Most hospitals have a statement of values but, in many cases, they are a predictable, unimaginative and uninspiring boilerplate that does little to differentiate that hospital from every other. An effective statement of values should help define who you are, what you stand for and what you won't stand for — but it should also create a distinct competitive differentiation.

Four Attributes

Every statement of values should contain four attributes that will give your organization a competitive advantage. These attributes are drawn from examples outside the health care industry:

Values should be the foundation of your culture.The preamble to Home Depot's statement of values, which is prominently posted on the corporate website, says: "Our values are the fabric of the company's unique culture and are central to our success. In fact, they are our competitive advantage in the marketplace."

When Home Depot hired a new CEO, Robert Nardelli, he implemented strategies that in the short term increased sales and profits, but he did so at the cost of trashing what had been a vibrant culture of ownership. He replaced knowledgeable long-term employees with part-timers who had minimal relevant experience and centralized decision-making. These strategies violated Home Depot's core values of respect for all people and promoting an entrepreneurial spirit. Home Depot's board eventually realized that by putting profits ahead of people, Nardelli was destroying a culture that its founders had carefully cultivated.

Values should be operationally relevant.Proctor & Gamble has five core values that are reinforced by 17 supporting statements and further amplified by eight operating principles that have 23 supporting statements (in case you're counting, that's a total of 53 statements that P&G's leaders believe are needed to fully define who they are, what they stand for and what they won't stand for). The preamble to the P&G statement of values simply says: "P&G is its people and the values by which we live."

P&G's values and operating principles define very clear expectations for employees, establish a competitive mindset (one of their five core values is "passion for winning") and inspire a connection with personal values (winning is a very personal thing for most people). The P&G statement of values is not a boilerplate, and has not been dumbed down to fit on the back of a business card; these values and principles are not just warm and fuzzy good intentions — they establish a high bar of performance expectations.

Values should inspire pride and trust. Zappos started as an online shoe store, and within eight years was a billion-dollar retail giant that is now part of Zappos has 10 core values that are featured prominently on its website. In his book Delivering Happiness: A Path to Profits, Passion, and Purpose, Zappos CEO Tony Hsieh writes: "Committable core values that are truly integrated into a company's operations can align an entire organization and serve as a guide for employees to make their own decisions."

The way Zappos lives these values has created an incredible competitive advantage in the marketplace (with values such as "Deliver WOW through service") and for recruiting and retaining great people (with values like "Create fun and a little weirdness"). It is easier to get into Harvard University than it is to get a job at the Zappos call center.

Values should help define your brand.Dame Anita Roddick started out making cosmetics in her kitchen and from there grew The Body Shop into a worldwide business empire. The company's core values relate to giant social issues, not just business. Their commitment to environmental sustainability, no animal testing and other noble social goals has created an iconoclastic image that supports a customer base that is price insensitive and virtually impermeable to competitive inroads. These values have created an unmatchable source of competitive advantage for attracting loyal employees and customers.

Operational Recommendations

Below are 10 things you can do to breathe new life into your statement of values; make them operationally relevant; and assure that they inspire pride, trust and commitment among your people.

Review, refine and revitalize. Every three to five years, pull your statement of values off the wall and subject it to a comprehensive review. When Johnson & Johnson CEO Jim Burke discovered that almost no one in the company knew the J&J credo (the statement of values initially penned by General Robert Wood Johnson in 1943), he mandated a companywide training program.

Several years later, the company was hit with the Tylenol poisoning crisis. When his leadership team met in emergency session, Burke placed copies of the credo at every seat, and these principles guided their response. Doing the right thing cost millions of dollars, but it created billions of dollars' worth of good will. (Unfortunately, in recent years J&J has paid a substantial price in monetary fines and tarnished reputation by straying from the credo.)

One of the 10 core values of Auto-Owners Insurance Co. (about which I wrote in the article "What Your Hospital Can Learn about Values from an Insurance Company") is loyalty; in its 97-year history the company has never had a layoff, it promotes exclusively from within and it defines loyalty in terms of commitment rather than mere tenure. Given predictions that we are headed into one of the worst staffing shortages ever and that turnover accounts for about 5 percent of operating costs in a typical hospital, should you elevate loyalty to the status of core value in your organization?

Assess your values-behaviors-outcomes continuum. An examination of this continuum can help your organization clarify its expectations. Most of the terms that appear in a statement of values are not values; they are valued behaviors or outcomes. Trust, excellence, safety and financial stability are not values; they are outcomes. Recognizing this distinction helps identify the expected behaviors; in the case of trust, they are honesty, reliability and humility. And the underlying value that inspires these trust-building behaviors is integrity.

