Chief Culture Warrior 2.0 Transformation Leadership Roles for Senior Strategists as Envisioned by Change-Leading CEOs Kathy Lewton, Steve Seekins, Ken

Chief Culture Warrior 2.0Transformation Leadership Roles for Senior Strategists

as Envisioned by Change-Leading CEOs

Kathy Lewton, Steve Seekins, Ken TresterSociety for Healthcare Strategy and

Market DevelopmentSeptember 17, 2008

TALK THIS PART

• This session is envisioned to go beyond lists of tactics and ideas – to focus on getting all of us to think deeply and broadly (oxymoron) about the reality of change --- and true transformation. First from POV of CEOs, and translating from that to what CCOs can, could, should, might do. SO we’re not distributing copies of the slides because they are to be idea starters – not to do lists. (If you want them later for inspiration or for some of the few bits of data that are embedded, we’ll post on our website or you can leave a biz card.

The only thing we know for 100% certain:

There is no magic bullet, secret formula or one-size-fits-all solution

It’s up to us to figure out what’s going on at our organization

(and with our CEO . . . And where and how WE fit into it

Last year, we surveyed SHSMD senior leaders

About culture change at their organizations – and the role they

played (or didn’t play)

From our vantage point, we suggested that CPMO’s ideally should:

• Be trend spotters -- hear the drumbeat, collect and “own” the data, sense the danger that failure to change can bring

• Have needed tools for telling, selling and persuading – defining and describing the new vision

• Work effectively with management peers & MDleaders -- critical forces in transformation

• Already be so close to the CEO that they can support his/her efforts OR prep him or her to be the spokesperson for change

How necessary is culture change?

0

10

20

30

40

50

60

Vital tosurvival

Critical toStrategy

Respondent

CEO

Sr. Team

Key platform of your organization’s desired culture

• Top Three:– Customer service/satisfaction – Employee engagement/satisfaction– Clinical quality

Commitment to change

0

10

20

30

40

50

60

70

80

Total Partial Negative None

Respondent

CEO

Sr. Mgmnt

Physicians

How we manage culture

0 10 20 30 40 50 60 70

Managers heldaccountable

Part of EE training &development

Happens on its own

Formal activity withdedicated resources

How we manage…

0 20 40 60 80 100

CEO defines andmanages culture

Culture justhappens

Culture is managed

Culture is in plan

Have strategic plan

Who’s on board and fully committed?

0 10 20 30 40 50 60 70 80

HR

Internal Comm

PR/Comm

Marketing

Planning

Board

Physicians

Employees

Nursing

Mid mgrs

Top mgrs

Barriers to change

• Not a priority(10)• Time and money (8)• Inertia (6)• Other mentions:

– CEO– Size & complexity – Physicians– Lack of commitment– …and at least 30 others

Respondent’s role in culture change

0 10 20 30 40 50 60

Contributer

Key teammember

Leader

If you are NOT a leader…

0 20 40 60 80 100

Organizational apathy

Overworked

Burned out trying

Lack expertise

Asked but denied

Someone else leads

Do you want to be?

…If not, why not?

This year -- transformation from POV of the CEO

• “Typical” group of CEOs – not scientifically selected, but very representative of hospital types

• Couple of huge AMCs, multi-state system, urban non-teaching, urban “community hospital,” several suburban hospitals

• Range in size and geography from NYC to N.California – and Utah, Michigan, Ohio and others in between

And the CEOs said . . . .

Q1: What kind of change do you want?

• We want our employees to FOCUS on delivering good customer service.

• We need to become more driven by the needs of the community and its changing demographics (Hispanic). We need to be IN the community.– And we need to become more customer driven.

” I believe that happy employees will make for more patient satisfaction, but do not really have any data to prove that, nor do we have a plan to make it happen.”

What kind of change do they want?

• We have been moving in the customer service direction pretty heavily.

• Change is huge here (AMC). I am trying to accomplish a common vision between all the previously competing entities – health sciences, med school, hospital. We need to eliminate obstacles to joint success.

”But some people don’t want joint success.””Baldridge is our guide and our glue for planning,

organizing and DOING:


• Well it’s quality – I mean that’s all there is.

”Anyone who says do something else without the grounding in quality is just wasting time, trying to dance around the edges. You do quality, everything else falls out from it – you get better patient service, you get growth, you get bottom line benefits. Skip quality and all you’re doing is marking time till you don’t have a choice.”


• We started with a good culture, sense of community but it was disconnected from patient service, so now we’re integrating it all including service, quality, staff development and growth, with bottom line impact.

”It’s a BIG BITE – we are changing the entire way we operate.”


• We have chosen to focus heavily on customer satisfaction. They make decisions and affect physician beliefs. I know our quality is fine – but it’s how we interact with the patients that will save or sink us.


