Rising to the top Featured

8:00pm EDT August 26, 2009

Look, Mitch Creem already knows you’re going to ask him for the one-size-fits-all answer.

I mean, you don’t think you’re the first person to ask Creem about a career filled with victories in handling distressed organizations — highlighted by one bottom line turnaround of roughly $100 million — do you?

“Everybody always looks for the silver-bullet answer, what can they take away from it and use somewhere else, but there were so many factors,” Creem says.

But, really, there has to be one trend that keeps popping up in a 25-year leadership career, right? Perhaps something he’s used to push through tough times in his current CEO role at USC University Hospital and USC Norris Cancer Hospital.

Maybe a more concise question will help: Has he seen a root theme to those struggling organizations he’s helped fix?

“Part of the reason why they were losing so much money was the employees were feeling bad about themselves and the organization, feeling disenfranchised and neglected and even disrespected by the senior management team,” Creem says. “So much of turning around an organization is turning around the psyche of the employees and making them feel that they’re important, that the organization is wonderful and that they are, too. And that they understand the business, they understand what’s going on and we listen to them, and if we can listen to them, we do very well.”

Now we’re getting somewhere. There may not be a perfect answer, but employee empowerment is something that Creem has learned to laud over the years. It’s a lesson he was preparing to bring to the two hospitals, months before the April 2009 transition in which the University of Southern California took ownership and people had to adapt overnight. The hospitals and the roughly 2,000 employees weren’t quite in the dire straights that Creem has seen before, but they still needed an overhaul.

Here are a few thoughts from Creem on how to build an empowerment culture that can be a game-changer for any organization.

Hire and empower doers

OK, so you’re trying to empower people. But you can’t be a personal cheerleader for every employee and you can’t spend months on every hire to make sure new people are entrepreneurial. What Creem has learned through the years is that you need more self-starters in your management team to start the process.

“I’m looking for people who I feel are ‘doers,’ people who can actually get things done,” he says. “You come across a lot of people who know theory, know management theory, know what’s happening in an industry, but you really need people who can take and translate good management ideas into action and can do that through delegation and getting their people behind them. That’s a trait that’s really important to me: people who can get things done and then they also have to be good people people who can motivate, manage and inspire their subordinates to reach new levels of performance.”

Putting those thoughts into practice is something that Creem has worked on over the years, and the first step to finding a doer is about taking the time to get to know someone.

“It is hard on paper to do it,” he says. “I make sure that I meet with them at least two, if not three, times and I try to get past the first interview where I feel like we’re both really selling each other and, in particular, I’m trying to sell them on the organization.”

But anyone can do multiple interviews. At USC, Creem makes the most of his second or third chances with a candidate by focusing on how people handle real-life situations that call for action.

“I can see more about the person and ask them questions about how they would handle certain situations and what would they do in this particular job and give them some scenarios to work through with me on how they would approach it,” he says. “Have they had similar situations, and what have they done in similar situations?”

He’s not looking for a perfect answer, he just wants to see the person taking charge of the situation. Further, a doer will show a flash of that trait by flipping the interview back to you.

“I can see it by questions they ask me,” Creem says. “How would I support them, how much latitude do I give them, how much autonomy. And then I give them examples of situations and how would I handle it, and I can get a strong sense of whether they can get things done or not get things done, and I can also get a better sense of their technical competency.”

Along the way, Creem also puts people through his personal litmus test: putting them in a room with an established doer or two.

“It’s also important for me to have them interview with other folks that I feel are doers, and I ask these people to tell me frankly whether they think they’re a doer or not a doer,” he says. “Are they a doer or are they a theorist?”

Once you’ve hired some doers, you have to let them do. When you have motivated managers, they’ll want to have a heavy hand in decisions for an organization’s direction. You have to let that happen.

“A good leader has to be very thoughtful and open-minded about the decision-making process,” Creem says. “Particularly in the environments where I work, it’s very complex environments and visions that I make can often have profound implications on patient care or patient service.”

But, of course, there’s the old leadership paradox that comes with inclusion: You still have to make decisions in a timely fashion. Creem does that through his managers. He can’t be at both hospitals 24 hours a day, so he congregates a core group of managers to design and implement the big-picture things.

