It’s not that John Stewart is disappointed to be named the top cardiac care hospital in all of Indiana for the fifth year in a row. He just wants to make sure he’s not the one at the helm when the streak ends for St.Vincent Heart Center of Indiana.
“One thing that keeps me awake now is that when you have been named by multiple sources as the leading program in the state for so many years, you don’t want your team to become complacent,” says Stewart, the company’s president and CEO.
“The good thing about transparency of data in health care these days is that your competition knows a lot more information about you, as does the general public, and that’s wonderful. But it causes everybody to do better. You can never rest on your laurels.”
Stewart was one of the lead consultants when the Heart Center first opened in 2000. He returned five years ago as president and CEO and faced the challenge of streamlining an operation that is now spread across multiple venues for its parent, St.Vincent Health.
The recent accolades show that the hospital is doing a lot of things right, but Stewart says there is always room for improvement. One area that needed to be bolstered was the camaraderie of employees spread across many different locations.
“I’m responsible for really cardiovascular care not only at both Indianapolis (Heart Center) locations but also all 18 of the ministries within St.Vincent Health,” Stewart says. “When you are working with multiple facilities, it’s only natural that people will focus on their own initiatives and less on the system’s initiatives.”
Stewart needed to get his 408 employees more focused thinking about what was best for the company as a whole.
“How do you keep educating individuals that they all play a part in it?” Stewart says. “How do you coach your leadership team so they understand and focus and stay away from the barriers to success? Typically, when you run barriers, it’s because people allow personalities and personal differences to get involved.”
Stewart had to show his employees the value of working together.
“We wanted to have the highest-quality, patient-centered cardiovascular care that we could deliver with the highest guest satisfaction,” Stewart says. “And we wanted to do it in an environment that was less about bureaucracy and hierarchy and more about the culture of teamwork.”
Here are some of the ways Stewart made it happen and, in so doing, helped St.Vincent Heart Center of Indiana earn $133.6 million in fiscal 2009 revenue and its fifth straight honor as the best heart hospital in the Hoosier State.Get out there
When Stewart got his first management job, he was continually impressed by the level of knowledge his CEO possessed.
“It always amazed me that the CEO never seemed to be surprised,” Stewart says.
In order to have a deep knowledge of what is happening in your company so you can keep moving to the next level, you have to get out there and talk to your people.
“That’s one of the things that I find challenging for me these days since I’m focused on so many different locations,” Stewart says.
It doesn’t change the need to get out of your office and get in communication with your employees, however.
“You’ve got a lot of people that are more than willing to tell you what’s going on,” Stewart says. “You have to create an environment that it’s OK for that to happen. So you take what you hear informally. You go out and you ask questions. I ask, ‘How are your leaders doing? What are you and your co-workers working on? What processes are you focusing on today?’ Sometimes, just by walking around and asking the questions informally, it will either validate the information you are getting directly from your leadership team or tell you that somebody is connecting the dots in the wrong direction. That’s when you start digging further.”
You need to create an environment where employees feel comfortable raising ideas that might not make everyone happy.
“You have to set the tone day one that everybody is important to us fulfilling our mission and our goals,” Stewart says. “Help them understand what their part is and how they need to help each other. When they identify barriers to things that need to be improved, they have to feel that they can bring that to the table, including meeting with me directly. They have to know there will be no retaliation from me or from their immediate supervisor. You’ve got to have openness and a culture of safety.”
You also need to approach your interactions with your people with the right frame of mind.
“When it becomes all about you, then you shut down the ability to effectively communicate and motivate,” Stewart says. “One of the most important things I think everybody agrees upon is humility. When personal ego is the leading factor and when people make decisions just because it will better them or their career or their income rather than the values of the organization, that’s when people get into trouble.”
So take a moment once in a while to remind yourself, very simply, that it’s not all about you.
“You have to learn that you can’t do it all and it’s not healthy for the organization that you do it all,” Stewart says. “I’m finding that my passion is more fulfilled by helping train others and teaching others than by my individual successes.”Set clear expectations
You need to work with employees to develop expectations so that both leader and employee are clear about what needs to be done to keep improving.
