How one business boomed by investing — even splurging — on employees

I set out to create a place where I wanted to work — and I also created a psychologically healthy workplace.

Flexibility has been central to our business model since I launched Grants Plus, a fundraising consulting firm serving nonprofits, in 2007. From the start, Grants Plus staff has had the option to work from home, our PlayhouseSquare office or anywhere. Sometimes we must be on-site — for a client visit or a staff meeting—but employees appreciate creating their own schedules and defining their work routines.

As Grants Plus grew, I added employee wellness opportunities and professional supports that I believed would produce optimal quality work and satisfied clients. We began offering workshops on grant writing and the other tasks of our business, but also on time management, personal branding and mindfulness. Each year, our staff members have 50 paid work hours for professional development.

I had naysayers: I recall one mentor who balked at that line item and said cutting it would make us more profitable. But I saw that investing in our team made team members more invested in the company. I made a commitment then to always prioritize employee training and enrichment.

The payoff

Nearly a decade later, these investments have paid off. In the last few years alone, revenues have grown 170 percent, and our staff has tripled. We’ve won awards for our growth, including the Weatherhead 100 Upstart Award for three consecutive years.

Now we’re also winning awards for our workplace culture. In 2014, we received state-level recognition from the Ohio Psychological Association, and in February, we received a national 2016 Psychologically Healthy Workplace Award from the American Psychological Association. Grants Plus is one of six winners in North America and the only winner in Cleveland.

These awards didn’t happen by accident: when we learned the APA had defined criteria for a Psychologically Healthy Workplace, we established a task force and set out to meet them, in five categories: employee involvement, work/life balance, employee growth and development, health and safety, and employee recognition.

Among other steps, we implemented a banded structure of small work teams, which has nurtured leadership and made advancement pathways transparent. We named “truth” one of our company values — lived out in quarterly culture surveys that invite employees to rate the business as an employer.

Leaving the comfort zone

We push ourselves outside our comfort zone, whether as a team completing a high-ropes course or as individuals tackling new work challenges. Employees work hard, but not at the expense of their well-being, and as a company we honor balance, not burnout.

A work-from-home environment works well for Grants Plus, but won’t suit every business model. Every company, however, can implement policies and practices that encourage employee well-being.

It’s our intention to continue these practices and to encourage other Cleveland businesses of all types and sizes to develop psychologically healthy workplaces — and ultimately set the region apart as a place talented leaders will come to work hard and stay.

To learn more about the APA criteria, visit

Lauren Steiner is president of Grants Plus, a grant seeking firm that has helped nonprofits across the U.S. raise more than $70 million in grant funding. In 2015, 73 percent of the grant proposals submitted for clients resulted in funding. Lauren was a filmmaker, attorney, college instructor and nonprofit development executive before founding Grants Plus in 2007 to help more nonprofits raise the funds they need to change the world.


Corporate leaders can encourage a startup mentality

Too often, corporate leaders hear the words “startup culture” and roll their eyes at images of airy offices with treehouses and dress codes that include flip-flops.

While that may have merit, it ignores the inherent advantages that a startup has in the marketplace — namely, the ability to solve specific problems for its customers and scale rapidly. Enterprise leaders may recognize the need for agility, but their cultures often lack the mechanics to support it.

Here’s a truth I’ve learned within my agency and our clients: innovation rarely stems from the C-suite. While leaders set the stage for a successful culture, innovative companies thrive on the creativity of their employees. Here are a few steps to drive change within your organization.

Recognize your two cultures

For better or worse, all corporations carry a legacy culture that can hinder the growth of new ideas. This legacy provides massive value — it’s what made the company successful to begin with, but it can allow inertia to overcome innovation.

Instilling that startup mentality requires a compelling reason for change. Many leaders try to emulate innovative brands like Google or 3M saying, “We give employees 20 percent of time to innovate,” without a cultural reason to do so.

Driving this change too quickly can break a culture — even the company. Leaders must find an incentive for a cultural shift, set a reasonable timeline and slowly blend innovative ideas into your legacy culture.

Reduce management barriers

S. Chris Edmonds recently wrote a great article on where the responsibility for promoting culture lies. Company leaders set the vision for culture, but it’s critical to hand employees the reins to foster ownership and accountability. At my digital product agency, 352 Inc., we took a radical step three years ago and completely removed management in favor of team-centric servant leaders.

Our small, cross-functional agile teams allow employees to work directly with clients, set their own production schedules and pursue disruptive ideas in a fail-fast, learn-faster environment. By removing managers from daily operations, both employees and leadership are freed to focus on what matters most for each group.

