Deborah A. Proctor leads with a mission that originated in 17th century France. It came from a priest named Jean-Pierre Medaille, who told the Sisters of St. Joseph to go out into the neighborhood, divide it into sectors, identify the needs of the people and bring others together to help meet those needs.
Now, across the globe and about 360 years later, Proctor tries to keep that calling relevant at St. Joseph Health System, the network of hospitals and other community care services the sisters planted in Orange.
A lot has changed since then. So the meaning behind the organization’s mission to be “continually improving the health and quality of life of people in the communities we serve” needs to keep up so employees can maintain a clear picture of their purpose.
About four years ago, Proctor led St. Joseph through strategic planning to define what the mission means today for the 22,000 employees across the system, which now has 14 locations.
“We grounded ourselves first in our heritage,” says the president and CEO. “We went all the way back to that point in time and looked at the call that was given to the sisters [and asked,] ‘So what would that mean to us?’”
The company invested time and involvement in the mission re-evaluation, and Proctor still strives to make its purpose resonate with relevance that her employees can understand.
“You can’t just publicize something and then expect it to become embedded in the organization,” Proctor says. “Everybody will tell you that it’s not about the creation of your strategy; it’s about the execution or implementation of your strategy that makes all the difference.”
Begin with the end
For a year before the strategic planning process started, Proctor asked her employees one big question: “How will we know if we achieve our mission?”
There were other questions, too, like, “What do you think St. Joseph is about?” and, “What should we strive to accomplish?” but this one laid the foundation for the direction of the company. The answers would define the mission in modern times.
“Sometimes, mission statements can seem fairly lofty and hard to translate,” Proctor says. “What we created was the way to say we’ll know that we’re achieving our mission when we can achieve these three mission outcomes.”
To make a mission statement new, ask your organization to explain what it would look like to achieve it.
“Leaders have to ask themselves, ‘What are the outcomes I’m trying to drive toward?’” Proctor says. “What usually happens is people develop strategy, but they don’t know the specific outcomes they want that strategy to deliver. You’ll write metrics for the strategy that measure how well you’re doing that strategy, but it doesn’t tell you if you’re getting any closer to what your mission statement is.
“My point was, we’ve got to start with the outcomes first. We need to say, ‘These are the outcomes we expect to achieve,’ and then, ‘What’s our strategy to achieve that?’”
The input she received wound up in front of about 100 leaders, including both systemwide and local hospital executives, physicians and members of the religious congregation. During a facilitated three-day retreat that included a couple 12-hour days, they worked to condense the spectrum of feedback into three snapshots of a fulfilled mission.
“We had them do visioning exercises such as, ‘What would The New York Times say 10 years from now about St. Joseph Health System?’” Proctor says. “Then we would digest that and say, ‘OK, well if they said these things about us, what was really important here was this, that we had accomplished these things, that we had improved the quality for patients, etc.’ So we just kept honing down through different exercises to get more and more focused.”
The CEO’s role in this is to listen — which may not be as simple as it sounds when you’re the funnel in a very iterative, involved process.
“One of my jobs in that retreat was to listen to everything and try and synthesize it,” Proctor says. “You listen to all of the input. And then toward the end, I took it and said, ‘OK, here’s what I’m hearing. I’m hearing these things are what’s really important to us.’ And then we debated.”
With the help of a facilitator from Boston-based Center for Applied Research, the retreat helped the St. Joseph team refine three conceptual mission outcomes: That every encounter would be sacred, that patients would receive perfect care, and that St. Joseph communities would be the healthiest in the country.
As you’re going through this process of defining what your company is about so you can deliver it, don’t be afraid to aim high. Proctor asked her company a big question, and she expected big answers.
“I’m of the mindset that you set aggressive goals and then you ask, ‘What will it take to get there?’” Proctor says. “And then you see if it’s realistic in terms of getting there.”
For example, the team debated over the term “perfect care.” Some worried that aiming for perfection stretched too far.
“Could we ever achieve perfect care? And was it arrogant of us to think that we could achieve perfect care?” Proctor says, recalling the dialogue. “The conversation around that really boiled down to, ‘How else would you state the goal: We want to give great care 90 percent of the time?’”
In the end, the group members agreed that it was best to state the outcome in terms of their aspiration, which was the best possible scenario: perfection.
“We’re not saying we’ll necessarily never fail at that, but it’s always our goal,” Proctor says.
The goal should also be broad enough to remain collective. In other words, make it applicable to all employees; later, you can fit more specific departmental initiatives under the umbrella it creates.
“If one of my strategies is to do something with information technology, that doesn’t excite the front-line employees — unless it’s going to make their job easier,” she says. “But if that technology helps us get to perfect care, that excites the employees. After you have those clear things in place that employees can relate to, then the strategies make sense.”
