response!

Seriously, in that

role the first thing I

would give my

attention to would

be…

The invisible ceiling

on your hospital’s

performance

Every child has super

powers, but we tend to

forget them as we grow up –

especially if subjected to an

emotionally toxic workplace.

In The Florence Prescription:

From Accountability to

Ownership, Sarah Rutledge is

a nurse with great clinical

skills but a toxic negative

attitude.

Our challenge as healthcare

leaders is to move people

from the “Rutledge

Quadrant” into the high-

passion and high-

performance quadrant of this

matrix…

I would help people

confront the

malignant echo of

negative self-talk

By showing them how

to have “The Janitor

in Your Attic” erase

such toxic mental

graffiti

And help them set

aside debilitating

emotional baggage

By showing them how

to leave it behind on

a cairn in the desert

146

147

A positive workplace

culture begins with

intolerance for toxic

emotional negativity.

148

“One toxically negative

person can drag down

morale and productivity

of an entire work

unit.”

149

“It is a leadership

responsibility to create a

workplace environment

where toxic emotional

negativity is not

tolerated.”

The Pickle Challenge is a

simple and light-hearted

approach for people to

hold each other

accountable for the

attitudes

they bring to

work.

153

A real “Sarah Rutledge” story

Remember these days? What

would happen to someone who lit a

cigarette on a plane today?

154

Building a

culture of

ownership

Do you have to start with the

right people on the bus?

You can’t always

choose who you

have on the bus!

You can’t just

throw all the

“wrong” people off

the bus!

You can create a bus that

everyone wants to ride

163

www.TheFlorenceChallenge.com

The Florence Challenge website

“resources” section includes a

wealth of additional resources

for building a culture of

ownership.

165

More than 400 hospitals and healthcare

organizations and nearly 80,000 books.

Only $5 per book:

166

Call Michelle:

800-644-3889

167

1. Commitment

To the values, vision, and

mission of the

organization

170

The Vision Statement of Columbus Regional Hospital

To be the best in the

world

at everything we do.

“We need to see

opportunities where others

see barriers. We need to

be cheerleaders when

others are moaning doom-

and-gloom.”

“We need to face problems

with contrarian toughness

because it’s in how we

solve those problems that

we differentiate ourselves

from everyone else.”

When the going

gets tough...

Cultural toughness is the ultimate competitive advantage

2. Engagement

With patients,

coworkers, and with the

work itself

“Having a highly

engaged workforce is

the first thing required

to win

on the global stage.”

Jim Owens, retired CEO, Caterpillar Inc.

At Best Buy, a 0.1%

increase in employee

engagement generates

a $100,000 increase in

gross store revenue*

* Harvard Business Review, October 2010

I went into the Apple

store to look at an iPhone

and walked out with a

$4,000 iMac computer –

sold to me by another

customer!179

Apple does not

have

employees…

Apple does not

have

customers…

180

Apple is a cult!

181

Books like In Search of

Excellence and Built to

Last remind us that great

companies have “cult-like

corporate cultures.

And in organizations with

such cultures, people are

inspired to be engaged –

with customers, with

coworkers, and with the

work itself.

3. Passion

Enthusiasm, positive

attitude, and joy

reflected in everyday

actions

What’s wrong with this picture?

There is an undeniable element of cheerleading

in the most effective leadership, according to

James O’Toole in the book Leadership A to Z.

The official uniform at

Texas Roadhouse

Restaurants

Colonel Jennifer is founding director of

the Center for the Intrepid, which cares

for the most horribly wounded soldiers.

Despite their grim task, CFI is a place that

shines with passion!

4. Initiative

Don’t wait around to be

“empowered” –

Proceed Until

Apprehended!

Leadership in

every corner, not

just in the corner

office.

No one gave Cool Hand Luke permission to become a leader on the chain gang, and to transform drudge work into a game.

His attitude was…

Proceed Until

Apprehended!

192

Courage is the

catalyst for

initiative

It did not take Randall Patrick McMurphy

long to realize that the men in “the

cuckoo’s nest” were not crazy – they were

frightened into paralysis.