Create values-based metrics

You can’t just offer the leeway to be innovative and expect staff to take risks on their own. Providing creative freedom is one thing; giving employees a reason to utilize it is another.

Pursuing change means fundamentally risking your job — leaders need to encourage, even celebrate, when innovation goes wrong. This requires strong core values and metrics that measure employees’ performance against those values.

Look outside your own walls

Sparking innovation within a large, complex organization isn’t easy, so external partners can introduce new ideas and mitigate the risk of pushing for change. Many companies simply aren’t built to take risks or struggle to empower an isolated innovation group within the company.

Agencies provide an independent team that can work in parallel to try new products, validate ideas in the marketplace and utilize emerging technologies in ways that may stump enterprise teams.

Ultimately, capturing that startup spirit requires strong storytelling and empowerment. Give your employees motivation to embrace risk and the means to do so, and I guarantee they’ll respond.

Geoff Wilson is the president and founder of 352 Inc. and an evangelist for his Barely Manage to Lead philosophy, using agile teams to drive iterative growth. 352 is a digital product development agency specializing in product strategy, user experience design, custom web development and digital marketing. 352 turns ideas into successful digital products for companies like Cox Automotive, Microsoft and YouCaring. 

Building an unbeatable culture in five steps

Collaborative Solutions was recently named among the top 20 2016 Best-of-the-Best professional service organizations by SPI research, and it got me thinking about what’s led us to this point. A strong industry, smart leadership, and efficient systems have played a role, but the biggest factor was the company culture.

Below are the top five tips that might help your company build an unbeatable culture.

  1. Encourage Collaboration

Collaboration is absolutely critical in maintaining corporate culture. Helping one another is extremely important, whether it’s with a customer challenge, a technical question or even something simple like trouble with a timesheet.

Foster collaboration from the start. Assign new employees a mentor on day one and teach them to rely on their fellow employees for support and advice. In order to further encourage collaboration, offer tools that make it simple like SalesForce Chatter, SharePoint and Skype, which all foster knowledge transfer and group learning.

  1. Check your Ego at the Door

In a fast-paced cloud consulting environment, innovation is key. How does your organization innovate? From the top down or the bottom up? The best ideas come from employees who are on the ground with customers every day. Encourage their ideas and innovation with an employee bonus structure.

With an open-door policy at the leadership level, employees know their ideas will be heard and that they can count on the support and resources they need to fully develop new ideas and innovations.

  1. Ask for Referrals

One of the single best ways to maintain an awesome company culture is to grow based on referrals. New hires who become stars are often those who come with “one degree” of separation.

How can you build a team of top talent? Put programs in place to encourage referrals. Collaborative Solutions offers a referral reward program to promote referrals, and we put “culture fit” high on the list of criteria we screen for during our interview process.

  1. Focus on Excellent Customer Outcomes

Talented consultants want to work for a proven winner. Focusing on excellent outcomes, no matter your business, will elevate your company and lead the best and brightest to join your team.

  1. Offer Efficient Onboarding and Invest in Learning and Development

The happiest employees are those who come up to speed quickly and are immediately able to contribute to customer success. Your onboarding process should support this. When new employees come on board, they should quickly move through an effective onboarding process to get access to the tools and information they need to be successful.

After onboarding, keeping employees happy long-term requires continuous learning and development to help your team grow into their roles and advance in their careers. Your company will want to invest considerably in a learning and development program to ensure that you continuously build your team’s knowledge and abilities through targeted training and professional development.

Bob Maller is president and chief culture officer at Collaborative Solutions, a leading global finance and HR transformation consultancy that leverages world-class cloud solutions to help deliver successful outcomes for its customers. For more information, visit

Developing an attractive work culture is key to performance

As the economy goes through its cycles, a common concern is keeping employers awake at night: culture, including employee engagement and retention. The proof is in the data.

  • Eighty-six percent of companies rate work culture a top priority, a 20-percent increase from last year, according to Deloitte.
  • Ninety-five percent of job candidates believe culture is more important than compensation, according to Johns Hopkins University fellow Liz Pellet.
  • Companies on Fortune’s Best Companies listing are also trending in Glassdoor’s Best Places to Work and LinkedIn’s Most-In-Demand Employers.
  • Only 32.5 percent of employees are engaged at work, according to Gallup.

What it means

Culture makes the difference between organizations that are able to sustain themselves and those who will give way to their competitors. Many organizations are talking about culture, but few are aware of the perception of their current culture or how to change it.

But what do we mean by a company’s culture?

