Minnesota health system CEO's advice: Help employees feel they're connected

James Hereford has helmed Fairview Health Services in Minneapolis throughout the pandemic and has had a front-row seat to the fluid circumstances of the last two years. In the wake of the challenges COVID-19 has created, he said he is more focused than ever on building a strong culture and ensuring his employees feel connected to the mission of the 10-hospital organization.

Mr. Hereford has served as president and CEO of Fairview since December 2016.

Before that, he served as COO of Palo Alto, Calif.-based Stanford Health Care. He also previously was COO of the Palo Alto Medical Foundation.

Mr. Hereford shared his experience leading Fairview during the pandemic, discussed his approach to employee engagement and offered advice for his peers. 

Editor's note: Responses were lightly edited for length and clarity. 

Question: What has your experience been leading Fairview during the pandemic? 

James Hereford: I'm not sure there's a return to pre-pandemic normalcy. I don't think that's in the cards. We had significant industry issues going into the pandemic in terms of our overall value we're producing for people who are purchasing healthcare. Certainly, that was not a new conversation. The pandemic has accelerated many of those forces, so from a leadership position, I think the challenge was keeping the teams together, making sure we were focused on rapid learning and a rapid action type of cycle because there was so much we didn't know going into the pandemic. We're having to really invent many things on the fly. And that was good for our teams because I think when they saw what they were capable of. It helped us progress a lot as a system. 

Now, we come out of this with a whole different set of challenges. Certainly, labor is going to be one of those significant challenges going forward, but there are many dynamics in our industry in terms of new entrants and new expectations, and this ongoing challenge of, "Are we creating sufficient value?" and "Can we continue to make healthcare more accessible and more affordable for the communities we serve?"

Q: What is the system's approach to employee engagement?

JH: The biggest thing is making sure people feel connected to the purpose of the organization. The financial part is the financial part, and labor markets are going to continue to set price points, and demand and supply of labor will continue to drive those to a large extent. For us, it's as much about, "How do we make people feel like they're connected to the mission of the organization?" Our strategic planning process tries to make sure we drive that to the front of the organization where the value is being created. We use our visual systems and processes to make sure we're having a conversation throughout the organization about what's important, why it's important, and what you as an employee can do to contribute to that success. I think that sets a good baseline for us. 

Maybe the most impactful thing, though, is we're systematic and disciplined about our chief executive getting out and being in the care setting where the value is being created. That's a critical aspect of making sure that we're all in this together and we don't have this separation between the executive leaders, senior leaders of the organization and the workforce. It's incredibly instructive for senior leaders to be out in the workplace, being seen, asking questions, understanding and learning what the challenges are, what the successes are. We try to reinforce that. We have a set of huddles every day that start on the front line and go up to our team at 9:45 a.m. where we call out the problems, the things that are going to get in the way of running today. But we also make sure we call out: What are the great experiences we've been able to create? Then amplify those through our communications process. We're the fourth largest employer in Minnesota with 34,000 employees. Scale is an issue. So how do we make sure we're telling ourselves our own story systematically? We've done that well throughout the pandemic, and now coming out of it, I think we're doing a good job of that as well. You can never communicate enough and really reinforce all those touch points throughout the organization.

Q: What is keeping you up at night the most right now?

JH: I worry the most about culture. How do we continue to build and strengthen the organizational culture? Of course, there's economics with the workforce. You need to pay them a fair wage. You need to attract and retain good people. I think the thing that does that is your culture. Do people feel like they're part of an organization that's doing the right things, taking on health inequity and racism, taking on delivering the highest levels of quality and great patient experience? 

I talk to a lot of my peers in and outside the industry, and one of the things everyone is trying to figure out is how you build a common culture when you don't necessarily have the same proximity and relationships you had before among the workforces. I talked to someone recently. He started his company in the middle of the pandemic, so he doesn't know many of the people who are working for him. How do you continue to build your culture? How do you create those experiences for people? The only thing they've had is the Zoom or Microsoft Teams call connection with people. What does that look like? How do we bring people in and create that common experience and do so at scale?

Q: If you could pass along a piece of advice to other hospital CEOs, what would it be? 

JH: We have to innovate our way out of this. Some of the old tricks, some of the old ways that got us here are not going to be the ways that get us to the next phase. Really bringing in diverse voices, diverse points of view, challenging ourselves about what our business models are, what they could be. Being willing to do the small-scale experiments to test new ideas is going to be crucial for the success of the industry moving forward.

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