If you believe that culture eats strategy for lunch (and I do), then fostering a culture of ownership should be at the top of your list of strategic priorities. In my last article, I laid out the argument that culture almost always trumps strategy. In this article, I'll share a dozen practical tactics for fostering a culture of ownership.
Twelve Great Ideas
The following strategies can be your most important source of sustainable competitive advantage:
Revisit your statement of values. Most hospitals have a statement of values, but it usually conveys what should be basic requirements (of course you are committed to compassion and excellence) and rarely provides a source of competitive differentiation. A statement of values often reads like a boilerplate that's been written by a consultant after doing a market research study; it could just as well apply to the competing hospital across town. A great statement of values is unique: It instills pride, guides decisions and actions, and galvanizes employee commitment.
In my last article I mentioned the 10 core values of Zappos (an online shoe store). These values feature prominently on Zappos' website and in its recruiting efforts. They are distinctive and unique (their core value No. 3 is "Create fun and a little weirdness" — you know that was not written by a management consultant!). Zappos is a great example of a company that uses core values to create a sustainable source of business success and competitive advantage.
Engage your hospital community in a discussion about the values that really matter to them and that should matter to your organization. For example, because demographers are universally predicting serious shortages in every category of health care professional, should loyalty be elevated to the status of a core value? How about stewardship, both for the ecological environment and for effectively managing the limited resources of the hospital?
Create a cultural blueprint.Your patients' first impression of your hospital is created by the visible architecture of the buildings, but their lasting impression (and what they will tell others about their experience) is shaped by what we call the Invisible Architecture™. While many health care executives might agree with the statement that "culture eats strategy for lunch," it is the rare organization that has a cultural plan to match its strategic plan.
Hospitals can use a construction metaphor to help create a cultural blueprint depicting a foundation of core values, a superstructure of corporate culture, and an interior decor of emotional attitude in the workplace. Creating this cultural blueprint can be invaluable for helping define and enforce the behavioral expectations necessary to live those values and shape that culture.
Reinforce your Big Story with little stories. Most organizations have a Big Story, often associated with its founding. The Big Story of Hewlett-Packard can be captured in just four words: started in a garage. That story line captures the essence of the great entrepreneurial success story of HP. And during its formative years, that Big Story was reinforced by countless little "Bill and Dave" stories that shaped the HP way — the corporate culture that inspired the book In Search of Excellence and has been the gold standard for corporate cultures ever since.
The Mayo Clinic is still substantially shaped by the Big Story of William Mayo, who founded the hospital after a devastating tornado destroyed much of Rochester, Minn., in 1883. Each year Catholic Health Initiatives publishes Sacred Stories submitted by employees from across its system. These stories help shape the system's cultural and behavioral expectations — and they tell patients more about what it's like to be cared for at a CHI hospital than all the billboards and radio ads in the world.
Teach managers how to tell those stories. Although the term "motivational speaker" often conveys somewhat of a negative connotation, shouldn't that be part of the job description of every middle manager: to inspire, encourage and engage the people in his or her department? The ability to stand in front of a room and move people — to think, to feel, to laugh and on occasion to shed tears — is a vital leadership skill. Fortunately, it is also a skill that can be taught and practiced.
When middle managers know the stories to be told (the Big Story and a collection of the little stories) and have the confidence and skill to deliver those stories in a compelling manner, they will be more effective in virtually every dimension of their jobs: promoting a positive workplace environment, increasing productivity, recruiting and retaining great staff, and engaging people in the work itself.
Incorporate culture into your branding. The culture of your organization will do more to establish your brand in the public eye than all of your promotional activities combined. (For proof of this, consider the experience of flying United vs. Southwest.)
Fairfield Medical Center in Lancaster, Ohio, has incorporated the eight essential characteristics of a culture of ownership described in the book The Florence Prescription: From Accountability to Ownership (commitment, engagement, passion, initiative, stewardship, belonging, fellowship and pride) into its "recruiting brand." Before the interview process even starts, prospective employees are told what to expect, and what will be expected of them, as part of the Fairfield culture. (For more detail on these characteristics, see the H&HN Daily article "Creating a Culture of Ownership" that I wrote with Tucson Medical Center CEO Judy Rich.)