Culture is the values, beliefs and behaviors that give meaning to an organization. It provides the filter through which people make decisions, how they work and interact with others. Culture is communicated top-down, through leadership, but is observed bottom-up.

Business leaders face a special challenge with millennials, who have high expectations on work-life balance, professional development, leadership opportunities and a personal requirement that your business provides goods and services proven to make a positive difference in people’s lives.

Yes, good pay and the ability to receive and provide feedback, including providing their manager with timely performance reviews makes the list too.

How to create culture

Here are some tips for creating an attractive, innovative and employer-of-choice culture.

  1. Assess your current culture. How does your workforce view your culture? Look at your current online reviews and conduct a cultural assessment with all employees.
  2. Research and design the culture you need to have — one that positions you for top talent, retains employees and distinguishes you in the marketplace.
  3. Create a roadmap including definitions, stories and a core statement that identifies and describes the culture.
  4. Begin the journey; cascade the roadmap throughout your organization through leadership, action groups and communication.
  5. Build in a review process to reassess, define and cultivate your distinct culture.

Somehow, among the spreadsheets and reports, it was easy to forget that organizations are comprised of people, which is at the expense of the company. Focusing on culture, engagement and retention will not only produce financial results, it will create an environment where performance, positivity and possibility flourish.

Debora McLaughlin is a certified executive coach and CEO of The Renegade Leader Coaching and Consulting Group. She helps business leaders ignite their inner renegade leader to unleash their full potential, drive their visions and yield positive results, both in business and in life.  Visit

Acquisitions and cultures: The right fit is the bottom line for both; make your decision after careful research

Editor’s note: Mal Mixon, former chairman of Invacare Corporation and a well-known entrepreneur, will regularly share his business advice and experience with Smart Business readers. Ask him a question at [email protected], and your inquiry could be the inspiration for his next column.

Q: I’m been growing my business organically the past several years and have concluded that in order to accelerate growth, I need to look at acquisitions. From your experience, what are the top factors to consider when evaluating the type of company to acquire?

A: I think it is essential to include acquisitions if you have a long-term growth plan. At Invacare Corporation, we wanted to grow 50 percent organically and 50 percent by acquisition. You can set it at 60/40 or at anything you want. It just felt like 50/50 was right.

During the period I ran Invacare, we did more than 50 acquisitions. They generally fell into three categories:

  1. Geographical expansion, such as in another area of the country or a foreign country.
  2. A new product line that uses your current distribution system. For example, wheelchairs and beds, in my business, are sold through the same channel, to the same people, to the same customers.
  3. Consolidation of your industry. As an industry consolidates, you should become a much stronger player and improve your sales and margins. Improved profitability is consistent with improved market share.

As far as what you look for, we always had an acquisition team to examine a business in every way they could. You can’t collect too much information. Sometimes even casual conversations are as important as formal presentations.

Try to find out if the business proposition is presented fairly and if you understand everything going on.

I never did an acquisition that wasn’t accretive to the shareholder. It always added to my earnings. We were able to do acquisitions because we had a good, positive cash flow and a solid line of credit from the bank. If you don’t have good cash flow and you don’t have a lot of credit, forget it.

Q: How important is culture when merging two organizations, and what pitfalls exist when trying to merge two cultures that may not perfectly mesh?

A: There are always issues with culture when merging two companies. In my case, I always thought that Invacare was the preferred culture. But we were always sensitive to other companies’ cultures and tried to blend them in over time.

You must recognize there are usually redundancies, particularly with infrastructure. For example, you don’t need two presidents. Take action fairly quickly. Morale will fall in the acquired company if you don’t show that they are loved and accepted by the new company.

If the acquired company won’t move its facility, and you need them, you’ve got to compromise. That’s a difficult subject but the important thing you want is one and one to equal three.

By putting the two companies together, you want the merger to be better than if they were alone. You have to be sensitive to that, use common sense and do the best you can. If you’re insensitive, you may destroy the company.

Three tips on using culture to transform your business

Organizational culture, or the way a company does things, takes all shapes and sizes. Culture can be based on flexibility, great workplace perks or traditional core values. Other elements of culture lie beneath the surface such as perceptions, unwritten rules and norms. Your culture impacts the way you do business.

Not long ago, the nonprofit sector was excited about mobile giving. And today, individuals and organizations attract attention through crowdfunding. Our industry is ever-changing, and the pace of transformation is faster than ever. For this reason, United Way of Greater Cleveland has adopted a culture of continual change.

How do you use ingrained culture to transform how you serve your client, audience or community?

Help or hinder

Culture enables successful change when the proposed change integrates the current culture. Management can use existing energy and team commitment to transform the work.

