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Annotated Edition
The Florence
Prescription
Building a Culture of Ownership
on a Foundation of Values
Independent Hospital Network Leadership Summit
January 13, 2012
Joe Tye, CEO and Head CoachValues Coach Inc.
Copyright © 2012, Values Coach
Inc.
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If your raft is in class 5
whitewater and the
guide hollers out for
everyone to grab a
paddle…
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What do you do to
the person who
says…
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Your
Hospita
l
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Healthcare Reform
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In the stormy seas of
healthcare reform, it is
everyone’s job to grab an oar
and paddle!
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Question #1
When did the
healthcare
crisis begin?
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Question #2
When will the
healthcare
crisis end?
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14
This story…
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15
Has a happy
ending!
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The Chinese symbol for crisis
means danger + opportunity
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“Brick walls are not
there to stop you, they
are there to make you
prove how much you
want something.”
Randy Pausch: The Last Lecture
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Whether it’s the best of times
or the worst of times depends
upon what we choose to see
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19
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What would you think of this ship and
its leadership if 25 of the 100 rowers did
most of the work while 60 of them
coasted by and 15 of them were actually
rowing backward?
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Companies that study
employee engagement*
consistently find:
~ 25% fully engaged
~ 60% not engaged
~ 15% aggressively
disengaged
* e.g. Gallup, HR Solutions, Press Ganey
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Engaged: Spark Plugs
22
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Not Engaged: Zombies
23
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Disengaged: Vampires
24
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Shift Your Bell Curve
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Employee
disengagement
negatively effects
clinical quality,
productivity, patient
satisfaction, and
marketing image.
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But what’s
even more
tragic...
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It has a life-diminishing
impact on the
disengaged.
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“Disengagement [is]
one of the chief causes
of underachievement
and depression.”Edward M. Hallowell, M.D. in HBR, 12-10
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The journey from mere
Accountabilit
y to a culture of
Ownership
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Accountability
Doing what you are
supposed to do because
someone else expects it of
you. It springs from the
extrinsic motivation of
reward and punishment.
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Do you know people
who seem to think that
this is the official
uniform where they
work?
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Or that this is the
official job description?
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You cannot hold people
“accountable” for the
things that really
matter.
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What’s wrong
with this
picture?
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Not My
Job!
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Nobody ever
changes the oil in a
rental car!
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Ownership
Doing what needs to be
done because you expect it
of yourself. Ownership
springs from the intrinsic
motivation of pride.
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In a culture of ownership,
every job description
includes first and foremost
being a caregiver, last but
not least being a janitor, and
in between being willing to
do whatever else needs to
be done.
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42
Cultural ownership is of the heart, not
of the wallet… No one ever walked off
the job of a Habitat project in a pay
dispute!
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When baggage handlers at United
broke Dave Carrolls’s Taylor guitar,
they refused to reimburse him for
the damage. When he said that he
was going to write a song about it,
they told him to go ahead. He did –
to date, more than 16 million
people have viewed “United Breaks
Guitars.”
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18,339,829 views
78,545– avg 5 stars
As of 01-13-11, 12:15am
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“We have hundreds if not thousands of examples…” 787,839
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The Taylor Guitar Company made
their own video: how to pack up
your Taylor guitar so United won’t
break it!
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How do you spell public
relations black eye?
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All it would
have taken to
prevent this PR
black eye is one
person taking
ownership for
the problem.
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Unfortunately, because
that did not happen,
every United employee
has been painted with
that brush.
49
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The real losers in
this picture are the
good people who
work at United.
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United does not
have broken
people; United has
a broken culture.
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A word about the
assumptions we
make.
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What do you get
when you break the
word “assume” into
its constituent
parts?
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Faulty Assumption #1
You can’t teach people
values – if they didn’t
learn in kindergarten,
it’s too late.
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Culture is a given –
especially in the short
term you cannot
transform it.
Faulty Assumption #2
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You can “empower”
people without them
having doing the work
of self-empowerment.
Faulty Assumption #3
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If you can’t measure it,
it’s not worth doing.*
Faulty Assumption #4
* The left brain counts
but the right brain matters.
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Invisible
Architectur
e“Invisible Architecture” is a trademark of Values Coach Inc.
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When it comes to employee
and patient satisfaction, the
blueprint that can’t be seen is
more important than bricks
and
mortar.
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Invisible architecture
is to the soul of your
organization what
physical architecture
is to its body.
