What is the role of leadership in navigating the headwinds and tailwinds of implementing a sustainable cultural transformation?
In this article, the fifth in a series, we ask Deborah Proctor, health care CEO and expert in organizational culture, how to be a role model, take bold action, and get the details right in leading a complex organization through a cultural transformation.
Moderator: Thank you for our last intriguing discussion about culture and strategy. Now let's turn to leadership. How do you engage your organization's leadership for cultural transformation? Does anything stand out when you're thinking back to taking on the CEO role and carrying it forward?
Deborah: The adage from stacks of business literature holds true. You must have the right people on the bus. You want leaders who live out your mission, embrace your values, and commit to a targeted set of outcomes. If they don't stand by what you are striving to achieve, you will not get there. You also must have leaders committed to sustaining the culture you are trying to create. I will do everything possible to assist a leader in becoming successful or, said another way, I will be an active sponsor of their leadership. But that brings with it the full commitment on their part to create our desired culture. They must "buy-in," which takes a lot of effort. It's not just saying it, it's working through it.
Moderator: When people lean in, and the mission makes sense, it's easy to move along. But sustaining a new culture is not always so easy. What happens when a strong cultural element from the past conflicts with an aspect you are trying to transform?
Deborah: It takes great discipline and lots of dialogue to change cultural aspects. Leaders need to see it in writing, read it, understand it, and continually live it before the culture can be changed. I’ll give you an example which proved especially difficult for me. St. Joseph Health System had a core value of justice. Justice has many implications for the workplace. When I first came to the health system one of our hospitals was facing a union campaign. Previously, we had hired consultants to help us with our employee communication and education materials to dissuade employees from choosing a union. Catholic Social Teaching actually states that employees have the right to organize. Some members of the community, including local priests, questioned our campaign practices. To truly live our value of justice we needed to affirm our employees’ right to unionize while trying to ensure that our workplace was desirable enough for them to feel this was not necessary. So, we developed a Code of Conduct that we shared with leaders to guide our behavior during any union campaign environment. Initially leaders felt uncomfortable with this new aspect of our culture, but over time they were able to understand the connection to our values. We only lost one election in the 11 years I was there.
When you are diligent about identifying and reinforcing the cultural attributes you are trying to build, it becomes palpable in the organization. St. Joseph Hospital in Orange County was the first hospital in the region to apply for and achieve the honor of Magnet status, a recognition of nursing excellence. The examiners said they had never been in an organization that was so consistently clear on its mission, vision, and values. They told us that everyone in the organization could identify the values, and they knew the three outcomes we were striving to achieve. They found this clarity throughout the organization.
Moderator: It's not just the modeling, it's intentional. That is the soul of the organization. The union example you talk about, I can't imagine a tougher test of leadership. You come into a longstanding organization, you're trying to create a systemwide culture, and you're trying to battle or reconcile the union issue.
Deborah: One of the great practices in Catholic health care is discernment. When we are making leadership decisions, we get all the facts, and we identify which values are in play and which are in conflict with each other. We generate multiple solutions and test each for whether or not they support the values. We select the best solution and then we take time to reflect quietly and see if anything has changed. And then we decide. That is the discernment process for deciding issues which are especially values-laden. The process was particularly helpful e when we explained to others why we made a specific choice. We were that explicit about living out our values.
Moderator: Values don't always make it into this discernment process, especially when it's a fast decision. Here at THEO, we also try to infuse values into everything we do to ensure it's in our dialogue.
Deborah: It's fascinating when you start putting that kind of diligence into decisions. And it is not enough to just say what you want. You have to ensure the structure and policy also supports the transformation. St. Joseph had a stated cultural attribute of work-life balance. When I came on board, leaders were not taking vacations. And when leaders don’t take vacations there is often an unspoken message that others should not do so either. I mandated that my direct reports take their full vacation each year, including one two-week vacation. I don't believe you are genuinely restored in a week. Well, I still had trouble getting it implemented. It dawned on me that we had a policy where you could save your vacation time and get it paid out at the end of the year. People were using it as a “bonus” opportunity. Taking away that policy did not make me very popular, but I still believe that our leadership had a new level of work-life balance.
Moderator: So that decision, which I think was brilliant, came from an orientation to the type of culture and behaviors you wanted?
Deborah: To get to the behaviors you want, you have to take that kind of action. I have found that you do not realize at first how many things may work against the cultural values.
Moderator: I was thinking about everything you laid out that you did around culture, mission, and values. We've been focused on belonging, and I'm wondering, is Belonging inherent when you have this healthy culture?
Deborah: Everybody would say we were a mission-driven, values-passionate organization. I think there was a culture of Belonging. But we were not as deliberate about it as we were about the values. Imagine the possibility if we take the same disciplined approach to creating a sense of Belonging for everyone.
Deborah Proctor has over 40 years of health care leadership experience and is the Board Chair for THEO, a trusted Transformation Advisory firm partnering with enterprise leaders and entrepreneurs at the forefront of the wellbeing movement. THEO’s uniquely human approach transforms your talent, deploys culture as a strategic advantage, and guides the enterprise across the entire transformational journey. THEO ensures organizations fulfill their vision and meet their potential in time for it to matter.