Each piece -- the medical services, the research organization and the teaching services -- needs to interact and work with the others. As CEO, Dr. Fred Sanfilippo says his mission is not only to keep these pieces together as seamlessly as possible but to also make sure employees are thinking of the good of the medical center as a whole.
"The toughest part about this job is on the communication side," says Sanfilippo. "I am constantly emphasizing that each department is connected -- our decisions, opportunities, time and resources have a much broader impact than just within a single group."
With more than 6,000 employees, Sanfilippo finds it challenging to keep that message uppermost in their minds.
"It can be difficult," he says. "The greatest challenge is breaking down those silos and showing why the best approach is to look at the group as part of a bigger whole. Some people can find that threatening."
One way Sanfilippo counters this challenge is by broadening the accountability of employees to include what is happening across the entire organization.
"It means changing the way things are done and the way people think about things, organizationally and operationally," he says. "It is a change of culture, and it is a major part of our success."
This very successful change has evolved over a short period of time -- four years -- says Sanfilippo, who adds that his challenge was to explain to his staff why the changes were necessary.
"We had to show the employees what was in it for them," says Sanfilippo.
To start, the medical center conducted a survey of its leadership.
"We asked them what culture they would like to see, and to describe the current culture," he says. "There was a big gap between the culture that was wanted and the culture they were experiencing. That drove the change. Then we laid out our plan and implemented it."
The results have exceeded even Sanfilippo's expectations.
"We've been tracking the numbers now for four years at the leadership level," he says. "The survey results show a significant change from passive-avoidant responses to leaders who are more performance-, competition- and success-oriented."
Putting the pieces together
Sanfilippo started unifying the medical center's culture early in 2001. Among the key messages he conveyed was a better understanding of the center's strengths.
"Our core business is creating new knowledge, teaching it and applying it," he says.
Part of his job was to instill an expectation that all of the medical center's employees need to keep that core mission in mind in everything they do. Then, he says, it was time to foster creativity by allowing them to take risks and think differently than they had before.
"Creativity is key to our core business," Sanfilippo says. "We developed a couple of ways to foster it and incentivize our employees to be creative. One of our organizational values is innovation, and creativity is embedded in that value, so it is high on our list. "
For Sanfilippo, incentivizing means recognizing and rewarding individuals and teams who "think outside of the box and push the envelope." Incentives, he says, include promotions for faculty based on creativity -- especially in their research -- and in allocation of resources such as money, space and staff to explore new ideas.
Today, risk-taking is rewarded, not punished.
"That has got to happen," says Sanfilippo. "People can't be afraid to voice an idea because it might sound crazy or they are afraid it won't work."
Another way Sanfilippo fosters creativity is to encourage teamwork across departments.
"We emphasize the value of teamwork," he says. "We encourage employees to build alliances and coalitions. They are great and add to our success, and the employees also get significant value from them."
Sanfilippo says his employees have relished the opportunity to be innovative. And, he says, the Medical Center's leaders now have a philosophy of wanting -- and achieving -- a sustained competitive advantage over other leading facilities in the country.
"That's hard to duplicate elsewhere," Sanfilippo says. "And we are doing that more and more."
Add increased accountability to the mix -- each leader is responsible for the success of the entire unified center, not just a piece of it -- and Sanfilippo's organizational transformation is complete.
Its success -- and the buy-in of every member of his staff -- is crucial because Sanfilippo relies heavily on members of his senior leadership team to manage the day-to-day operations of their departments.
"You have to have great people," he says. "My management style is to delegate as much as possible. I give them the authority to make decisions and hold them accountable. I don't micromanage at all."
And each leader needs to depend on every other leader.
"The department chairs and leaders need administrative support," Sanfilippo says.
So part of his plan for a change in culture included getting the "right folks on board," which he says has led to stronger teamwork in developing, then supporting, his mission, vision and values.
"That's the first step," he says. "If you've got that, then you've got a team that will have the energy and passion to figure out how to be successful. So making sure people are aligned with each other and the organizational direction is key. It is likewise critical that new faculty and administrative leaders brought in are aligned with the mission, vision and values of the organization to help drive things forward."
Sanfilippo says he's been fortunate that the leaders who have joined his organization over the past four years have "not only been on board, but have helped others get on board."
Keeping the puzzle together
The external results of the culture change are just as satisfying as the internal ones, as the center continues to improve when it comes to research grant awards and recognition.
"We've seen a significant increase in funding from the NIH [National Institutes of Health]," Sanfilippo says. "And because of the governor's Third Frontier competition, we've put together some very strong programs and proposals with other organizations that don't typically get together."
Never far from Sanfilippo's mind is the fact that the real glue that holds his organization together is its people. The culture change he has instituted has not only allowed more innovation but has also attracted top-notch researchers who want to work for him.
"We have excellent, world-class people that are very competitive," he says proudly.
And Sanfilippo is acutely aware that his role includes supporting their efforts.
"We are putting in for larger programmatic grants, and we are getting quite a few of these," he says. "The programs are bringing in more world-class folks to complement the ones we already had."
That's important because the medical center is getting more national recognition for its research and teaching efforts, which translates into more press, more publishing of findings and results in prestigious publications and, not coincidentally, more money.
"The recognition brings in more resources," he says, "Which, in turn, allow us to do more."
Even so, Sanfilippo is quick to point out that the medical center isn't wasting its hard-earned cache and simply applying for any and all funding available. There is, he says, a definite strategy at work and a laser-like focus behind the center's research direction.
A big part of his strategy relies on the new, unified culture and teamwork that he worked so hard to put in place.
"We are really playing to our strengths," he says. "Our most competitive growth strategy leverages these on a variety of levels. We look for interfaces [among the three medical center pieces], and we have been successful."
For example, the medical center has been historically strong in cancer genetics and informatics and imaging aspects, as well as cardiovascular research.
"We've become more focused because we have the interface with clinical care and research in those areas," Sanfilippo says.
While the culture change has had numerous positive impacts, Sanfilippo admits he still faces challenges, the most pressing of which is diminishing funding. He says the gap between what the medical center earns and what it receives through the state, and what it costs to operate, is growing.
"Our biggest mission here is education and research," he says, "and our funding has been decreasing."
Some of the gap in funding is made up by clinical services, gifts or donations from previous patients or alumni.
"That is a major source of funds as well, and we are fortunate to have so many people in the community that help us close that gap," he says.
But Sanfilippo isn't sitting back waiting for patients, either; the center markets its services in a number of ways.
"We have a trained staff whose goal is to get patients here," he says. "We do it in each of our areas."
One way they market the center is by telling its story to as many people as possible.
"We talk about what we're about, what we do and the quality of care, which is why we do it all," Sanfilippo says.
Again, the basics of this plan rely on communication and people, which, in turn, rely on having a great culture in place.
"A lot of our marketing efforts focus on our physicians," he says. "They are what drive everything. At the end of the day, it is the people that are creating our success."
How to reach: The Ohio State University Medical Center, (800) 293-5123 or medicalcenter.osu.edu