Reviving the conversation Featured

8:00pm EDT May 26, 2008

His first day on the job, Steve Wolfe’s welcoming committee consisted of a single labor attorney. He knew things were going badly at Indiana Regional Medical Center before accepting the role of president and CEO — market share was falling, patient satisfaction was abysmal, and there was a daunting communication gap between management and employees — but he didn’t expect to be confronted with such adversity as he stepped in the door.

“It was clearly their plan before somebody could get in and establish trust that they wanted to get right back to the second vote,” he says of a second attempt at unionization, the first of which had failed by a few votes the previous year. “We really just made a plea to give us a chance, (but) we lost a close vote and the union was formed.”

What really concerned Wolfe was the looming threat of a strike. A fiercely adversarial culture, when combined with national rallying calls for the whole nursing industry, led to a heated meeting that would inevitably decide whether or not the health care provider’s employees would hit the picket lines. But Wolfe was able to convince labor representatives not to strike.

“I think everybody was prepared for a strike, but fortunately, we were able to avert it,” he says.

Having avoided near disaster and finally getting a chance to catch his breath, the leader and former pharmacy director sought to cure the medical center of its own toxic culture. He devoted his first 100 days to the task, familiarizing himself with the nonprofit institution, identifying major areas in need of improvement, and then choosing benchmarks to help track and measure progress.

Nearly a decade later, Indiana Regional Medical Center has posted fiscal 2007 revenue of $107 million — up from $54 million in fiscal 1999 — and has been named the best to place work in Pennsylvania twice.

Here’s how Wolfe transformed the culture from one on the verge of a strike to one of the best in the state.

Identify problems by listening

After enduring unionization and teetering on the threshold of a strike, many executives would have blindly taken action to address the hospital’s many ills.

Wolfe took a decidedly different approach. “In my first 100 days on the job, I really didn’t come in to impart any wisdom on the organization,” he says. “I came in to listen, and I did.”

That action — or rather, the lack thereof — may seem a bit backward to those more familiar with a take-charge style of leadership. Wolfe says that in such a tumultuous situation, it’s better to slow down and assess your surroundings rather than make rash decisions to change them.

“We were trying to understand the circumstances that we had, why that was occurring, what we needed to do to make ourselves better, what our goals should be, our weaknesses and strengths,” he says. “It was a chance to understand some of those things better.”

Wolfe says that the best way to uncover those issues is to meet with employees and other stakeholders one by one. It’s not a matter of walking the halls and eavesdropping on private conversations or asking direct reports to infiltrate different departments. If you really want to understand a given problem, you must set aside time to speak with the people it affects and just listen.

“I really did have a lot of formal meetings set down,” he says. “Especially when you’re starting out, people generally appreciate the fact that you would take the time to set a meeting to really hear from them.”

This process may seem daunting at first. Meeting with hundreds of people and hearing hundreds of complaints and hundreds of opinions over the course of 100 days isn’t going to be easy. Wolfe says to stay the course and never delegate the task to your management team. The best feedback comes straight from the source.

“I really was a bit of a lone ranger as far as just hearing what people were saying,” he says. “I didn’t want to have it filtered or screened from the team. That’s no disrespect from them. They’re good people. But you need to hear it unfiltered for the first bit.”

Wolfe says by personally sitting through so many one-on-one meetings, it’s much easier to identify the major themes that continually float to the top of the conversation.

“I wish I could tell you there was more science to it,” he says. “When you talk to that many people, and you keep hearing the same top 10, 15 things, I really had no shadow of a doubt as far as what the major things were.”

That’s not to say the task is easy. Those themes only made themselves apparent after countless sessions of diligent focus and concentration. But if you’re willing to put in that effort and listen to hundreds of people vent their frustrations, Wolfe says the benefits are certainly worth it.

“It was intense going out and listening to all the stakeholders, whether it was physicians, employees, managers, [the] senior team, the board or the community,” he says. “If I would take another job, I would do the same thing for the first 100 days again. It came back in spades.”

Measure progress

Wolfe wasn’t just getting feedback in his first 100 days. He was also gaining trust.

He says in any turnaround, trust is the single most important thing. Before you even think about addressing any issue, you must first show your constituents your devotion to the company and the culture.