If your business culture encourages employee-led initiatives, expand the reach from holiday party planning committees to cross-functional teams focused on implementing needed strategies. This special project team, led and comprised of staff members with varying expertise, is an efficient method to implement the ancillary tasks needed to transform your business.

On the other hand, culture can hinder transformation when change is not aligned with the normal strategic flow of business.

If your culture is based heavily on hierarchy, peer-led initiatives may not be the best approach for successful transformation. Instead, develop change strategies to mimic the pulse of the organization such as allowing management to lead projects and include members of their team in the execution stages.


People resist change particularly when fear of the unknown exists. To successfully transform your business, strive to instill a culture of transparency to deal with questions of job status and roles and responsibilities.

Address looming concerns among your team with one-on-one and small group discussions combined with other forms of communication to thoroughly share the rationale for change.

Mistrust is a top reason new initiatives fail. Use transparency to build or enhance a culture of trust between management, staff members and external stakeholders. Involve interested parties in planning stages by asking and answering questions and incorporating their suggestions. 


Although transformation is often initiated by leadership staff, the rest of the team should feel ownership and inclusion in the change. Tap into employee expertise by creating a culture where employees are invited to contribute to change tactics outside of their normal assignments.

When transforming your business, foster a culture of staff members who “want to” vs. “have to.” Mandates from leadership will deter the desired change. But team members who raise their hand to help with the challenge will have more passion for the project and ensure change occurs.

Successful transformation needs culture, with all its pieces and parts — attitudes, beliefs and practices —  to thrive. Research shows more than half of change initiatives are unsuccessful. This is due, in part, to organizations utilizing strategies unaligned with company culture. To transform your business to better meet the needs of your client, audience or community, acknowledge and capitalize on your organization’s culture.

Bill Kitson, president and CEO of United Way of Greater Cleveland, is committed to advancing education, income and health by engaging community members to give, advocate and volunteer. To learn more about how he shifted United Way to turn outward, contact him at (216) 436-2101 or [email protected] For more information, visit

Your culture is your brand; help it evolve

Many think that company culture is an aftereffect that evolves on its own. It will if you let it, but you shouldn’t. If you don’t decide what your culture is going to be, it will get decided for you, and not always for the better. Culture doesn’t mean people have to drink the Kool-Aid, but it is just as important as your marketing strategy, R&D or your ERP system. Like those aspects of your business, it needs to be intentional.

There are a number of good reasons to be intentional about culture. Culture shapes your team’s internal activities. Maybe even more importantly, it influences the public’s perception of your brand. Here are two good examples:

  • Starbucks intentionally created a culture that’s caring and respectful of employees. The employees, in turn, are upbeat and friendly. That promotes the Starbucks brand: great coffee, yes, but you also can count on a warm, welcoming atmosphere.
  • Apple also intentionally created an effective culture, although it’s the opposite of warm and fuzzy. Apple’s culture says, “You’re the best or you work for someone else.” When it comes to innovation and quality, it’s do or die. This supports the Apple brand, which is about being on the defining edge of the market and offering products that may cost more, but are worth it.

Effective culture also fosters commitment and passion, and helps retain top talent. A college grad may earn close to minimum wage as a Starbucks barista, but they’ll stay for years because they love working there. Apple retains top talent by hiring people who are motivated to perform at a high level and then providing the kind of challenging culture they thrive in.

So if you’re just starting a business, pay as much attention to culture as you do to any other facet of your model. If you’ve been in business for years, you can still re-think and re-engineer your culture, just as you can overhaul your sales strategy. And even if you have a well-designed culture in place, you need to nurture it constant constantly.

Trader Joe’s, for example, has been quirky and offbeat since 1967. Even today, though, senior executives will go into the stores and ask employees, “What are we doing, in corporate, to screw you up?” And they respond to employee input. That kind of respect goes a long way toward keeping employees motivated.

If you’ve been to TJ’s, you know the staff are all about the bringing the vision to life: a trip to Trader Joe’s is like a mini-tropical vacation, with free samples in grass huts, upbeat and friendly staff in Hawaiian shirts, and unique food.

It’s true that Trader Joe’s also pays very generously, but money alone won’t create employee engagement. Ask any HR professional. Trader Joe’s culture goes deeper than bonuses and Hawaiian shirts. It helps their people feel they are part of something special that is bigger than themselves.

One way you can tell your culture is healthy is widespread use of “tribal speak.” An example I love to share comes from my own company, from an actual email I sent to my leadership team:

Our CP just landed a chunky monkey. Please send the Green Flag, iceberg it and flag the cockroach committee. Dog has fleas.

