It’s one thing to ask employees to assess their job satisfaction in an anonymous survey that rates their responses on a scale of 1 to 5. But you’ll learn quite a bit more if you ask them to tell you a story about their life on the job, says Dan Evans, president and CEO at Clarian Health Partners Inc.
The $3 billion consolidated health care organization recently conducted 600 interviews of its nurses and asked each of them to tell a story about life on the job. Several nurses at Riley Hospital for Children relayed the touching story of a young boy whose final days they were able to make just a little bit brighter.
“His love was construction equipment,” Evans says. “There is nothing but construction going on around our hospitals. We’re building new stuff all over the place. However, his window looked out over a street, not a construction site. If these nurses had asked the bed assignment people if they could move the patient, they might or might not have heard back from them quickly. Instead, they just did it.”
The boy was moved to a room where he could see the construction equipment and the bed assignment staff was told later of the switch.
“They felt secure enough to go ahead and do it,” Evans says. “That tells me the nurses were intently focused on the needs of the patient. They were willing to take a risk and do something in an unapproved manner because they weren’t afraid the system would punish them.”
As the leader of an organization, you need to go out and create an environment where your employees feel comfortable offering their input and even taking action when they believe it’s the right thing to do, just like the nurses did. When you do that, employees act in the best interests of the customer instead of being afraid to act because of company policies.
If you have developed a clear set of values to live by, you should-n’t worry that this freedom will be abused.
“A just culture is one in which we learn from our mistakes and we are able to re-evaluate real time what is happening because people trust each other not to be punished for using creativity and innovation in how they do their jobs,” Evans says.
“You sure as heck don’t want people abusing the system and taking shortcuts to go home a little earlier, to look a little better or to shift work to somebody else. So the culture itself, that is your coworkers, they have to watch out for each other and constantly remind themselves that their culture is a just culture. You’re allowed to be creative in a way that permits you to use your intellect. From time to time, you might make a mistake. But the culture is not going to punish you for making a mistake that wasn’t purposeful.”
Here’s how Evans has developed a culture among his more than 15,000 employees that gives people the chance to take meaningful steps to improve their organization.
Be more than a boss
Evans recalls a lesson his father, who ran a chain of department stores, once taught him about executives.
“He said, ‘There are two kinds of executives: Elevator guys are the ones that come in the morning and punch a button to go to their floor and never saw a customer or an employee; the escalator guys are the ones who rode to the floors all day long every day to check with the customers and check with the employees. If you don’t have happy customers, you probably don’t have happy employees. If you don’t have happy employees, you probably don’t have happy customers,’” Evans says. “I think it’s translatable. I bet there’s not a factory manager in this country who doesn’t learn more going to the floor than he does staying in his office.”
If you want a culture where people are helping you improve the organization, the key is to realize that your job as the leader is not simply to be the boss.
“My job is to help them do their jobs better,” Evans says. “I am the steward of the system within which they operate. I can’t understand how well the system is or is not operating unless I learn from the folks in the system what they think needs to be done to improve it. Most of the good ideas come from the people who do the real work. Very few ideas come from the muckety-mucks, like me, way up top. My job is to find the good ideas and implement them.”
A large chunk of Evans’ daily activity is spent “rounding,” or visiting employees and checking out various locations across the Clarian organization. Sometimes the visits are scheduled, and sometimes they are impromptu.
The visits help reduce what Evans calls the authority gradient. Once you accept that you don’t have all the answers, you need to make your employees comfortable with giving you some of those answers.
“People are reluctant to tell their boss they’ve got a better idea than he or she does,” Evans says. “It has to be a place without fear to do it.”
“If I said to you, ‘Hey, I don’t think you should use a keyboard,’ and you were my boss and you said, ‘Boy, that’s a stupid idea,’ I’m never going to give you advice again.”
But if you approach employees and ask for suggestions and offer positive reinforcement, an atmosphere of trust and mutual respect develops.
Walk with a purpose
You have to be diligent about the way in which you interact with employees and visit the different locations in your organization.
“Walk around with a purpose,” Evans says. “That is, go to specific places within the organization with specific questions. Be looking for a specific thing and see if it’s consistently done in the places you visit. ... If you round with a purpose, then you keep notes about it, and you can reflect on your recollection from week to week and month to month and have your own judgment as to how accurate your view is as to what’s actually going on.”