“You have to establish trust and integrity,” Wolfe says. “You can have the best strategic plans and operational plans in the world, but if people don’t believe the trust and the integrity, then nobody’s going to follow.”

By setting aside time to meet with employees, Wolfe says you’ll not only gain their trust, but you’ll have a much easier time setting goals to address areas of concern. After all, the goals you set are in direct response to the issues that stakeholders addressed during your initial assessment.

But this process entails more than just getting buy-in. For a goal to mean anything, Wolfe says you must have some way to measure your progress toward it. Many companies resort to in-house surveys and metrics for evaluation. The management team at Indiana Regional instead opted for a third-party consultant for two reasons.

First, outside companies are better suited to devote resources to track every aspect of performance. In an abstract area like patient care, for example, they can measure countless variables that give employees a better picture of their performance.

“They actually give you a priority index,” Wolfe says. “The biggest variables that are impacting the patients’ perceptions, for example, may be communication by the nurse, explanation by the doctor, etc.”

Secondly, third-party companies can often give you a better picture of how your performance matches against others in the same industry.

“They benchmark you in a percentile ranking with peers,” he says. “If I’m working on a nursing floor or a medical or surgical floor or whatever, I get a score, and that’s translated into other medical or surgical or nursing units across the country.”

Wolfe says you should share these scores regularly in meetings. If you want employees to work to make your company a better place, they need to know where they stand and what they have to shoot for. When Indiana Regional’s constituents first saw how the hospital stacked up against the competition, for example, it was a rather eye-opening experience.

“When we first started doing that, our scores were not good,” he says. “With 100 percent being the best you could do, some of our scores were like 12th percentile, 17th percentile, 22nd percentile. It was a real eye-opener. Until that point, I don’t think people realized that so many other people were doing a better job.”

Wolfe didn’t let those numbers discourage him. Instead, he set benchmarks atop every industry percentile they were measuring.

“We were not going to stand for being in the bottom quartile of some national database on any monitor,” he says. “There was a real key decision point for everybody when we started picking what our goal was going to be. We picked the top (10 percent). There was a lot of pushback that, that was an unrealistic goal, and we could really dishearten troops with an unrealistic goal. We stood firm, and we said, ‘We could do just as well as anybody else in the United States of America, and we’re going to shoot for the top decile.’”

To combat resistance when setting benchmarks, Wolfe says to continuously communicate your goal. There will be a lot of repetition at first, but as soon as you see signs of improvement, celebrate those achievements to raise morale and boost confidence.

“It’s the old analogy of a rocket using most of its fuel to get the first whatever feet off the ground. It can be slow in the beginning, and it can be tough, and it can be frustrating, but once you break through with a victory or two, it can get contagious,” he says.

After rough goings in the first few months, Wolfe continued to push toward the goals until emergency room patient satisfaction suddenly skyrocketed into the 90th percentile.

“It was just a total breakthrough,” he says. “That was the thing that we could talk about. It was being able to have a win, and then building on those successes.”

And build they did. After championing that first victory, Wolfe and his staff continued to ride that momentum and have since found themselves perched atop the 90th percentile of nearly every area they set out to measure.

He says it’s easy to get complacent amid such success, so you must constantly set new benchmarks.

“Without the benchmarks, it’s almost impossible to shoot for peak performance,” he says. “You are always going to have the argument or the pushback that we’re doing a good job already, or you don’t know what you should be shooting for.”

To fight that pushback, Wolfe has now set an even higher benchmark for his 1,200 employees: The Malcolm Baldrige National Quality Award.

“There could be a temptation to think that you’ve done what you needed to do and perhaps it was time to coast to rest,” he says. “I think the Baldrige was the thing that we needed to keep focusing on. It keeps calling you to a higher level.”

No matter the state of your company, be it on the verge of strike or at the head of the industry, Wolfe says it’s important to aim higher. If you’re willing to invest time to gain trust and identify major shortcomings, improvement shouldn’t be far behind.

“Sometimes, people are in a situation where they don’t think it could ever be dramatically different or better than what it was,” he says. “We want to be an encouragement for people out there that it can be better. It really does boil down to trust, identifying the brutal facts, setting that target and then measuring yourself. Once you’ve had the breakthroughs, then people then realize that they can do it.”

HOW TO REACH: Indiana Regional Medical Center, (724) 357-7000 or