Singing from the same sheet. Following the same path. Reading from the same page.
No matter what idiom you want to use, Stan Johnson’s message is the same to everyone at Veteran’s Affairs San Diego Healthcare System: He wants everyone aligned on delivering the best possible experience to the system’s customers — its patients.
“That is really leading a culture change in terms of working with all staff, informing the staff of what it means to provide patient-centered care,” says Johnson, the director of the 2,400-employee, La Jolla-based health care provider within the U.S. Department of Veterans Affairs. “A lot of what we do was already patient-centered care. But it was really looking at redesigning our delivery of care so it is geared toward meeting and exceeding the patient’s expectations.”
Johnson says changing a culture can be challenging and exciting at the same time. You are excited to implement a new way of thinking among your team, but at the same time, there will be bumps in the road as you rebuild processes from the ground up and try to uproot habit-entrenched employees and attempt to show them that the new way is a better way. It can be much more easily said than done.
At the VA San Diego system, the leaders put a template in place by becoming an affiliate of the Planetree Alliance — a nonprofit partnership of health care organizations that advocates for care that is centered on an overall positive experience for the patient. The alignment with Planetree gave Johnson a path to follow when he assumed control of the health care system in 2009. But Johnson had to bring the plan to life every day and coach more than 2,000 employees to do the same.
He did it by involving as many people as possible in the decisions that would affect the system’s future. He sought out the opinions and ideas of not just his employees but patients, as well.
“You really need to look at your organization through your customers’ or patients’ eyes,” Johnson says. “What we’ve done with some of our system design groups is involve many of our patients, because you have to know firsthand what the expectations and needs of your customers are.”
Engage your employees
You’ve probably heard it countless times in your career: Your culture isn’t what you say it is; it’s what your employees believe it is. You can preach all you want on your organizational principles, but if you don’t follow those words with like actions, your culture is going to wither, and distrust will seep into the hierarchy of your company.
One of the actions you need to take is opening a dialogue with your employees. If you are preparing to point your company in a new direction or alter your defining principles in any way, your employees will need opportunities to speak with you in person.
Johnson and his leadership team create those opportunities by getting many people together for a few days off-site, free from workday distractions, where employees can feel enabled to speak up, offer feedback and share ideas.
“About 85 percent of our staff has been on a retreat where they begin to understand what patient care is,” Johnson says. “They begin to individually understand what they individually could look at to improve the patient experience. As a leader, you want to listen to their ideas and suggestions and start to implement things that come out of that, so that it starts to be driven by them instead of being driven by upper management.”
Of course, you can’t implement every employee idea in the name of strengthening or changing your culture. But you can offer feedback on all ideas that come your way, and you can implement the ideas that make the most sense for where your organization is at that point in time. If you don’t at least do that much, you can expect the dialogue, and the wellspring of ideas that comes with it, to dry up .
“You can ask and you can listen, but unless you actually implement some of those suggestions and react fairly quickly to their good ideas, that will dissipate or go away fairly quickly,” Johnson says. “People simply will not continue to give you good ideas and suggestions if you’re not listening to them and implementing some of them. So what you really want is a mechanism to allow your people to make some of those suggestions but also to follow through on your end with the action and implementation of providing feedback and recognition.”
Recognition is another key cog in achieving buy-in on any new initiative. If you want your employees to embrace new cultural principles, reward their good behavior and hold your high performers aloft as an example for everyone else.
It’s something that Johnson emphasizes on a regular basis throughout the San Diego VA system.
“Recently, our communications work group had a patient call center that is about 16 staff members who take a lot of calls, schedule appointments, and the wait time for those calls was longer than we what we liked,” he says. “So those individuals worked with our system redesign staff, flow-mapped the process to see if there were steps that didn’t really add any value to the process any longer, and they were able to make significant improvements in about a two-month time frame.
“Myself and our leaders in that area went to that work area and personally recognized them with an in-person thank you as well as a cash bonus. Many times, it’s a combination of the personal recognition and financial reward that really helps keep employees engaged on that level.”
Stay close to customers
As a business leader, it is imperative that you maintain close relationships with your customers. Without customers, you don’t generate revenue, you don’t turn a profit, your employees don’t keep their jobs and, eventually, you go out of business.
