Chief Culture Warrior 2.0 Transformation Leadership Roles for Senior Strategists as Envisioned by Change-Leading CEOs

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Chief Culture Warrior 2.0Transformation
Leadership Roles for Senior Strategistsas
Envisioned by Change-Leading CEOs

• Kathy Lewton, Steve Seekins, Ken Trester
• Society for Healthcare Strategy and
• Market Development
• September 17, 2008

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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
  were 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, well post on our website or you can
  leave a biz card.

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The only thing we know for 100 certain

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

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Its up to us to figure out whats going on at
our organization (and with our CEO . . .

• And where and how WE fit into it

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Last year, we surveyed SHSMD senior leaders

• About culture change at their organizations and
  the role they played (or didnt play)

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From our vantage point, we suggested that CPMOs
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

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How necessary is culture change?
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Key platform of your organizations desired
culture

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

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Commitment to change
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How we manage culture
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How we manage
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Whos on board and fully committed?
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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

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Respondents role in culture change
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If you are NOT a leader
If not, why not?
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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

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And the CEOs said . . . .
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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.

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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 dont want joint success.
• ?Baldridge is our guide and our glue for
  planning, organizing and DOING

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What kind of change do they want?

• Well its quality I mean thats 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
  youre doing is marking time till you dont have
  a choice.

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What kind of change do they want?

• We started with a good culture, sense of
  community but it was disconnected from patient
  service, so now were integrating it all
  including service, quality, staff development and
  growth, with bottom line impact.
• ?Its a BIG BITE we are changing the entire
  way we operate.

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What kind of change do they want?

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

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What kind of change do they want?

• We started changing our culture in the late 80s.
  Its 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.

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What kind of change do they want?

• Every place Ive worked Ive focused on the need
  for a positive culture its about people,
  helping them reach their full potential.
• Its about being open, transparent . . . how
  leaders behave, communication, no blaming,
  treating people with respect. When times are
  hard, we need to communicate more.

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What kind of change do they want?

• As the performance bar rises, so do culture
  challenges. First I focused on customer service,
  now its 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. Were doing acquisitions and that
  brings culture shock.

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What kind of change do they want?

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

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Desired ChangeObservations 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 dont know if there are tools to
  measure ROI
• Levels of sophistication vary widely, wildly
• There are models, but they dont seem to be
  exported

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Desired ChangeObservations and Insights

• 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?

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Desired ChangeObservations and Insights

• 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.

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Desired ChangeObservations and Insights

• Some clearly ID employee satisfaction as
  foundation for any type of change
• Others either dont get it or dont say it

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Q2 How do you manage change?

• Its 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 thats a cost issue, and
  without a provable ROI.
• Top and middle management have to drive it but
  they dont get that yet.

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How do they manage change?

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

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How do they manage change?

• 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.

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How do they manage change?

• Baldridge senior management team are the
  leaders. It starts with us. We have the
  scorecard and track our resources. Communication
  is essential!
• I lead its on my plate and everyone knows
  that. Im 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.

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How do they manage change?

• We created an entire infrastructure headed by one
  of the leading experts on quality, with a fully
  formed team. They report to me and its Job 1.
• ?You cant do this as an add on to someones
  existing job, or it wont get done. Its 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.

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How do they manage change?

• I manage the process. Me. Hands-on. If youre
  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
  cant be a speech and then introduce someone else
  who is responsible.

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How do they manage change?

• We were starting from ground zero, so we brought
  in an acknowledged leader and said tell us what
  to do. Its a science and your garden variety
  typical hospital administrator or manager doesnt
  know the science. And he leads a system-wide
  effort.

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How do they manage change?

• 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 Im thinking.
• We have to be seen as warm and engaged, its how
  we model the behavior.
• And we manage by using culture surveys.

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How do they manage change?

• 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.

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How do they manage change?

• You dont 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 its the basis
  for how we plan, how we communicate. Its values
  lay the foundation for goals corporate, unit,
  individual performance.

