Team first Featured

8:00pm EDT April 25, 2009

Eight years ago, Richard Miller discovered that a business could grow through downsizing.

It’s not as contradictory as you might think.

In 2001, Virtua Health’s Camden, N.J., hospital was facing low occupancy rates and, in turn, a lack of revenue production. Miller, the president and CEO of the 7,200-employee South Jersey health care system, soon found that the only option was to close the Camden hospital as an inpatient facility.

More than 500 employees’ jobs hung in the balance. History is full of companies that closed a facility, padlocked the doors and walked away, leaving displaced employees to fend for themselves.

But Miller saw an opportunity emerging from the adversity. He could support the affected people, strengthening Virtua Health’s bond to its employees and the Camden community while performing the necessary closure. So Miller and his management team set about reassigning as many of the Camden employees as possible.

“We found a job for virtually every employee in the hospital,” Miller says. “Our human resources department painstakingly went through and placed them at our other sites. The ones that wanted early retirement, that’s what we let them do, but the very first thing we did is went through and decided on job placement.”

Virtua Health maintained a presence in Camden by using the former hospital as an outpatient services facility, now known as Virtua Health Camden, and leasing a portion of the facility to other businesses. It took a great deal of extra work, but the end result was a creative solution to a problem, a solution that strengthened both the trust of employees in management and the trust of the Camden community in the Virtua Health organization.

“People didn’t forget what Virtua did in that regard, because we didn’t board up the doors and walk away from our people,” Miller says. “The community never felt we abandoned them, and now the building is full and is a successful economic venture for us today.”

It’s a lesson Miller still carries with him: Even in difficult times, if you are willing to take the steps to build trust and a spirit of teamwork among your employees, you will strengthen your business over the long term.

Talk it over

One of the biggest keys to building employee trust is to communicate the mission and goals of the organization to them, showing them how their jobs help the organization achieve its overall mission. But keeping employees in the loop is about more than just disseminating information. It’s about showing employees that you care that they take an interest in the direction of the organization.

At Virtua Health, communication starts where the overarching strategies of the organization start: at the top. The goals of the organization need to originate on the same level as the plan for communicating those goals, so that senior management is working together to move the messages downward.

To monitor the downward movement of messages, Miller meets with all of his management-level employees quarterly.

“The key is, when I have meetings with all of my management-level employees, I open up a dialogue about where Virtua is and any questions they might have about the direction,” Miller says. “It’s all about having a constant dialogue with your people to ensure that the message is uniform, clear and concise. There has to be a concise line of sight from the vision, mission and strategy right through to the end results.

“It’s especially important for your management-level people because they are the communicators where the rubber hits the road. They are the people who are, day in and day out, communicating to the staff. Your department directors are probably the most important role players because they’re right there at the employee level.”

Miller says that if your senior leadership team isn’t on the same page, you’ll see the negative effects farther down the ladder. That’s why Miller and his management team conduct an annual employee survey that directly asks whether employees understand the direction of Virtua Health. On a monthly basis, Miller meets with an advisory group of 35 employees from areas throughout the organization.

“I test concepts with our employees,” he says. “We go through a lot of scenarios and get their feedback, and they are very honest in terms of the rank and file and where we need to shore up communication. I use the group as a sounding board for our strategy and whether we are hitting the mark. If there is any area in which we aren’t hitting the mark, we need to shore that up and talk to our employees about it.”

Miller focuses the entire organization on five measurement areas. If his communication strategy is working, every employee should be able to recite the five areas, summarized in Miller’s “star initiative.”

“Every employee knows we measure patient satisfaction, quality and safety, operating margin, and overall job satisfaction,” he says. “We measure those four things every year, relentlessly. The star initiative is composed of those four points plus our fifth point, which is building a caring culture. Every employee can recite the star, and the most important point is that there is a clear line of sight of how our strategies tie into the star initiative.”

