Culture: Solving for WhyMitch Wasden Ed.D – CEO OHSU Healthcare

1. $3.0 Billion in Clinical Revenues

2. 1,200 Employed Physicians

3. 14,000 Employees

4. Nationally Ranked in 13 Specialties by US News & WR

5. #30 in NIH Funding - $300M+ in research spend annually

6. Received $1 Billion from Nike Founder Phil Knight for

Cancer Research

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OHSU:Oregon Health & Science University

Q1. How many of you have

strategic planning retreats?

Q2. How many have strategic

plans?

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SURVEY

“Culture eats strategy

for breakfast.”

Peter Drucker-

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Q3. How many of you have Culture

retreats?

Q4. How many of you have Culture

Plans?

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SURVEY

If culture is that powerful, why do

we have strategy retreats and

strategic plans, but NO culture

retreats and culture plans?

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“Culture eats strategy for breakfast” -Peter Drucker

RESULTS FROM LEADING WITH

CULTURE

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Benefits of Engagement in Culture

• Create 22% higher productivity (Gallup survey of 1.4M employees)

• Doubles the rate of success of an organization

• Lower absenteeism

• 25% lower turnover

• Higher quality

– 41% fewer patient safety incidents

– 41% fewer quality incidents (defects)

Results at Ochsner Medical Center-Baton Rouge

How identity drove results from 2007-2012

• Hospital: From 15th percentile patient satisfaction to 90th (3 years running)

• Clinic: From 50th to 95th (3 years running)

• Employee engagement from worst in the 8 hospital system to #1 in the 8 hospital system

• RAMI/RACI from worst in system and city to tied for 1st

• From unprofitable to profitable

Results at MU Health Care

How identity drove results from 2012-present

• Hospital: From 15th percentile patient satisfaction to 89th

• Exceeded budget 5 straight years, margins from 4% in 2012 to 8.75% in 2016

• Employee engagement increases for four consecutive years from 14th to 60th percentile

• UHC/Vizient Ranked MUHC #9 in the nation in 2014, tracking in top quartile.

• Market share growth from 19.6% to 26.7% in four years

• 1,200 PDSA/QI projects done per year by 5,500 employees

KNOWING + DOING = SKILL

USELESS USEFUL

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KNOWING

DOING

KNOWING

DOINGSKILL!

BKD Model: Work is MEANINGFUL when we see our identity in it.

MEANINGFUL

WORK

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USELESS

KNOWING

DOING

KNOWING

DOING

USEFUL

SKILL

KNOWINGDOING

BEING

MEANINGFUL

WORK

WE LIVE IN

COMPLEX TIMES

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Exponential Intellectual Property

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1900 1940 19701910 20001920 1930 19501950 1960 1980 1990

0

500

1000

1500

2000

2500

3000

3500

4000

Doubling every 2 yearsApplications

US Patent

Applications

EU Patent

Applications

Source: USPTO and EU PCT and EPC

Explosive Risk - Bankruptcy

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1900 1940 19701910 20001920 1930 19501950 1960 1980 1990

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Doubling every 10 years

Personal

Bankruptcy/1000 persons

Source: Administrative Office of the US Courts and Census Bureau

Booming Population Growth

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Wo

rld

Po

pu

lati

on

(B

illi

on

s)

100 900 1500300 2100500 700 1100 1300 1700 1900

0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Source: World Population Growth: Historical Trends & Future

Prospects, Charles Hirschman

Our Mental Dilemma

What is noise and what is signal?17

25 YEARS AGO:

515 YEARS AGO: TODAY:

20 100+

MEMOS/WEEK

VOICEMAILS/

DAYEMAILS OR

TEXTS/DAY

“The healthcare industry is the most complex form of organization we have attempted to manage in human history.”

Peter Drucker-

Complexity in the Healthcare Industry

• Cultural Identity is the “Butterfly Effect”

• Butterfly effects explain how tiny actions can cause huge results

• The problem is these actions are non-linear and so are difficult to flow chart out. As a result we often discount them.

IDENTITY AS A BUTTERFLY EFFECT

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INSIGHT #1YOU CAN ONLY MANAGE

COMPLEXITY WITH SIMPLICITY

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Group Behavior: Complex Flocking Behaviors

3 individual instructions creates group order:

1. ALIGNMENT: Steer toward the average

heading of the flock (see the vision)

2. COHESION: Steer toward the average

position of local flock mates (stay close to

your team)

3. SEPARATION: Avoid crowding other birds

(but not too close…need for autonomy)22

What complex flocking birds can teach us

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3 Rules make Order from Chaos

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INSIGHT #2YOU MUST CREATE IDENTITY

WITH THE BRAIN IN MIND

IDENTITY - drives - ACTION - drives - RESULTS

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Identity is behind every action

Identity is the butterfly effect, that small thing that

creates large scale change

VS.