Avoid boilerplate. If you take down the values statement from the wall of a typical hospital and post it in the lobby of a competitor, no one will think it out of place. In my book The Florence Prescription: From Accountability to Ownership, I poke fun at hospitals that force-fit words into a cute acronym like I CARE, mainly because they set the bar too low. Of course, integrity, compassion, accountability, respect and excellence (the most common words stuffed into that acronym) are important, but how do they differentiate your organization from crosstown competitors?

Create an expectation of learning. When I'm speaking, I'll often ask people in the audience to raise a hand if they know the values of their hospital by heart. It is appalling how often people, including those who have the word chief in their titles, are unable to recite their organization's values, much less explain why those values were chosen and the expectations they create. This should be an absolute expectation for every single employee.

If a 5-year-old child can learn the pledge of allegiance in kindergarten, then you as a health care executive can expect your people to know and understand (not just memorize) the core values of your organization and to be able to talk intelligently about them. Establishing this expectation will foster pride and commitment; failure to establish it creates an implicit assumption that people are either not smart enough or don't care enough to make the effort.

Incorporate values into recruiting. Even before the first interview, prospective employees should be required to read and sign your statement of values as a way of conveying their importance. Fairfield Medical Center in Lancaster, Ohio, created posters defining the eight characteristics of a culture of ownership that it has incorporated into its "employment brand" for use in staff recruiting. Your values should be featured prominently in every new employee orientation, ideally by a senior executive. Jeff Harrold, CEO of Auto-Owners Insurance, meets with new employees six months after their start date; one of the questions he asks is, "How have you seen our 10 core values being acted out in the daily operations of our company?"

Include values in performance appraisals. It is not possible for someone to be a negative, bitter, cynical, sarcastic, emotional vampire in the break room and then somehow flip an inner switch and become genuinely caring and compassionate when dealing with a patient. Patients see right through the fraud.

One of the criteria in the Zappos performance appraisal process is: "You inspire others to live and breathe our core values." Do managers in your organization hold people accountable to such a standard?

Make values beautiful. A statement of values does not have to be a boring brass plaque on the wall. Chances are you put more time and money into the design of a promotional flyer than you do the visual presentation of the most important document in your organization — your statement of core values.

One of the most beautiful renderings I've seen is the values statement of Tucson (Ariz.) Medical Center, which is featured on its website.  In addition to displaying the values and supporting statements, this illustration captures the spirit of the American Southwest. The Jarrard Phillips Cate & Hancock health care public relations firm has a beautiful display in the main lobby of its Brentwood, Tenn., office featuring a representative icon for each of its 11 core values.

Make values fun. Use poster contests, collect stories (nobody does this better than Catholic Health Initiatives with the sacred stories they publish each year) and engage in other activities to encourage people to take personal ownership for your values. In Wyoming, Star Valley Medical Center in Afton and Memorial Hospital of Converse County in Douglas are competing in the Great Wyoming Values and Culture Challenge to galvanize their employees, and eventually their entire communities, to be passionate about and committed to their core values and to a more positive organizational culture.

Communicate in multiple ways. Include your core values prominently on your website, make them part of employee recruiting and orientation, insert them into patient information packets, begin budget meetings with a review of those values, and do anything else you can think of to keep them front and center in people's consciousness. Enron's statement of core values had an eloquent description of its commitment to integrity, but this was obviously never effectively communicated within the company, much less made a part of the performance review process.

Create a tangible link between personal and organizational values. Research by Kouzes and Posner (authors of The Leadership Challenge) shows that the clearer people are about their personal values, the more committed they will be to the values and vision of their organization. One of the tools we share with clients is a matrix listing personal values down the left side and organizational values across the top. Asking people to think about the connection between their personal values and the values of the place in which they work is helpful on two fronts: It challenges them to clarify and act on the values that guide their personal lives, and it fosters a greater level of ownership for the values of their organization.

The Critical Core Values

One of the most important actions that you as a health care leader can take to ensure the competitive positioning and long-term viability of your organization is to be clear about your core values — how those values make your organization special when compared with all others — and to make sure that your people know, are committed to and act upon those values.

Joe Tye, M.H.A., M.B.A., is the CEO of Values Coach Inc., a health care consulting and training firm in Solon, Iowa. He is also a member of Speakers Express.