Every organization has it, and those who can understand it are part of the tribe. It helps define us as a unique and special “Us” — insiders who share a common vision and a common language.

Speak it, live it, love it, but above all, intend it. Your culture is critical part of your business’ success.

Kim Shepherd’s ideas on leadership, virtual workplaces and company culture have been featured in Fast Company, Huffington Post, Forbes and SUCCESS. A three-time Inc. 5000 CEO, she has also authored “The Bite Me School of Management — Taking a Bite Out of Conventional Thinking.” She joined Decision Toolbox, a 100 percent virtual organization providing recruitment solutions, in 2000 as CEO. Today, she leads the company’s growth strategy as an active member of the Los Angeles and Orange County human resources communities. She can be reached at [email protected].

This article is derived from Kim Shepherd’s new book “Get Scrappy: Business Insights to Make Your Company More Agile” , available in Kindle and print editions from booksellers everywhere. 

Destroying and creating: Both start with a vision, but one is great theater; the other only a step to being great


Over the last 10 years since I first moved to Cleveland, I have met some great people. One such person is Vic DiGeronimo. His family is one of the nicest, most genuine and caring families I have ever met. On top of that, the DiGeronimos have built a tremendous business and have figured out how to effectively run a family business unlike any other I have ever seen.


Independence Excavating, DiGeronimo’s company, is not only one of the premier demolition companies in the area, it is probably the best in America.

Independence has torn down some buildings for us, and I’m always awestruck as I watch the equipment flatten, destroy and wipe out structures in what seems like minutes. It’s almost mesmerizing. The speed in which workers knock the building down and make it so that it never existed is great theater; there is no question about that.

Building is carefully laborious

Since starting my business in Cleveland, I have built 15 dealership buildings, most from scratch and some via major renovations. Watching the buildings go up is like watching paint dry. Unless you have a time lapse camera, you really don’t see any meaningful progress from day to day. A new wall here, an office there, and slowly the vision of what the building will look like takes shape.

Watching buildings go down and seeing them constructed, I’ve been struck by the similarities between that process and creating a company culture. Both start with a vision. You don’t lay the foundation without an architect’s extraordinarily detailed drawings.

These blueprints lay out the completed project with every facet of the building thought out, debated and agreed upon. Construction cannot start until everyone agrees what the building will look like.

Culture has to be planned

Likewise, you must know the company culture you desire and the steps necessary to get there. Without that goal in mind, you’ll end up with a mess on your hands, much like a poorly designed building. Great architecture and great companies don’t happen by accident; they happen as a result of tremendous effort, planning and tenacity.

Everyone on the project must follow the blueprints. Failure to do so will create the wrong result, cause enormous amounts of effort for others and could cause you to end up with a structure that is unstable. Likewise, in business, you need leaders and team members who believe in your vision and your culture. Failure in that regard has the same result: an unbalanced and ineffective organization.

On the other hand, knocking down or destroying a company’s culture happens quickly, just like the demolition. It doesn’t take much effort and requires much less planning. A wrong leader, a wrong team member or a wrong shift in attitude all come barreling down an organization much like those cranes the DiGeronimos use. Worse yet, the damage takes a long time to repair.



Bernie Moreno purchased his first auto dealership in 2005 and now has 25 dealerships in the Bernie Moreno Companies. (440) 716-2700

Dr. Akram Boutros finds the Rx for MetroHealth is engaging in the culture

When he joined The MetroHealth System as president and CEO, Dr. Akram Boutros, FACHE, needed to know if employees and management knew what the organization’s mission and vision statements were.

After asking those that he met, he determined it was a lost cause. No one could recite the few paragraphs that comprised either of the guiding proclamations.

“I asked about 50 people to describe in their own words what the MetroHealth mission and vision was,” he says. “I got probably 60 different answers from 50 different people.”

That situation became a critical issue. Without knowing where they were going, the organization’s 6,000-plus employees were unable to reach any goals. Boutros knew employee engagement was essential if he was going to turn the operation around, both to stop the bleeding and to make over the aging main campus, a project of such scale that it had to be viewed as a complete transformation of all things MetroHealth.

The problem was quite clear to Boutros.

“There is no engagement in the campus transformation without engaging the entire MetroHealth transformation,” he says.

When he took the helm on June 1, 2013, Boutros discovered a first quarter deficit of $6.5 million. Under his leadership, he helped MetroHealth finish 2013 with $18.9 million in net operating income. Several factors contributed to the financial improvement, including a reduction in the cost per patient and an experimental Medicaid waiver program that expanded insurance coverage to nearly 30,000 people in Cuyahoga County.