1) EMOTION

• How we feel about the identity

• Emotion is encoded on each

mental map

• The stronger the emotion, the

more quickly it can recruit the

mental identity map (for good

and bad)

2) INSTRUCTIONS

• The brain creates a list of

instructions regarding behavior

associated with that identity

IDENTITY MAP: I am a Mizzou Fan

1) Emotion Pride/Joy

2) Instructions Shout: Go Blue!

Yell at the other team

Wear Maize & Blue

In a new context, identity maps

generally recruit .05 to 8 seconds

before we are consciously aware

of them affecting our behavior

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Ingredients for a Mental Identity Map

Mother Doctor Stressed Victim

Every situation recruits new

identities which want to be

validated or enhanced. Only

occasionally do we drop

identities that don’t serve us.

The Identities cloud reality

and keep us from seeing

things clearly.

The Situation

You are running behind

schedule and have three more

patients before you can leave.

One of your partners told the

receptionist to send any walk-

in patients to you so they can

leave early for a social

function. You then walk into

the room to see the patient…

Recruited Identities Activated by the Situation

Possible IdentitiesFear based identities keep us from

seeing clearly given they are more

clouded than power-based identities

(due to a limbic hangover)

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When we perceive a situation through identity filters, reality is obscured

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INSIGHT #3WE ALL THINK IN IDENTITY

NARRATIVES 95% OF THE TIME

When you see a group photo that you were in, who is the first person you look for?

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The Narcissist Test

CHANNEL 1: NARRATIVE

• Plays our favorite program called “Me and My Story”

• We are always the main character

• We broadcast on this channel 95% of our waking hours

• High ego needs

CHANNEL 2: DIRECT EXPERIENCE

• We broadcast on this channel 5% of the time

• We are not the main character but rather feel at one with the story line and those in it.

• No ego needs

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Science has proven the brain broadcasts on 2 channels

Why can you listen to an hour

lecture and only recite back 7%

of it’s content but remember

almost 100% of the stories that

were told?

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INSIGHT #4MAKING THE SCIENCE OF

IDENTITY PRACTICAL

PROGRAMS THAT ENFORCE IDENTITY

• “Power of One” Awards

• Linking behaviors in evaluations

• Reciting the identity at the start of staff

meetings

• Making the phrases part of the public

language

• Power of One stated at the end of e-

mails signatures, memos, etc…33

The Practice: Culture Building through “Attention Density”

Imagine Inspire Engage Excel

• Invent the future

• Simplify complexity

• Connect to the mission

• Lift others

• 10/5 Rule

• Assume positive intent

• Say Do Ratio 1:1

• Reach higher

The Power of One: Together we Imagine, Inspire, Engage, & Excel

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INSIGHT #5OTHER ORGANIZATION WHO HAVE

DELIBERATELY FOCUSED ON

CULTURE AND BEHAVIORS

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Culture as a trade secret

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INSIGHT #6EMPLOYEES FOCUS ON WHAT

THE LEADER FOCUSES ON.

SO FOCUS ON THE DESIRED

ORGANIZATIONAL IDENTITY.

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Leader as a museum curator

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Museum Curators

make choices

about what they

want people to

focus on...

Leaders make

choices about

what they

want people

to focus on...

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CULTURE AND

MISSION

EMPLOYEES

Imagine Inspire Engage Excel

• Invent the future

• Simplify complexity

• Connect to the mission

• Lift others

• 10/5 Rule

• Assume positive intent

• Say Do Ratio 1:1

• Reach higher

The Power of One: Together we Imagine, Inspire, Engage, & Excel

Employees focus on what the leader

(curator) is focused on...

If you don’t want employees to focus on

something (drama, victim mentality, etc…)

get it out of the gallery.

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What employees focus on

• It will take 18 months to get 12,000

people to memorize 1 sentence

• It will feel cool in the first six months,

stale from 7-12 months, and then

become who we are at 12-18 months

• Employees will never model it if the

leader doesn’t model it and recite it at

huddles, reward for it, and hire for it.48

What to Expect…

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MOUNTAIN TRIBE VALLEY TRIBE

Strong Identities Drive Higher Performance

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“You were not

his mother…”

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“Education is not the filling of a

pail, but the lighting of a fire….”

W.B. Yeats

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Thank You