With that in mind, you need to develop avenues to build and maintain customer relationships. Johnson takes it a step further, utilizing the vast amount of military technical training that his organization’s patients have absorbed, by encouraging patients to get involved in various initiatives throughout the system.
“One of the system redesign efforts right now is focused on communication, and a subset of that talent is telecommunications,” Johnson says. “We have a couple of individuals who use the VA for their care, and they have an area of expertise in telecommunications. They’re kind enough to volunteer their time to work with our work group.”
If you always keep it front of mind that your customers are your reason for being, you will be much more apt to seek out their opinions and input on how you run your business from a service standpoint.
“That is the key, to have constant feedback from the people you take care of,” Johnson says. “That is what we’re here for. You have to make sure you’re meeting their needs. It’s not just what we think they’re asking us for, it’s finding out what they’re truly challenged by in using your system.”
As with any other aspect of your business, customer interaction needs leadership with an eye toward continuous improvement. No matter how good you think your system is, no matter how well you think you stay in touch with the people you serve, it can always be done better, and you and your leadership team should constantly seek ways to build a better customer service mousetrap.
“It’s like anything else when you’re in a leadership position,” Johnson says. “You continually work at it. You take nothing for granted. Just because you’re doing something well now doesn’t mean that you’re not continually looking for improvements, how you can be more efficient and effective with what you’re doing. Just because it’s working well now doesn’t mean it can’t be done better.”
Johnson takes the reins when it comes to driving that mentality throughout the organization, but ultimately, he wants all of his employees to become self-starters in delivering an exceptional patient experience.
“It is the responsibility of every single person on our staff,” he says. “We’re here to provide a service to veterans who have served our country. Each one of us, each individual who works with the VA San Diego Healthcare System, can make sure that the patient experience exceeds their expectations. That is what we’re trying to instill in our patient-centered care and affiliation with Planetree, to make sure all staff understand that and can individually make a difference. That is why we want everyone to view it as their responsibility, all the way up to me.”
Once you have systems in place to allow for engagement of both employees and customers, you need to keep watering the ground with frequent communication. Johnson views continual communication and cultural reinforcement as one of the biggest challenges before him each day.
The challenge of delivering good communication each day is complicated by the fact that you can’t be in all places at all times. You have to have a network of managers and electronic interface points that allow you to keep your messages in front of both employees and customers when you can’t be there in person.
“Communication is another one of those things that you’re always striving to do better,” Johnson says. “What we try to do is communicate in multiple ways. For instance, we have electronic message boards up in elevator lobbies at clinics. We use them to share updates on what is going on at the facility, new information that we want to share, whether it be patient satisfaction or how we did with a recent survey.
“You’re also getting that information out there through e-mail, social networking sites like Twitter and Facebook, many different ways. Different methods of communication work for different people, and you have to use them all to communicate your strategies and your benchmarks that you have set or that have been set for you.”
But even after you’ve rolled out a new direction for your company, even after the meetings and dialogues with employees and customers, communication remains a two-way street. Feedback from multiple channels is the only way you can ensure that your message is reaching the people you want it to reach and if they are buying in to the message.
“You’re always kind of surveying people, both formally and as you talk with people throughout the day,” Johnson says. “We think we might be doing a good job of communicating, but until you hear it from your customers, patients or staff, you probably haven’t done a good enough job yet.”
How to reach: Veterans Affairs San Diego Healthcare System, (858) 552-8585 or www.sandiego.va.gov
The Johnson file
Veteran’s Affairs San Diego Healthcare System
Born: Bloomfield, Iowa
History: I joined the Navy and came to San Diego in 1972. I did my boot camp here and served here. I was in the Navy for four years, and they were kind enough to support my education and training, so after that, I went back to Iowa and earned a bachelor’s degree in business administration and a master’s degree in health care administration from the University of Iowa.
What is the best business lesson you’ve learned?
Listen to the patient. Involve your staff and your customers in your improvement efforts.
What traits or skills are essential for a business leader?
The key is to develop good working relationships, be transparent and treat people fairly.
What is your definition of success?
For me, it boils down to hearing firsthand from our customers that we’ve done an outstanding job for them.