• We started changing our culture in the late 80s. It’s all about quality, and integration across a multi-hospital, multi-facility, multi-state system. We kind of had to make it up as we went along because there was nothing out there to use as a model.


• Every place I’ve worked I’ve focused on the need for a positive culture – it’s about people, helping them reach their full potential.

“It’s about being open, transparent . . . how leaders behave, communication, no blaming, treating people with respect. When times are hard, we need to communicate more.”


• As the performance bar rises, so do culture challenges. First I focused on customer service, now it’s transparency and safety. We have to get all professionals to understand that errors are intolerable.

• We need to be quick, new skills, no inertia-laden management. We’re doing acquisitions and that brings culture shock.


• Our culture boils down to “what’s best for the patient. We worked diligently in instilling this and it was central to winning the Baldridge.

Desired Change:Observations and Insights

• Wide range of goals here – some are focusing on quality and true TRANSFORMATION– Others seem to going after one facet (customer

service, employee satisfaction)

• Some hospitals are doing it and measuring and mapping – others don’t know if there are tools to measure ROI– Levels of sophistication vary widely, wildly

• There are models, but they don’t seem to be exported


• Some CEOs clearly see that quality is king. Unfortunately in some places this raises more questions that it answers:– Who has the responsibility for making it

happen? – What are the accountabilities?– What are the right measures?


• CEOs at high performing organizations realize that achieving a common vision (what should we BE) is critical to achieving the desired result – and CPMOs can and should be involved in both.


• Some clearly ID employee satisfaction as foundation for any type of change– Others either don’t get it or don’t say it

Q2: How do you manage change?

• It’s CEO leadership in each facility. We are discussing a corporate program to mandate it.

”We probably need someone tasked with just this in each facility – but that’s a cost issue, and without a provable ROI.”

• Top and middle management have to drive it – but they don’t get that yet.

How do they manage change?

• We don’t have a formal change management process – but we need one. I’m not sure where this will be managed –needs to be close to me, maybe chaplain? Community affairs? Maybe marketing??


• We have a plan and starting to execute it. We probably need to think bigger in terms of overall culture. Our marketing staff and quality team are the leaders of this initiative.

”It has been interesting to see them working together since that is not necessarily a regular fit here.”


• Baldridge – senior management team are the leaders. It starts with us. We have the scorecard and track our resources. Communication is essential!

• I lead – it’s on my plate and everyone knows that. I’m using a consulting firm to help make it happen, using their standard approach. And I got the two unions to make a commitment to participate.


• We created an entire infrastructure headed by one of the leading experts on quality, with a fully formed team. They report to me and it’s Job 1.

”You can’t do this as an add on to someone’s existing job, or it won’t get done. It’s an add-on. The people who ran it the old way are NOT going to have an epiphany and decide to be change agents. It takes a dedicated team doing nothing BUT this.”


• I manage the process. Me. Hands-on. If you’re going to ask every employee to change the way they think and act, the CEO has to do the same, be the person at the lead in every meeting. It can’t be a speech and then introduce someone else who is responsible.


• We were starting from ground zero, so we brought in an acknowledged leader and said tell us what to do. It’s a science and your garden variety typical hospital administrator or manager doesn’t know the science. And he leads a system-wide effort.


• We work hard at, especially communications. SVP PR/Mktng is on senior management team and reports to me. I meet with the comms team monthly so they know what I’m thinking.

• We have to be seen as warm and engaged, it’s how we model the behavior.

• And we manage by using culture surveys.


• Culture is driven from the top. Period.

• We manage culture by trying to instill new processes, and engaging everyone.

• Early and prompt feedback is critical, as is holding people accountable.

• We use Root Learning approach, have reached every one of our 15,000 employees.


• You don’t “manage” culture – you create it. You have to live it, model it, set examples, lead by example. Breath optimism into the story.

• We use a Plan for Excellence and it’s the basis for how we plan, how we communicate. It’s values lay the foundation for goals– corporate, unit, individual performance.

Managing Change:Observations and Insights

• Most get that it starts at the top – no if’s, and’s or but’s – it’s the CEO’s responsibility


• But after that, there’s less uniformity– Some use the “add on” method – give it to

someone there as a new part of their existing job (so it’s not Job #1, but Job #43)

– Some hire consultants (so it’s the consultant’s program, and then they eventually go away)

– The ones that seem most successful pony up – hire staff, create a home-grown, fully embedded quality team. They dedicate substantial, if not massive, resources.


• CPMOs not often mentioned unaided as part of the team making the whole thing happen . . . . but when probed, most (not all) get that the function should involve the CPMO as leader

• And the presence of some CPMOs at the CEOs right hand, as lead change agent, shows that we can play this role.