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Core Values are
the Foundation
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Core values
define what you
stand for and
what
you won’t
stand for
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65
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Zappos Family Core Values1. Deliver WOW Through Service
2. Embrace and Drive Change
3. Create Fun and A Little Weirdness
4. Be Adventurous, Creative, and Open-Minded
5. Pursue Growth and Learning
6. Build Open and Honest Relationships With
Communication
7. Build a Positive Team and Family Spirit
8. Do More With Less
9. Be Passionate and Determined
10. Be Humble
Source: Zappos website
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1. Deliver Wow Through Service
He goes above and beyond the average level of
service to create an emotional
impact on the receiver
and give them a positive
story they can take with
them the rest of their
lives.
Source: Zappos website
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The Values Behaviors Outcomes Continuum
68
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Trust is an outcome that is
earned…
By the behaviors of honesty,
reliability, humility, and
stewardship, which are founded
on…
The value of integrity. 69
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What are the
core values of
your
organization?70
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Why were those specific
values chosen and what
do they say about who
you are and how you do
your business?
71
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Which value do nurses
feel is more important
to executive
leadership?
72
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Compassion
73
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OR…74
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Productivity
75
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This is a false dichotomy. No
organization can be optimally
compassionate if it is not also
optimally productive.
The first person ever to
calculate cost per patient day
was… 76
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OR
AND77
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Most organizations, no matter
what industry they are in,
claim integrity as a value,
either explicitly or implicitly.
But in almost all of them (most
likely including yours) there
is… 78
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An Integrity Gap
79
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Because almost every organization
has a rumor mill… And what does
it say about your commitment to
integrity, respect,
and dignity if your
culture tolerates
people spreading
rumors? 80
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The root of the word
integrity is “integer”
– one unified whole
The incredible
invisible man
81
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The guiding insights
behind our work at Values
Coach…
82
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Values are
Personal
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and…
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Values are
Skills
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Nobody learns
everything they
need to know in
kindergarten!
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Why should you
care about the
personal values of
your people?
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“People who are clearest
about their personal
vision and values are
significantly more
committed to their
organizations.”James Kouzes and Barry
Posner:
A Leader's Legacy
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Participants say it’s like
graduate school for life (or like
graduate school for the seven
habits).
92
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These universal values
transcend political
opinion, religious belief
(or non-belief), ethnic
heritage,
and social class. 93
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After all, who
wants to be a
phony?
Core Action Value #1
is Authenticity
94
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Don’t we all need to live
with integrity, awareness,
courage, perseverance,
and faith?
The first six Core Action Values lay
a solid foundation of character
strength 95
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Don’t we all need the
power of purpose, vision,
focus, enthusiasm, and
service?
The second six Core Action Values
help us do our work and make a
difference 96
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Don’t people who live
their values inspire and
influence others?
Core Action Value
#12 is Leadership
97
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The business case
for values
training…
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Is not really about
business
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A Classic Win-Win!
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The individual wins:
“If people could understand
their core values, they would
save years of doubt,
confusion, and misplaced
energy as they try to find
direction for their lives.”
Laurie Beth Jones: Jesus CEO101
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The organization wins:
“People who are clearest about
their personal vision and values
are significantly more
committed to their
organizations.”
James Kouzes and Barry
Posner:
A Leader's Legacy
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It’s not that you do or
don’t practice values –
it’s where you fall on
the continuum.
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And if you are not
moving forward, then
you are sliding
backward.
104
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105
In Stage 4 decline “people
cannot easily articulate
what the company stands
for; core values have
eroded to the point of
irrelevance.” Jim Collins: How the Mighty Fall
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Why it
matters now
more than
ever before…
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Values and
value-based
purchasing.
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108
People will sustain
personal change only
to the extent that they
are motivated by
deeply held core
values.
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Recruitingandretention
is not one word.
Use the “Honey and
Glue” formula to find
and keep great people.110
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You recruit with the
“honey” of left-brain
features such as pay and
benefits… 111
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You retain with the “glue”
of right-brain qualities
reflected in values and
culture. 112
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Values and Employee Loyalty
Source: Roger Herman, et al: Impending Crisis: Too Many Jobs, Too Few People (page 139) 113
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When a critical mass
of people connect
with and act upon
their core values,
they will have a
positive impact on…
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Corporate culture is
the superstructure
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Culture is morally neutral.
Enron had a powerful
culture.
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Culture is to the
organization what
personality and
character are to the
individual.
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“I came to see, in my
decade at IBM, that
culture isn’t just one
aspect of the game –
it is the game.”