As far as sprucing up the vintage main campus, discussions took place as early as 2010, but it took last year’s polar vortex to illustrate how fragile the facility had become. Pipes froze and burst in subzero temperatures and patient rooms flooded.

Boutros announced the $400 million transformation plan calling for about 75 percent of the main campus to be rebuilt or renovated, with work to start in 2016 and end in 2020.

Here’s how Boutros is taking a holistic approach to turning around the 178-year-old institution, which saw 2013 annual revenue of $855 million.

First step: start writing

Developing the mission, vision and values statement became Boutros’s key issue and would be the first step to drive the transformation.

“That’s one of those critical steps that without it, you can’t engage the management, the staff, the community, your patients, your doctors,” he says. “They have to know what they’re doing.”

MetroHealth System’s
new statements

Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork.

MetroHealth will be the most admired public health system in the nation, renowned for our innovation, outcomes, service and financial strength.

Service to others
Inclusion and diversity
Quest for excellence

It was time for a cultural makeover. Management turnover and significant financial cuts made in 2008 to balance the budget contributed to low employee morale at the county-owned MetroHealth.

The first thing Boutros undertook was a back-to-basics review, revisiting the mission, vision and values. Even before he came to MetroHealth, he told the board of directors that during his first week, he would hold weekly two-hour mission, vision and values meetings with his strategy committee for the next six weeks.

“We needed to be absolutely clear about what our purpose for existence was, what we saw ourselves becoming and how we were going to get there,” he says.

The strategy team consisted of representatives from the board, senior management, the medical staff and even competitors.

“We had a pediatrician from University Hospital on the committee,” he says.

Other members included a union representative and the head of the nursing senate.

Starting with a blank slate, the committee encouraged participation from all employees and constituents. While the discussions took place, a graphic recorder turned the complex dialogues into instant visuals. These were then posted in a hallway to be shared with employees. Notes and discussion summaries were also emailed each week to employees and constituents.

“We had more than a thousand submissions, comments, changes and things for consideration,” Boutros says, “and I had lied to the board — I told them it would take six meetings for us to do it; it took five.

“By having such an inclusive process, not a single person in this organization felt strongly against us,” he says. “We were very passionate about our mission, vision and values.”

Well-known for his exuberant persona that values employee feedback and interaction, Boutros is also famous for starting at 5 a.m. and working sometimes until 11 p.m., greeting employees enthusiastically as he walks the hallways and asking if they need anything.

But even with that familiarity, he made sure he distanced himself from the strategy discussion and says the mission, vision and values statements had very little to do with what he saw for the organization, but more of what the committee collectively saw for MetroHealth.

“My job was as a facilitator, so I didn’t participate,” he says. “I in no way had an opinion about the mission, vision or values.”

When the person in authority is genuinely interested in learning from somebody, there’s no higher amount of respect they can show them, Boutros says.

“Each individual interaction confirmed what they were hoping to have,”  he says.

The focus became sharp as a needle: “Our mission is why we exist, our vision is where we are going, and our values are how we are going to get there,” Boutros says.

“If we want to change how health care gets delivered in the U.S., the only way we’re going to do that is by influencing others. That’s why our vision is to become the most admired public health system in the nation, so we can influence others to follow the good works we’ve done.”

Decide where best to start

Putting the mission, vision and values statements to work must start at the most opportune level. Many organizations follow the concept that leading by example, from the top executive down, is the proper method to institute a cultural makeover.

Boutros, however, disagrees with his colleagues who follow that process. He starts the makeover from the employee level. This is where faith in the leadership is important.

“You cannot follow someone you don’t trust,” he says. “The employees who provide direct care are the most important people in this hospital, much more important than me and my management team. They’re the people who actually make a difference.”

To experience this firsthand, Boutros on his first day dressed as a transporter and whisked patients throughout the hospital in wheelchairs and gurneys. It gave him an important view of the entire operation.

“It demonstrated a respect for every part of our organization and everyone’s contribution. We all have a role to play, and we don’t succeed if each one of us is not playing that role,” he says.

By making himself available to employees, meeting and talking with them and answering every email, he has earned the trust of his team.

“It’s a level of comfort and partnership that exists honestly between me and the individual staff member,” he says.

Developing that comfort and partnership goes hand-in-hand with developing a culture of safety to think freely, Boutros says. For instance, he feels it is important to demonstrate that it’s OK to make a mistake and fail for the right reasons — on the operations side, that is.