“You always start by identifying the perceived problem or the opportunity for improvement,” Stewart says. “You develop a mutually agreed-upon plan on how you are going to resolve that or improve performance. You offer them whatever time you can or is necessary to make sure they feel comfortable in asking you for help.”
It’s all about servant leadership, and that’s where you really rely on your other leaders in the organization.
“Leaders are here to serve those who serve others,” Stewart says. “Sometimes, there are things that that person needs to learn or develop that may very well be outside my skill set. In that case, you’ll either work with them to identify another mentor that they can work [with] or, in some cases, I’ll pull in outside help to help those individuals.”
Whether it’s you or another leader, there needs to be collaboration in developing the work plans.
“For a mutual agreement to be effective, it’s no different than when you choose to get married and you have a mutual agreement with your spouse,” Stewart says. “The most successful relationships or marriages or employee relationships are when you have clear definitions of expectations from both sides. We have certain behavioral standards that every new team member signs when they come to work so they understand.”
Start setting expectations from day one.
“Even when I’m interviewing for an executive-level position, one of the first questions I’ll always ask in an interview is, ‘Are you clear of the expectations for this position and what do you understand them to be?’” Ste wart says.
Then you need to reinforce the importance of the plan by checking in on it on a regular basis.
“I would say minimally halfway through the year, sit down and say, ‘OK, this is what I’m seeing,” Stewart says. “How are you feeling? What do you feel you’re doing well? What do you feel you need to be doing better? What are the things that we need to readjust today so that we’re back on course by the end of the year?’”
This effort will pay dividends as employees see that you care about their growth in the company.
“It’s amazing how once you start and work though a couple key initiatives and they start realizing, ‘Yes, we can influence change; our input is respected, desired and even required,’ they see the outcomes from that and the positive energy and it starts to create synergy in the organization that is almost palpable,” Stewart says.Focus on quality
If you’re going to use data to track how well your company is doing in terms of meeting goals and expectations, you need to know what the data is trying to tell you if you are going to keep getting better.
“That sounds more simple than it is,” Stewart says. “When cardiovascular clinical databases first started coming into existence back in the ’90s, when a physician sees their data for the first time, there are always two arguments that you have to go through. One is that the data is flawed and the second is, ‘My patients are sicker.’”
The key is to not focus on the data but on what it is you want to accomplish. In the case of St.Vincent Heart Center, the goal is to provide quality service.
“If you focus on quality, you inherently are going to be more efficient because you’re going to make less mistakes and your patient throughput is going to be shorter. By focusing on quality and putting the focus on that and what’s right for the patient first, inherently you will see a better and stronger financial performance.”
That doesn’t mean data should be ignored. But if you’re going to share it with your people, you need to do it in such a way that everyone understands what it means.
“You have to synthesize it down to what are the most critical and important items that we need to communicate,” Stewart says.
Break the data down into smaller groups so that it’s targeted to groups and numbers that the employees would care most about. Use all the standard forms of communication, but don’t forget about the spoken word.
“It’s a responsibility of all of leadership to walk around and verbally communicate, even in much smaller groups, as to what the important issues are,” Stewart says. “It can’t be just top down. It has to be a network that you have to have other individuals and multiple layers of management.”
One of the challenges in working through areas that need improvement is the reluctance to confrontation that can occur.
“People go into health care, more often than not, out of a personal sense of mission of wanting to provide care to others,” Stewart says. “Individuals of that personality type, it’s very hard for them to confront another. The only way you can do it is to start from an educational standpoint. Start using opportunities and almost create, for the lack of a better term, constructive abrasiveness.”
It’s through this kind of dialogue that you build trust.
“Every time you run into a barrier or an area of conflict, it gives you an opportunity to work through it and by working through it, you start to gain trust,” Stewart says. “You have to have some patience and allow time for the trust to develop.”
Stewart is pleased with the efforts of his team thus far, but he always sees room for more improvement.
“It takes a lot of hard work and effort,” Stewart says. “You have to make sure you have the right leadership in place. You have to make sure you’re developing your leadership and your team members to prepare them for what’s coming. It takes all hands on deck to make it happen.”
How to reach: St.Vincent Heart Center of Indiana, (317) 338-2345 or www.theheartcenter.com