Communication is a two-way street, with information heading downward and feedback upward. But with Miller accessible to thousands of employees, he needed to develop a plan for sifting through feedback and deciding which matters need his attention.

If a problem or issue arises that an employee or department can’t address outright, Miller will have a manager or executive lead the process for finding a solution. But whenever possible, he says you should enable employees to find their own solutions. Miller says it is a form of enabling and empowering employees, which is another element in building trust.

“What I tell my employees is to come back to me with a game plan, tell me what you would do to solve it, because you’re closer to the issue than me,” he says. “Nine out of 10 times, employees solve their own problems. They understand what they have to do and end up bringing back great results. That’s why I’m a real fan of employees taking ownership in their own issues. You need to, whenever possible, let them solve their issue, because they’ll do a good job of it.

“Even in a case where a manager is leading the process for them, I always like to keep our people engaged, because once you own the solution, you carry it out for everybody else.”

Hire team players

As your organization grows, your management-level employees will play an increasingly significant role in tying the people in your organization together. Without the cooperation of your direct reports and their direct reports, chances are you won’t be able to build or maintain a culture of trust and inclusion.

That’s why Miller wants to find managers who can help build and maintain Virtua Health’s vision, mission and culture from their first week on the job.

To cultivate the right kind of managers, you need to start out with the right kinds of raw materials. Miller says managerial candidates should, first and foremost, mesh with your organizational values.

“When you’re hiring, you first really have to look at the values of the person, what kind of individual are they, are they trustworthy and honest,” Miller says. “You try to measure that through the interview process as well as you can. Obviously, you also have to know whether they’re coming in with the technical skills you need, but those technical skills are very secondary to the values set.

“I’m a firm believer that you can teach a skill set but you can’t teach a values set. A person comes into a position with a values set. If their skills need enhanced, you can provide that, but you can’t provide the values set.”

Miller and his staff get down to the nuts and bolts of a managerial candidate’s values set through a rigorous interviewing process. When you apply for a managerial position at Virtua Health, three or four sets of interviews await — provided you pass the screening tests that are part of the recruitment process.

“If we’re going to hire a manager who is going to be in a position of managing other people, we panel interview them, and the people on that panel could be from all parts of Virtua,” Miller says. “It could be a nursing director, a physical therapist, someone from human resources. There might be four or five people on a panel, and they interview and determine that person’s fit at Virtua Health. Then, if you make it through that round, the individual manager you’re going to be working for does a personal interview.”

Situational interviewing is part of the vetting process at Virtua Health. Miller and his leadership team place potential managers into hypothetical situations that involve challenges the candidate might encounter on the job.

“Usually these are people issues,” Miller says. “We ask them how they would deal with this person if a certain situation occurred. ‘What would your response be to someone who is ineffective; how would you deal with it?’ We would gauge the response partly on how the person feels they would take corrective action on a nonperformance issue and partly on whether they’re doing it kindly and with care, so that the person can self-correct.

“If someone tells us that they’d fire a person after a mistake, we have the wrong manager. What we want them to do is consider how to make this person better, how to improve their skill set.”

The process of performing the proper amount of due diligence on a managerial candidate can be time-consuming, but it’s better to put in the work ahead of time than to backtrack because you made a poor hire.

“I’d rather spend the time on the front end to hire good people than hire someone who is not optimal, someone who ends up costing the organization money and might end up causing the organization damage from which we never recover,” Miller says. “That’s why the work spent upfront in hiring a manager is crucial.”

If you put the right managers in place, they will help you engage your employees, promote your vision and build a positive culture in which employees and management trust each other and are willing to work together toward common goals.

“The biggest challenge I have faced, a challenge just about any leader faces, is to make sure you have the right leadership team on board,” he says. “Whenever you form an organization, you need to put a quality senior management team together. Good leaders beget good leaders; quality people beget quality people. That is the first, and probably the largest, challenge you have as a leader.”

How to reach: Virtua Health, (888) 847-8823 or