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Managing ChangeObservations and Insights

• Most get that it starts at the top no ifs,
  ands or buts its the CEOs responsibility

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Managing ChangeObservations and Insights

• But after that, theres less uniformity
• Some use the add on method give it to someone
  there as a new part of their existing job (so
  its not Job 1, but Job 43)
• Some hire consultants (so its the consultants
  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.

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Managing ChangeObservations and Insights

• 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.

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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.

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What are the barriers?

• Taking a short-term view. You have to say this
  is long-term and stay the course, but its hard
  to keep the workforce engaged through a long-term
  process.
• Organizational leadership, including middle
  management.
• Its hard to get docs and nurses to commit.
• We cant find one good customer service program
  that we can implement systemwide.

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What are the barriers?

• It (customer service) is new and viewed as too
  soft, not science-y or clinical.
• Top and middle management dont get it
• Our planning, marketing and PR people arent on
  board. Inertia. We want leadership from them,
  but we treat them as simply communicators, not as
  strategists.

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What are the barriers?

• Its pretty simple people dont like to change
  what theyre doing, especially when they think
  things are going pretty well.
• But since I fired three directors, that may
  change the dynamics.

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What are the barriers?

• Docs and nurses are tough to convince. They stay
  so stuck on the day to day issues I know they
  are stretched thin, but Ive gotta convince them
  that this is a KEY to success.
• ?Although Im not sure of the metrics other than
  satisfaction scores, which I hope translates into
  dollars and patients.

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What are the barriers?

• 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 thats the only way to get
  to long-term goals.

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What are the barriers?

• 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
  theyll wait it out, keep doing what theyre
  doing, and it will go away.

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What are the barriers?

• Difficult to sustain momentum. Its 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.

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What are the barriers?

• We didnt involve our voluntary physicians in
  this initially and thats 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.

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What are the barriers?

• Getting people to totally change their focus
  its not just filling out the form, its the
  person sitting in front of you who is scared
  its not just getting the blood sample, its
  reassuring the patient . . . . . .
• Keeping going. This is not a one-month thing
  its FOREVER. So if you cant do it, then get
  out now.

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What are the barriers?

• We had a huge system, all different kinds of
  facilities, with different cultures (and even
  different names theyd 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.

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BarriersObservations 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?

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BarriersObservations 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.

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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 were 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.

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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 dont think of them as integral
  to the process beyond what they already do.

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

• 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.

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

• 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, theyre more likely to be tactical.

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

• CEOs dont 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.

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

• We need robust communications. We actually
  created a new internal communications department
  because we think its 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.

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

• 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.

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

• 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 havent given much thought to what I need from
  them. Good thinkers, but need to empower them to
  be mavericks, too.

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

• 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 havent 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.

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

• We have various people doing different tasks
  but its not at all integrated, I have realized.
  
• I need strategic thinking, creativity and
  judgment.

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Marketing Communications RoleObservations 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.

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Marketing Communications RoleObservations and
Insights

• Some CEOs say they havent 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

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Marketing Communications RoleObservations and
Insights

• CEOs are starting to understand the real value of
  creativity cant 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.

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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

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SO what are the BIG lessons to take away?
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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

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BIG Take Away 2

• Culture change is never over
• You cant plant a flag and say were done
• The messages and desired behaviors have to be
  sent and reinforced FOREVER
• Speed of transformation may vary depending on how
  CEO approaches it

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BIG Take Away 3

• Theres 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

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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 dont seem
  to get it, dont wait to be asked. Even if they
  dont see YOU in the role, figure out how you can
  help address the barriers that exist, then speak
  out, step up, present your plan.

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BIG Take Away 5

• Its all about working with YOUR CEO
• No silver bullet or magic formula.
• Cant ask this on SHSMD ListServ
• YOU have to get inside YOUR CEOs head

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Getting inside the CEOs 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 thats inclusive and gets all the right
  people involved (friends and enemies)

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Getting Inside the CEOs 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)

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Getting Inside the CEOs 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

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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

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Now, lets drill downto your reality!

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