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Culture eats
strategy for lunch!
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Corporate culture didn’t
even make the top ten list of
CEO concerns in the 2010
ACHE survey on issues
facing the industry.
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Who has the
power to change
the culture of
your
organization?
124
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Anyone can have an influence on
the culture of the organization
simply by raising expectations of
how we treat our patients and how
we treat each other.
125
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Shawneen Buckley of Saint Francis Hospital
and Health Center in Poughkeepsie, New
York
You do not need an architectural
degree to design the Invisible
Architecture of your organization!
126
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Culture doesn’t change
unless people change,
and that is
emotional
work!
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Emotional attitude
is the interior décor
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As with finishing off a
building, the outward
reflection of
corporate culture is…
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If I were to
become a hospital
CEO today…
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This would be my
response!
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Seriously, in that
role the first thing I
would give my
attention to would
be…
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The invisible ceiling
on your hospital’s
performance
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Every child has super
powers, but we tend to
forget them as we grow up –
especially if subjected to an
emotionally toxic workplace.
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In The Florence Prescription:
From Accountability to
Ownership, Sarah Rutledge is
a nurse with great clinical
skills but a toxic negative
attitude.
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Our challenge as healthcare
leaders is to move people
from the “Rutledge
Quadrant” into the high-
passion and high-
performance quadrant of this
matrix…
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I would help people
confront the
malignant echo of
negative self-talk
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By showing them how
to have “The Janitor
in Your Attic” erase
such toxic mental
graffiti
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And help them set
aside debilitating
emotional baggage
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By showing them how
to leave it behind on
a cairn in the desert
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147
A positive workplace
culture begins with
intolerance for toxic
emotional negativity.
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148
“One toxically negative
person can drag down
morale and productivity
of an entire work
unit.”
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149
“It is a leadership
responsibility to create a
workplace environment
where toxic emotional
negativity is not
tolerated.”
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The Pickle Challenge is a
simple and light-hearted
approach for people to
hold each other
accountable for the
attitudes
they bring to
work.
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153
A real “Sarah Rutledge” story
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Remember these days? What
would happen to someone who lit a
cigarette on a plane today?
154
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Building a
culture of
ownership
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Do you have to start with the
right people on the bus?
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You can’t always
choose who you
have on the bus!
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You can’t just
throw all the
“wrong” people off
the bus!
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You can create a bus that
everyone wants to ride
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163
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www.TheFlorenceChallenge.com
The Florence Challenge website
“resources” section includes a
wealth of additional resources
for building a culture of
ownership.
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165
More than 400 hospitals and healthcare
organizations and nearly 80,000 books.
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Only $5 per book:
166
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Call Michelle:
800-644-3889
167
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1. Commitment
To the values, vision, and
mission of the
organization
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170
The Vision Statement of Columbus Regional Hospital
To be the best in the
world
at everything we do.
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“We need to see
opportunities where others
see barriers. We need to
be cheerleaders when
others are moaning doom-
and-gloom.”
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“We need to face problems
with contrarian toughness
because it’s in how we
solve those problems that
we differentiate ourselves
from everyone else.”
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When the going
gets tough...
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Cultural toughness is the ultimate competitive advantage
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2. Engagement
With patients,
coworkers, and with the
work itself
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“Having a highly
engaged workforce is
the first thing required
to win
on the global stage.”
Jim Owens, retired CEO, Caterpillar Inc.
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At Best Buy, a 0.1%
increase in employee
engagement generates
a $100,000 increase in
gross store revenue*
* Harvard Business Review, October 2010
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I went into the Apple
store to look at an iPhone
and walked out with a
$4,000 iMac computer –
sold to me by another
customer!179
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Apple does not
have
employees…
Apple does not
have
customers…
180
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Apple is a cult!
181
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Books like In Search of
Excellence and Built to
Last remind us that great
companies have “cult-like
corporate cultures.
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And in organizations with
such cultures, people are
inspired to be engaged –
with customers, with
coworkers, and with the
work itself.
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3. Passion
Enthusiasm, positive
attitude, and joy
reflected in everyday
actions
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What’s wrong with this picture?
There is an undeniable element of cheerleading
in the most effective leadership, according to
James O’Toole in the book Leadership A to Z.
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The official uniform at
Texas Roadhouse
Restaurants
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Colonel Jennifer is founding director of
the Center for the Intrepid, which cares
for the most horribly wounded soldiers.
Despite their grim task, CFI is a place that
shines with passion!
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4. Initiative
Don’t wait around to be
“empowered” –
Proceed Until
Apprehended!