You make those broad, aggressive goals less daunting by breaking them down into achievable milestones. St. Joseph sets three tiers of each goal.
“We set a threshold level, which we want to achieve, the actual target and then an exceptional level,” Proctor says. “That gives you some range of performance to achieve. We say, minimally we have to achieve this much, we hope to achieve this much, but we’d be really excited if we achieved this much.”
For example, St. Joseph set out to lower its rate of ventilator-associated pneumonia. Initially, it fell into the seventh decile of industry-measured standards. It set a threshold target to be in the fourth decile, which was above average, an actual target in the third decile and an exceptional target in the first.
Now, St. Joseph is in the first.
“One thing that’s really important is to set aggressive targets — not unachievable targets but aggressive targets that cause people to really stretch,” Proctor says. “If you put that kind of goal out in front of people, I think people really do want to achieve.”
Of course, you also help make those goals attainable by slicing them into achievable steps.
“Obviously, in 2006, I couldn’t expect by 2007 that we would achieve those outcomes,” she says. “You have to say, ‘OK, what are the likely steps we have to take to be able to achieve that to get to perfect care?’ And then you have to break it into realistic strategies for getting to that.”
A good first step, for example, is often defining and communicating the goal — or the mission outcome, in this case. St. Joseph spent a whole year on that, again getting employees involved to refine the definitions.
“We knew before we could expect that everybody was having sacred encounters that people would have to understand what a sacred encounter meant,” Proctor says, explaining it means each encounter should leave people more healed and more whole. “So our first strategy was to define sacred encounters and to get some level of clarity where people could say, ‘This is what a sacred encounter looks like.’”
Make it happen
After you’ve set goals at the intersection of aggressive and achievable, your employees need to accomplish them. You’ll get their buy-in — and their effort — when you keep them involved.
St. Joseph employees participated from the start by giving their input. They stay involved now through lean processes, referred to as the St. Joseph Way. Basically, they’re empowered to solve problems in their own work areas to improve performance in pursuit of the strategic goals.
“It’s a culture of continuous improvement (where) you’re equipping front-line employees to constantly identify gaps in performance, to identify ways to improve the organization, ways to eliminate waste, ways to save time, ways to improve our processes,” Proctor says. “It’s not management doing the work; it’s front-line employees doing the work of improving whatever the gap is that they’ve identified in their particular area.”
Employees go through training to learn specific tools and methods that can streamline their workflow.
“In that kind of thinking, you get a full understanding of your current situation and then you identify your target state,” Proctor says.
St. Joseph has internalized and customized the lean process, not only in name but in the process itself. When local hospitals take a lean look at a certain area, questions about the mission outcomes are built into the improvement effort. That way, the overarching goals stay collectively clear as employees drive improvement at the local level.
“The biggest thing is translating the strategy all the way down into every single department to where every department understands what they contribute to that particular strategy and how they play a role in it,” Proctor says.
In an organization as large as St. Joseph, her role as CEO is to communicate goals and strategies to local leaders, and then help them deliver the message to their areas of the company.
“The best you can do is create support systems that try to eliminate variation,” she says. “So if it’s a message that needs to be consistent across our entire health system, then we put together a message statement, we put together frequently asked questions statements and we provide that to the leadership across the system.
“We allow the individual leaders to determine the best way to communicate in their organization. They know their employees best. … The most important thing is trying to create a line of sight between the front-line employees’ work and whatever it is you’re trying to accomplish.”
To bolster that alignment, St. Joseph is piloting a lean tool called strategic deployment, in which one level of the organization identifies what it can contribute to achieve the strategy, then it passes the ball to the next level, and so on, all the way to front-line employees.
Proctor keeps employees motivated in this process by recognizing improvement along the way.
“When you’re trying to drive improved performance or improved outcomes in an organization, the easiest mistake could be to not recognize improvement as it happens in such a way that you demotivate employees,” she says. “You have to pay close attention to recognizing improvement and to encouraging the growth and learning.”
But when you adopt a culture of continuous improvement, you’re never done improving. The company, which grew revenue from $3.9 billion in fiscal 2008 to $4.1 billion in fiscal 2009, is still going strong. Accomplishing one initiative — like the several hospitals in the system that have gone more than two years without a case of ventilator-associated pneumonia — just frees up the company to reach toward its next goal.
“I just think that there’s too much in what we do, that we can always learn how to do it one step better,” Proctor says. “Yeah, maybe we can eliminate [certain things] altogether, once and for all from ever happening again in our hospitals, but there will be something else that has come along in the meantime.”
How to reach: St. Joseph Health System, (714) 347-7500 or www.stjhs.org