Create intolerance for emotional negativity. The first step to creating a more positive workplace culture often is fostering a higher level of intolerance for toxic emotional negativity, as reflected in chronic complaining, gossiping and passive-aggressive behavior. In his pioneering work on emotional intelligence, Daniel Goleman shows how one negative person can drag down the morale and productivity of an entire work unit.
Teaching people practical skills to confront bullying, rumor-mongering, and chronic complaining in a constructive manner is an essential investment in a more positive workplace environment. One of the most effective, but almost universally overlooked, tools for this training is structured role-playing. (For more ideas on this, see my H&HN Daily article "A Positive Approach to Negative People.")
Reinforce culture with rituals. Every morning a group of people gather at Tri Valley Health System in Cambridge, Neb., to recite that day's promise from the Self-Empowerment Pledge, something that has been happening for well over a year. In fact, if you watch the YouTube video closely, you'll notice that about half of the people participating aren't reading that day's promise — they have memorized it. CEO Roger Steinkruger says this ritual has been one of the most important factors in the hospital's cultural transformation over the past several years.
Honor the WIIFM Principle. Motivational speaker "Zig" Ziglar said that everyone listens to the same radio station — WIIFM, or What's In It For Me? Before you ask people to make efforts on behalf of the hospital, think of ways you can create that personal connection. Hospitals everywhere are asking people to "do more with less," but most of those people are facing the same challenges on the home front as they struggle with expenses and debt. You are more likely to gain commitment to your "do more with less" strategies if you first help employees do more with less at home (for example, by offering courses on personal financial management).
Create a fill-in-the-blank job description. According to surveys by Gallup, fully 80 percent of American workers feel their greatest strengths are not being used on the job. If that's true for your organization, it means there is an incredible opportunity to tap into non-traditional skills and passions. One way to do this is to allow people to make the case that they should be able to devote a portion of their paid hours to do something they love in a way that benefits the organization.
For example, you might have a poetry-writing nurse who wants to create special cards for patients, or a housekeeper with a passion for woodworking who wants to build custom overbed tables to sell in the gift shop. If you think this is a silly idea, consider that the most profitable ideas Google has ever implemented, including Gmail and Google Maps, were created by people being paid by the company to work on projects for which they had a passion, but were not part of their official job description.
Take open book management seriously. Open book management was pioneered by Jack Stack and his team at Springfield ReManufacturing Corp. — a company that rebuilds diesel truck engines. They don't just share financial information with employees; they teach them how to understand and use it in their everyday work. If you ask someone installing crankshafts in a truck engine how much the part costs, he'll reply by asking you whether you want the incremental or fully loaded cost, then provide either figure. They have turned what they call the Great Game of Business into a profit center, teaching other organizations how to implement open book management.
Teach effective followership. Most organizations provide managers with courses on leadership, but a much better investment might be courses on followership. In his book The Courageous Follower: Standing Up to & for Our Leaders, Ira Chaleff defines courageous followers as being "high-challenge and high-support." One of the biggest barriers to effective culture change in hospitals is middle managers who are "low-challenge and low-support." In our experience, the single best predictor of success or failure in a culture change initiative is the enthusiasm, or lack thereof, of the middle management team. Laying out specific expectations, and consequences for not living up to those expectations is essential to replacing a "culture of optionality" with a culture of ownership.
Reach out to engage families. The culture of your organization is part of a larger cultural ecosystem. Most of your people go home to a family setting once they leave work, and that setting has a profound impact on their moods and mindsets. When we conduct values training for hospital clients, we always recommend special sessions for spouses and adult children because if they understand and support the attitude and behavior changes you are asking their spouse or parent to make, you are much more likely to see those changes sustained over time.
Pride of Ownership
No one ever changes the oil in a rental car. People return rental cars with a full gas tank because that's in the contract — they are accountable for it. The only car people wash and wax is a car they own. When you move from a culture of mere accountability to a culture of ownership, you create a sustainable source of competitive advantage for both recruiting and retaining great people and for earning long-term patient loyalty.