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Leadership in
every corner, not
just in the corner
office.
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No one gave Cool Hand Luke permission to become a leader on the chain gang, and to transform drudge work into a game.
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His attitude was…
Proceed Until
Apprehended!
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Courage is the
catalyst for
initiative
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It did not take Randall Patrick McMurphy
long to realize that the men in “the
cuckoo’s nest” were not crazy – they were
frightened into paralysis.
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People and organizations can
both be paralyzed by irrational
fears
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Are people afraid
of change?
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5. Stewardship
Because we don’t own
the earth – we are
borrowing it from our
grandchildren
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Operation Wipeout – Spark Plugs at
the Alaska VA Healthcare System
adopt local homeless shelter
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Last year, the nonprofit Supplies
Over Seas organization sent 60
tons of discarded medical
supplies and equipment to third
world countries
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6. Belonging
In a culture of
ownership, people are
treated like partners,
not just hired hands
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202
“You would think they’d give me
as much information about our
hospital finances as I get at my
once-a-month school board
meeting.”
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203
Would you expect to see
some of America’s most
financially literate
employees working on an
assembly line rebuilding old
diesel truck engines?
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But you would at Springfield
Remanufacturing, where Jack
Stack invented open book
management
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7. Fellowship
Because (as Mother
Teresa reminded us) we
are all children of the
same God
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The need for fellowship is so
profound that in the absence
of other people…
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We can find it in a
volleyball
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The most memorable Coke
ads don’t even talk about
fizzy brown sugar water, do
they?
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209
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210
Committee of the Ring
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211
The Ring Team
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212
Fellowship of the Ring
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213
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8. Pride
In your organization, in
your profession, in your
work, and in yourself
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Pride is reflected in the answer
to that universal icebreaker
question:
What do you do?
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Does the answer convey:
I’m good at what I do.
I love what I do.
I’m proud of what I do.
What I do is important.
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The most powerful and
cost-effective
marketing campaign
your hospital could
ever launch!Thanks for asking…
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What could be more boring than
industrial ventilation systems?
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220
Big Ass Hospital.comThis page is parked free, courtesy of GoDaddy.com.
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Key Lessons Learned
(thus far) from
Implementation of
the Values
Collaborative
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Lesson #1
Launching a movement is
a lot harder than starting
a program – it is also
much more likely to
achieve a lasting positive
impact.
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223
Lesson #2
Achieving critical mass
requires approximately
30% population
commitment.
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You need enough people
moving fast enough to
escape negativity,
pessimism, cynicism, and
inertia of the past.
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Lesson #3
Senior leadership must
have a highly visible
level of engagement
and commitment.
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Lesson #4
Middle management’s
mere support is not
enough – they must be
gung ho champions for
change.
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The privileges of being a
manager also entail
certain foregone
freedoms
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Lesson #5
Sustainability requires a
growing core of
passionate “Spark
Plugs” who have a
personal stake in
cultural transformation.
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Personal stories
resonate far better than
scripted lectures –
cultural transformation
is more about sharing
than it is about
teaching.
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Lesson #6
Embrace the skeptics,
marginalize the cynics,
and plow through
resistance.
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Lesson #7
Engage potential critics
in a constructive
manner – encourage
them to think like
partners in the change
process.
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Lesson #8
Avoid identification of
the change process with
any single individual or
“program.”
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Lesson #10
Create initiative
coherence by being
clear about how various
projects reinforce one
another.
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Lesson #11
Keep it visible: posters,
banners, screensavers,
newsletter articles, web
pages; include it at the
start of every meeting.
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Lesson #12
Remember that
everyone listens to the
same radio station:
WIIFM
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Lesson #13
Balance urgency and
patience; be in it for the
long haul.
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Lesson #14
Sometimes it’s more
magic than it is science!
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“If we each do our
part, we will
change our lives for
the better.”
240
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The work of changing an
organization begins with helping
the people who work there make
positive changes in their own lives
Responses fromMaster Values Coach Trainers in VISN 20of the Veterans HealthAdministration
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“If we all do our
parts, we will
change our
organizations for
the better.”242
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In a growing number of
organizations across the
country, groups of
people gather daily to
read that day’s promise
from The Self-
Empowerment Pledge 243
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244
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“And in changing our
organizations, we can
change our world for the
better.”
245
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Building a Culture
of Ownership is the
Ultimate Win-Win-Win
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The Patient Wins
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The Hospital Wins
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The Caregiver
Wins
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