People and organizations can

both be paralyzed by irrational

fears

Are people afraid

of change?

5. Stewardship

Because we don’t own

the earth – we are

borrowing it from our

grandchildren

Operation Wipeout – Spark Plugs at

the Alaska VA Healthcare System

adopt local homeless shelter

Last year, the nonprofit Supplies

Over Seas organization sent 60

tons of discarded medical

supplies and equipment to third

world countries

6. Belonging

In a culture of

ownership, people are

treated like partners,

not just hired hands

202

“You would think they’d give me

as much information about our

hospital finances as I get at my

once-a-month school board

meeting.”

203

Would you expect to see

some of America’s most

financially literate

employees working on an

assembly line rebuilding old

diesel truck engines?

But you would at Springfield

Remanufacturing, where Jack

Stack invented open book

management

7. Fellowship

Because (as Mother

Teresa reminded us) we

are all children of the

same God

The need for fellowship is so

profound that in the absence

of other people…

We can find it in a

volleyball

The most memorable Coke

ads don’t even talk about

fizzy brown sugar water, do

they?

209

210

Committee of the Ring

211

The Ring Team

212

Fellowship of the Ring

213

8. Pride

In your organization, in

your profession, in your

work, and in yourself

Pride is reflected in the answer

to that universal icebreaker

question:

What do you do?

Does the answer convey:

I’m good at what I do.

I love what I do.

I’m proud of what I do.

What I do is important.

The most powerful and

cost-effective

marketing campaign

your hospital could

ever launch!Thanks for asking…

What could be more boring than

industrial ventilation systems?

220

Big Ass Hospital.comThis page is parked free, courtesy of GoDaddy.com.

                      

Key Lessons Learned

(thus far) from

Implementation of

the Values

Collaborative

Lesson #1

Launching a movement is

a lot harder than starting

a program – it is also

much more likely to

achieve a lasting positive

impact.

223

Lesson #2

Achieving critical mass

requires approximately

30% population

commitment.

You need enough people

moving fast enough to

escape negativity,

pessimism, cynicism, and

inertia of the past.

Lesson #3

Senior leadership must

have a highly visible

level of engagement

and commitment.

Lesson #4

Middle management’s

mere support is not

enough – they must be

gung ho champions for

change.

The privileges of being a

manager also entail

certain foregone

freedoms

Lesson #5

Sustainability requires a

growing core of

passionate “Spark

Plugs” who have a

personal stake in

cultural transformation.

Personal stories

resonate far better than

scripted lectures –

cultural transformation

is more about sharing

than it is about

teaching.

Lesson #6

Embrace the skeptics,

marginalize the cynics,

and plow through

resistance.

Lesson #7

Engage potential critics

in a constructive

manner – encourage

them to think like

partners in the change

process.

Lesson #8

Avoid identification of

the change process with

any single individual or

“program.”

Lesson #10

Create initiative

coherence by being

clear about how various

projects reinforce one

another.

Lesson #11

Keep it visible: posters,

banners, screensavers,

newsletter articles, web

pages; include it at the

start of every meeting.

Lesson #12

Remember that

everyone listens to the

same radio station:

WIIFM

Lesson #13

Balance urgency and

patience; be in it for the

long haul.

Lesson #14

Sometimes it’s more

magic than it is science!

“If we each do our

part, we will

change our lives for

the better.”

240

The work of changing an

organization begins with helping

the people who work there make

positive changes in their own lives

Responses fromMaster Values Coach Trainers in VISN 20of the Veterans HealthAdministration

“If we all do our

parts, we will

change our

organizations for

the better.”242

In a growing number of

organizations across the

country, groups of

people gather daily to

read that day’s promise

from The Self-

Empowerment Pledge 243

244

“And in changing our

organizations, we can

change our world for the

better.”

245

Building a Culture

of Ownership is the

Ultimate Win-Win-Win

The Patient Wins

The Hospital Wins

The Caregiver

Wins