Chief Culture Warrior 2.0
Transformation Leadership Roles for Senior Strategists
as Envisioned by Change-Leading CEOs
Kathy Lewton, Steve Seekins, Ken Trester
Society for Healthcare Strategy and
Market Development
September 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?
60
50
40
Respondent
CEO
Sr. Team
30
20
10
0
Vital to
survival
Critical to
Strategy
Key platform of your
organization’s desired culture
• Top Three:
– Customer service/satisfaction
– Employee engagement/satisfaction
– Clinical quality
Commitment to change
80
70
60
50
Respondent
CEO
Sr. Mgmnt
Physicians
40
30
20
10
0
Total
Partial
Negative
None
How we manage culture
Formal activity with
dedicated resources
Happens on its own
Part of EE training &
development
Managers held
accountable
0
10
20
30
40
50
60
70
How we manage…
Have strategic plan
Culture is in plan
Culture is managed
Culture just
happens
CEO defines and
manages culture
0
20
40
60
80
100
Who’s on board and fully
committed?
Top mgrs
Mid mgrs
Nursing
Employees
Physicians
Board
Planning
Marketing
PR/Comm
Internal Comm
HR
0
10
20
30
40
50
60
70
80
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
Leader
Key team
member
Contributer
0
10
20
30
40
50
60
If you are NOT a leader…
Do you want to be?
Someone else leads
…If not, why not?
Asked but denied
Lack expertise
Burned out trying
Overworked
Organizational apathy
0
20
40
60
80
100
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:
What kind of change do they want?
• 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.”
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 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.”
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 it’s how we
interact with the patients that will save or
sink us.
What kind of change do they want?
• We started changing our culture in the late
80s. It’s all about quality, and integration
across a multi-hospital, multi-facility, multistate system. We kind of had to make it
up as we went along because there was
nothing out there to use as a model.
What kind of change do they want?
• 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.”
What kind of change do they want?
• 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 inertialaden management. We’re doing
acquisitions and that brings culture shock.
What kind of change do they want?
• 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
Desired Change:
Observations 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?
Desired Change:
Observations 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.
Desired Change:
Observations and Insights
• 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??
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.”
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 – 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.
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 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.”
How do they manage change?
• 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.
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. 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.
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 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.
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.
How do they manage change?
• 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
Managing Change:
Observations and Insights
• 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.
Managing Change:
Observations 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.
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 longterm 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.
What are the barriers?
• 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.
What are the barriers?
• 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.”
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
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.”
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 that’s the
only way to get to long-term goals.
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 45minute 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.
What are the barriers?
• 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.
What are the barriers?
• 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.
What are the barriers?
• 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.
What are the barriers?
• 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.
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.
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, they’re more likely to be tactical.
And where do marketing and PR
fit in all of this?
• 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.
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 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.
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.
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 haven’t given much thought to what I
need from them. Good thinkers, but need
to empower them to be mavericks, too.
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 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.
And where do marketing and PR
fit in all of this?
• 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.
Marketing & Communications Role:
Observations and Insights
• 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
Marketing & Communications Role:
Observations and Insights
• 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 down
to your reality!
.