“The business side of the operations, and the way we deliver care, we can change all of that. The medicine that we use to take care of somebody we can’t change,” he says. “That needs to be scientifically based, and based on how we’ve done things over time.”

Success is great but failure can also be very good, Boutros says, because it offers a second chance to convert failure into a positive.

“Convert failure into learning,” he says. “People have tested my veracity to that. They have done it in multiple ways and are always pleasantly surprised when we celebrate the learning as much as we celebrate their successes. That’s how we’re creating this culture of safety. For the right reason, you can challenge anybody.

“The culture certainly is working because the idea of us making this financial, clinical and operational transformation in a short period of time makes people think there’s wizardry involved. The only wizardry involved is having 6,000-plus people working on the same thing, rowing in the same direction.”

Management focus: teamwork

Boutros says by their very nature, managers tend to be personally focused overachievers, not only in health care but in almost every corporation in America. The challenge therefore is to bring a teamwork focus into the management, removing the spotlight from individual contributions and putting it on team contributions.


To offset the self-centeredness and to build a sense of teamwork, Boutros met with senior leadership during his first year and developed collective goals.

“Today, 70 percent of their goals are organizational goals and only 30 percent of their goals are personal,” he says. “It continues to be not about who scores the baskets but what the final score is.”

Speaking of making baskets, Boutros uses the example of a hometown sports hero to illustrate his stress on teamwork.

“I admire LeBron James because of that,” Boutros says. “He may be the most capable player on the team, but he understands that if everyone on his team performs to his very best, then they’re going to win. So that’s the same things we try to do here. Just because you can doesn’t mean you should. Sometimes it means letting somebody else take the lead and move with a project, and in total we get the successes.”

Middle management, however, offers the most challenges, since organizations have hired middle managers to do what they’re told.

“They are inherently risk-averse people,” Boutros says.

To help change that frame of mind, MetroHealth launched programs to change middle managers’ perception and skill sets. A chief experience officer was hired and a patient experience office was launched. Boutros, who admits his penchant for metrics, took the approach to focus on patient outcomes, not satisfaction.

“Our measuring stick was, ‘Were patients better off than when they came in?’ It wasn’t, ‘Were you happy with our services?’ So we needed to change that,” he says.

Every employee, manager, board member and physician goes through patient experience training their first year.

One other program offers the TeamSTEPPS system through the Agency for Healthcare Research and Quality to not only improve patient safety but to improve communication and teamwork skills.

It caught on so well that MetroHealth went from being a hospital just learning about TeamSTEPPS to becoming one of eight regional training centers in record time.

“We are giving employees training, we’re giving them opportunities to prove themselves, and, frankly, people are also selecting to stay in or go out,” Boutros says. “For example, in the three months that we’ve had values testing for our new employees, we’ve reduced our 30-day attrition rate from 6 percent to 0 percent and our three-month rate from 12 percent to 2 percent.

“Some people have left the organization saying, ‘This is too much stress for me. I just want to be told what to do and do it.’ That’s not accountability for me; that’s not exercising leadership. If you don’t want to exercise leadership, this is the wrong place for you.”

Evolve your external image

As the internal perception of MetroHealth improved, Boutros used the same plan to improve the external perception.

“We used the same candor, transparency and passion to transform the internal stakeholders as we are doing with external stakeholders,” he says. “There’s nothing you can’t ask us that we won’t answer. We’re your hospital. So whatever you need, whatever you want, we’re here for you and we will answer any questions you have.”

Boutros made it a priority to engage with the Cuyahoga County Council, the county executive, the mayor, Cleveland City Council and with competitors — Cleveland Clinic and University Hospitals.

The latter two Boutros prefers to call collaborators, not competitors.

“We want to work with everybody, and we think the MetroHealth mission and our progress wins the day,” he says. “It may take a little bit longer to achieve than a sales job, but it has more staying power.

“We have a very different mission, and we have a very different focus to deliver that mission. We don’t want to rely on high-cost facilities to provide the best level of care. We want to be able to provide services at your convenience in your neighborhood on your own terms. We want to be able to engage patients, not for the short-term treatment but for life sustaining wellness. It’s a very different model.

“It’s like saying that bicycles, cars and boats are all transportation. They are, but I think they just have different customers and different ways of approaching transportation,” Boutros says.


  • Develop concise mission, vision and values statements.
  • Start your transformation at the level that makes the most sense.
  • Focus on teamwork and improving your overall image.

The Boutros FileDr-Boutros-490

Name: Akram Boutros, M.D., FACHE
Title: President and CEO
Organization: The MetroHealth System

Born: Cairo, Egypt. I came to the U.S. when I was 12 ½, and lived in Queens, New York.