That’s tricky, because having 40 empowered people in the room will lead to 40 strong opinions. When it comes to big issues, it’s about having a smaller group. At USC, it’s usually six senior leaders: the chief financial officer, chief information officer, chief marketing officer, chief human resources officer, chief operating officer and chief nursing officer. When there’s a specific issue with compliance, marketing, etc., the heads of those departments are brought in. Once you have a small, focused group, then you can let everyone express his or her opinion.

“I try to drive people toward a consensus, and I often find that during that process I can get many different points of view on the table at the same time,” Creem says. “I can create a sense of participation and transparency in the decision-making process, and I find that as long as everyone is involved, they’re less likely to be upset with the outcome if it’s not theirs if they feel they are part of the process.”

Establish the right systems

Creem’s second key to a game-changing culture is putting systems in place that recognize and reward the entrepreneurial behaviors that will make front-line employees self-starters.

“It seems like every year we have to do more with less, so we try to create a spirit of empowerment and entrepreneurialism so that we can always find new ideas and different ways of approaching old problems,” he says.

That sounds good, but, again, with 2,000 people, he doesn’t have time to sit down for quarterly reviews with everyone to discuss that. Still, he can start the process by telling hospital employees times are different and then take the opportunity to share and reward those who exemplify the systems he’s trying to put into place.

“We try to create reward and recognition programs where we can celebrate managers and employees who have come up with new ideas. ... We also just want to highlight and celebrate people who are trying to do new and innovative things throughout the hospital,” he says. “So the more we can identify the kind of behavior we want to model and make it visible to our employees, the more they can learn what behavior we’re rewarding and promoting.”

Those steps are done through things most companies do: newsletters, company meetings, meetings with middle managers, town halls, etc., but the key is to do it consistently — as in every time — and to specify the behaviors you want. With that, highlighting the rewards helps. For example, USC has a strategic partnership with the Los Angeles Dodgers and gives away game tickets to employees with other rewards and awards during high-profile hospital celebrations like Nurses Week.

“During those weeks of celebration, we have the opportunity to give awards to employees that exemplify the values and virtues that we are holding in the highest regard,” he says.

You also want to get it started by being a touch point. While Creem wants his managers to handle the overall leadership, the early stages of empowerment mean you have to hear thoughts on daily systems that are out of whack. Empowering people means you have to give them tangible ways to see they have a voice. Creem gives everyone at the hospital his e-mail and tells them to shoot him ideas. But don’t think that just letting employees touch base with you will do the trick. If it’s an issue best handled by someone else, Creem forwards it on. Still, responding is important.

“It’s really important to respond to every e-mail,” he says. “And let them know that we’re going to try to push forward this idea or maybe try to explain what else is going on in the organization that would give them a different viewpoint, give them more information to work with as to why certain things are the way they are.”

When you’re doing that, any piece of information that you take and use must be publicized.

“Certainly, with respect to minor changes in benefit structure or some policies that we were implementing, we talked about how voices of the employees have helped us stay on the straight and narrow,” he says.

For the record, people won’t immediately bang down your door with ideas. At USC, Creem got about 200 e-mails from employees during his first 45 days. But the more you respond, the more momentum you’ll create. Further, building that momentum takes some personal stories that people can take to the masses. Early on at USC, Creem had a nurse come to him about an initiative for a patient program.

“She came all the way over to my office to drop off a letter — she was a little bit nervous to talk to me — but we ended up talking about it anyway,” he says. “I saw that she was nervous, so I decided that we should have a talk about some of her ideas and she wanted to be involved. So these are the kind of things that I see throughout the organization that make me realize it’s working, it’ll take root, (but) it will take some time.”

Doing those things helped in the first steps at USC: They didn’t lose one employee the day of the ownership transition.

“With a new CEO, some new managers, I don’t think everyone understands what response they might get,” he says. “But my sense is that the spirit is lifting. People are becoming more vocal.

“The word is getting out that we’re approachable and that we’re eager to hear from everybody. And I think slowly we’re starting to hear from everybody.”

How to reach: USC University Hospital, (888) 700-5700 or www.uscuniversityhospital.org; USC Norris Cancer Hospital, (800) 700-3956 or www.uscnorriscancerhospital.org