Q 3: What are the barriers?

• Our culture (AMC) is very negative about customer service.

• Negativity of attitudes

• Protectionism of professionals – especially MDs and nurses

• Middle management feels disenfranchised by change, so you have to drag them along.

What are the barriers?

• Taking a short-term view. You have to say this is long-term and stay the course, but it’s hard to keep the workforce engaged through a long-term process.

• Organizational leadership, including middle management.

• It’s hard to get docs and nurses to commit.• We can’t find one good customer service

program that we can implement systemwide.


• It (customer service) is new and viewed as too soft, not science-y or clinical.

• Top and middle management don’t get it

• Our planning, marketing and PR people aren’t on board. Inertia. We want leadership from them, but we treat them as simply communicators, not as strategists.


• It’s pretty simple– people don’t like to change what they’re doing, especially when they think things are going pretty well.

“But since I fired three directors, that may change the dynamics.”


• Docs and nurses are tough to convince. They stay so stuck on the day to day issues – I know they are stretched thin, but I’ve gotta convince them that this is a KEY to success.

”Although I’m not sure of the metrics other than satisfaction scores, which I hope translates into dollars and patients.”


• Our governing structure (AMC). The practice plan and school of medicine interaction lead to enormous inertia.

• Resources to make it happen.

• Time frame. I need durable change, but will make short-term changes if that’s the only way to get to long-term goals.


• I inherited a hospital in shell shock from the “initiative of the month.” They had so many of these short-term, gimmicky programs – Patient Service Training (a 45-minute video), MBO, gainsharing – the employees now look at any new initiative with great cynicism. They figure they’ll wait it out, keep doing what they’re doing, and it will go away.


• Difficult to sustain momentum. It’s VERY hard. You can change ops and systems, but people are the ones who impact the patient.

• We have to increase employee satisfaction first before we can ask them to do more and act differently. And THAT is my biggest hurdle right now.


• We didn’t involve our voluntary physicians in this initially and that’s been a huge disconnect. Big mistake, but who knew?

• Physicians who think they know best – because they DO know best about their specialty and clinical care, but they can learn about efficiency and safety, too. If they draw down on you and balk, you have to INSIST, drive on, bring in experts, present them with data and have a backbone.


• Getting people to totally change their focus – it’s not just filling out the form, it’s the person sitting in front of you who is scared; it’s not just getting the blood sample, it’s reassuring the patient . . . . . .

• Keeping going. This is not a one-month thing – it’s FOREVER. So if you can’t do it, then get out now.


• We had a huge system, all different kinds of facilities, with different cultures (and even different names – they’d hide the corporate name on their signs back then). And here we came with “change.”

• Managers are neither hired not trained to be LEADERS. We had to teach and train and require and motivate and reward. But they CAN ALL do it.

Barriers:Observations and Insights

• Changing attitudes of physicians is a key task – and as we all know, extremely difficult– But nurses also seem to be a problem– Have to cast change as a win/win in realistic

terms and involve them in leading the process

• Middle management inertia is also a critical challenge – and do we see ourselves as part of that group, or part of Transformation Team?

Barriers:Observations and Insights

• Every team member in the organization must have the culture change issue as part of their performance accountabilities and held to that standard, which means massive communications effort that never quits – just keeps on going

• Some barriers are lack of vision, others lack of motivation. CPMO can help articulate a vision that enhances motivation.

Q 4: Where do marketing and PR fit in all of this?

• They help execute the program. PR creates and delivers the messages. Marketing identifies the key markers and keeps the scoreboard.

• Communications is essential – we do round the clock town halls. Used to be 10% participation, now we’re up to 34%. Plus newsletters and blast emails (but not everyone has email) and videos of patient stories and banners. We are trying to reconnect our employees to our purpose.

And where do marketing and PR fit in all of this?

• Well, sort of peripherally, I think. In a support way. I mean, they manage the channels the quality team needs to use to disseminate info. And they do take our success story out to the media. But I don’t think of them as integral to the process beyond what they already do.


• Their leadership has been a critical success factor. We had to create from the ground up an entire communications system, dozens of facilities in several states – and it had to be based on first-line supervisors as the communicators. WOW! Our PR team created the system, the training, DID the training, for months. Now they manage the info flow, the sups make it work. It is the rock of our success.


• They create the vehicles we need to send out the messages.

• I expect that my communications team will have the pulse of this very decentralized organization. They bring valuable insights and info to the table.

• I need them to be creative and strategic – right now, they’re more likely to be tactical.


• CEOs don’t have time to understand the marketplace – marketing people need to bring the data to us, and help us prioritize strategies based on consumer needs. They need to analyze and ID our sweet spots.