When you hear something that resonates in your mind, it only increases the chances that you’ll take some type of action in response. And you must respond to what your employees tell you if you expect to hear from them in the future.
“Employees have got to believe that if they have an idea, it has a fair shot of being evaluated,” Evans says. “If it’s a good idea, it has a fair shot of being implemented. If they think their ideas are being ignored, then they won’t submit ideas. There has to be a feedback loop. It’s one thing to have a suggestion box or a computer linkup for ideas. It’s another to have one where you say, ‘Hey, that’s a pretty good idea. Let’s talk that one through.’”
One of the best ways to get those kinds of thoughtful responses from your employees is to ask them to tell you a story.
“If I say to you, tell me a story about your job, I’ll learn more by that story about you and your job than I will by saying, ‘Are you satisfied or dissatisfied with your job? Do you trust your boss or not trust your boss? Are you paid an adequate salary or not?’” Evans says. “Stories are very powerful. People remember stories. They don’t remember data.”
By listening to the stories told by his employees, Evans learned that they are very focused on customer needs and want to do what they can to help Clarian’s customers.
“We have to constantly ask people and see what they have got to say,” Evans says. “We do the town-hall meetings, but we learn more from these stories than we do from anything else.”
Be clear about your goals
If you are going to ask and expect your employees to abide by your values of ethical behavior and honest empathy for your customers, you must set the right example with your own actions.
“When somebody says something to me that indicates to me they don’t trust and respect me as the CEO of the company, that really gets my attention,” Evans says. “I want to know why. Is it because they think I say something different than what I say internally? If that’s true, I want to understand that. That means that senior managers and the board have to have a high level of self-awareness and not live in some fantasy world where they think they are loved by everybody because it just ain’t true.”
You must constantly be measuring your behavior, along with that of your employees, against your organization’s vision and goals.
“Around here, our goal or vision is pre-eminence,” Evans says. “We measure pre-eminence by being in the 90th percentile of whatever the function is that is being measured. ... We know that our standard is not to compete against the local competition. Our standard is to compete against the best in the country.”
Your commitment to these goals must be emphasized repeatedly, whether it’s through a one-on-one conversation in the hallway, at a staff meeting or at a charity fund-raiser your company is involved in.
The message can be conveyed both in words and in actions. “On Christmas morning, I rounded all three of our downtown hospitals with the chief medical officers of each hospital and visited with the employees who were at work on that day,” Evans says. “The purpose was to hear what they have to say about working over the holidays.”
Constant communication is the oil that keeps the engine that is your company operating smoothly. It ensures as much as possible that your employees understand what the organization is all about and can make the right decisions that a just culture enables them to do when a choice needs to be made quickly.
“You are going to find people that abuse a just culture and view it as a way they can make excuses,” Evans says. “The culture itself has to say, ‘That sounds like an excuse to me, not a reason.’”
Evans discovered the true value of his just culture recently when a friend received a letter in the mail after his wife had been brought to a Clarian hospital and where she succumbed to injuries suffered in an auto accident.
“The letter said, ‘Dear Mr. Jones, [not his name] we are aware that you lost a loved one at one of our hospitals recently,’” Evans says. “‘We are very sorry for this. Regrettably, you will receive a bill for services rendered. We are sorry about that. Please know we care, and call this number and ask for this person when you get the first bill so we can talk about it.’ ... They were in that man’s living room two weeks after his wife died literally. He’s by himself opening his mail and that could have been a terrible experience. That’s a culture I’m proud of, people who would have thought that up.”
Evans says he talked to someone in patient financial services and discovered the department had decided after a tragedy a couple of years earlier that it needed to change its letter for those circumstances.
“That’s a culture that wants to do everything as well as they can,” Evans says. “That means they had to feel comfortable they would-n’t be punished for not sending out a standard letter.
“That’s what I meant when I say walk the talk. When I walk around this building, if somebody doesn’t use the word patient in the first few minutes of our conversation, I figure I don’t need to have the conversation. I think that’s a pretty good test.”
HOW TO REACH: Clarian Health Partners Inc., www.clarian.org