Education: State University of New York Health Science Center at Brooklyn, Harvard Business School’s Advanced Management Program, St. John’s University.

What was your first job, and what did you learn from it?

I worked for my dad in the jewelry business. I learned that it’s not good to work with family. You spend way too much time with each other. I also learned early on business skills that I would never have had otherwise.

The first outside job I had was a paperboy. That also led to a life-altering event because I was heading down the wrong path in life. I was hit by a truck. I spent a long time in the hospital recuperating and that kind of altered my life. I decided I had to do something that mattered. The accident put me on track to become a doctor.

Who do you admire in business?

The late Steve Jobs is somebody I admire because he believed stronger, longer and more passionately in what Apple was doing than anybody else. Resilience, tenacity and leadership are really important. He also believed in being transformational, doing something that impacts the world. It wasn’t purely the money, and it wasn’t purely the accolades; it was about instilling change.

I also admire LeBron James. We have a very similar story: the Cavs with LeBron and MetroHealth with Akram; many, many of the same people working a little bit differently together, focused on a greater good than on individuals. I’ve learned a lot from him.

What is the best business advice you ever received?

This was from David Garvin, Ph.D., at the Harvard Business School: fail effectively. It has three components to it. Fail small, fail fast and fail forward. Don’t make huge mistakes, but you’re bound to make mistakes. Make small ones. Fail fast; don’t wait too long to make a decision because it’s bound to be wrong anyway, so you might as well just get it over with. Fail forward means to learn from your mistake and just move on. That’s when you can transform failure into learning.

What is your definition of business success?

Creating an organization that provides value and is sustainable without you, that fills its purpose, has good operations, good methodologies, good structures, is hopefully adaptable and it doesn’t need you for it.

Culture trumps cash as deciding factor for today’s top job candidates

Culture is more important to today’s job candidates than money. The younger generation is empowered by a culture centered on purpose, which gives companies that have clearly defined values and a culture that supports those values a powerful differentiator.
“There’s a war for top talent going on, especially in high-demand industries, so companies must differentiate themselves to stay competitive,” says Aaron Grossman, CEO of Alliance Solutions Group.

The hardest part for both employer and employee is neither ever knows if they’re a good fit for each other until a decision is made and an employee is in place. It becomes a matter of a company projecting the most accurate depiction of its values into the market so candidates can get a strong sense of what it’s like to work for that company before they step through the door.

Smart Business spoke with Grossman about the importance of culture on talent acquisition and retention.

What are the signs that a culture is good? That it’s bad?

Initially, in judging whether a culture is good or bad, a new employee will compare the picture the employer painted of the work environment during the interview stage against his or her feeling once in the door. If a company has managed expectations correctly, it’s a sign of good culture.

Other indicators of a good culture are high levels of employee engagement, employees who readily say good things about the company and employees who would refer their friends to the company.

High retention rates are also a good sign. When employees do leave, understanding why they left can give an employer a clue as to how employees feel about the work environment. Leaving isn’t always a bad thing. In a defined culture there will be some people in the organization, who upon reflection, realize they’re not in the best fit for their long-term career goals and they find another opportunity.

If it’s a bad culture, employees are doing the absolute minimum and there’s a lack of communication. Employees aren’t talking to each other or being candid and moving past issues to work together.

How might a company’s culture impact its ability to retain employees?

Good employees get offers from other companies. Whether they stay with their current employer in the face of another offer is often directly related to their current employer’s culture. Employees typically would rather be a part of a company with a great culture than leave for a few thousand dollars more.

It’s commonly understood that turnover has a high cost. It can take at least four months to get someone new producing at or near the level of the person who was replaced. That ramping-up period can cost an employer thousands of dollars, and that doesn’t include the search process and on-boarding.

A strong culture is important to a company’s productivity. When you have an aligned culture and people who are really connected to it, your productivity increases immensely.

How does a company’s culture get projected into the market?

Social media provides transparency around a company’s culture, showcasing what the work environment is like through pictures and text. This messaging allows a company to highlight what it’s involved with and the good things employees are doing.

Another way companies project their culture and values into the market is through community involvement. Supporting causes or otherwise being active in community initiatives gives prospective employees a sense of what the company sees as important.

What can employers do to nurture a great employee experience?

Having clearly defined company values allows leadership to manage employees to those values, which ensures every market interaction is in alignment. It’s important that business leaders who talk about culture can define it. When you can simplify what your culture is in a few words, it empowers and engages employees because they’re working under a clear purpose.

Insights Talent is brought to you by Alliance Solutions Group