• And I want their skills in networking with biz and government constituents.


• We need robust communications. We actually created a new internal communications department because we think it’s so important.

• Communicators give the organization clarity. They need to stick to the message and the plan and most of all, support management with optimism.


• Each of our strategies has an oversight team that the communications people manage. They document the plan and make sure it feeds back to the board and medical staff.

• They need to maintain a public policy context – understand state/federal policy and how it impacts what we do.


• We give them direction to be more strategic and more challenging – but we have to give them a climate that allows them to do that. We are failing to tell them this is our expectation

• I haven’t given much thought to what I need from them. Good thinkers, but need to empower them to be mavericks, too.


• Now that I think about it, this is where culture change really belongs. But our people do not seem to be strategy focused – I need to change that and see if they can respond. They have done nothing to date, but I haven’t asked them to.

• I expect them to be skilled strategists, to disagree with me and come up with new ideas not just in culture, but in marketing.


• We have various people doing different tasks – but it’s not at all integrated, I have realized.

• I need strategic thinking, creativity and judgment.

Marketing & Communications Role:Observations and Insights

• Marketing and communications people are owning some or parts of the process at some places, barely remembered at others

• These same M and C teams must create the strategies for driving culture change to success working with the CEO and senior management team.


• Some CEOs say they haven’t yet told their CMPO that they expect strategic counsel– BUT should they have to ask or tell?

• The high performer CEOs clearly understand value of internal communications, rating it above external PR. – BUT CPMOs often relegate internal comms to

a newsletter editor and concentrate on marcomms, media and advertising


• CEOs are starting to understand the real value of creativity – can’t get results with old methods.– Creativity should be our sweet spot

• CPMOs key skills – analyzing the market, develop strategies and manage communications – are central to transformation. So we should be central to the process.

And to add a little current context beyond healthcare:

• New McKinsey global survey on organizational transformation found that most organizations seek transformation in order to move from good performance to great. Those that succeed:

• Have well defined financial and operational goals AND a genuine NEW LEVEL OF PERFORMANCE

• Had HIGHLY VISIBILE CEO• Had large-scale COLLABORATION across biz units• Had COMMUNICATIONS THAT FOCUSED FIRST ON

BUILDING ON SUCCESS, then on than fixing problems• ENGAGED employees at all levels

SO – what are the BIG lessons to take away?

BIG Take Away #1

• Not one CEO said “Change?? Why?””

• They clearly have moved beyond denial (FINALLY) but are at various stages of “what now?”

• SO for us, that means no more waiting – the change train has left the station

BIG Take Away #2

• Culture change is never “over”– You can’t plant a flag and say “we’re done” – The messages and desired behaviors have to

be sent and reinforced FOREVER– Speed of transformation may vary depending

on how CEO approaches it

BIG Take Away #3

• There’s some dissonance in here somewhere– CEOs said culture is being carefully managed– Last year half of CPMOs said “culture just

happens”– Either the CEO is kidding him/herself, OR . . .– The CPMO is out of touch or out of the loop

BIG Take Away #4

• There is a clear role for marketing and communications teams– Some CEOs clearly get it – learn from what

they have their CPMOs doing– If you work for someone like those who don’t

seem to get it, don’t wait to be asked. Even if they don’t see YOU in the role, figure out how you can help address the barriers that exist, then speak out, step up, present your plan.

BIG Take Away #5

• It’s all about working with YOUR CEO– No silver bullet or magic formula.– Can’t ask this on SHSMD ListServ

–YOU have to get inside YOUR CEO’s head

Getting inside the CEO’s head

• Some CEOs are process oriented and care about systems, metrics. – SO you have to talk Baldridge

• Some are people oriented and care about attitudes and behaviors– So you have to help with visioning

• Some are political and care about relationships and power bases– So you have to help them by creating a planning

process that’s inclusive and gets all the right people involved (friends and enemies)

Getting Inside the CEO’s head

• Three typical archetypes– The innovator, already out in front – wants

you on board with him/her and probably sees a specific role for you

– Resigned but willing – wants you to help figure out how to do it, you can design your own role

– Resistant – needs you to convince him/her (then make it his/her idea and work it behind the scenes)

Getting Inside the CEO’s Head

• Take your best shots– Give him/her the data so s/he can own the

issue and answer– Bring new tools– Trot out an outside expert– Teach via scenario drills

But above all else . . . .

• Get on the train– Drive the engine– Be a conductor, in a supporting role– Run to catch up, get on board and get busy

Now, let’s drill downto your reality!

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Documents

Chief Culture Warrior 2.0 Transformation Leadership Roles for Senior Strategists as Envisioned by Change-Leading CEOs Kathy Lewton, Steve Seekins, Ken