'We didn't fall apart': How Salem Health built a culture prepared for crisis

Culture plays a key role in employee satisfaction, and a great culture can help hospitals and health systems prepare for a crisis like the COVID-19 pandemic. Building that great culture takes time and investment. 

At the Becker's Healthcare Community Hospitals Virtual Forum on Oct. 12, Salem (Ore.) Health CMO Ralph Yates, DO, discussed how his health system has invested in culture over the last decade and shared his takeaways with colleagues coping with the pandemic.

Here is an excerpt from the session, lightly edited for clarity. Click here to view the entire conversation on demand.

Question: How has Salem Health navigated this challenge and invested in its culture over the past decade?

Dr. Ralph Yates: We started a decade ago, and I think at the time, the organization first started some of its important programs. I'm not sure that people understood that what they were doing was shaping future culture. But we have a wonderful CEO who came here as chief nursing officer and launched us on our first Magnet designation. We've since been redesignated for our third Magnet designation. That was one of the first. Ten years ago, we also launched and have been fully engaged now in our Lean methodology. Both programs, Magnet and Lean, have at their heart, emphasis on team.

Ten years ago, we also launched an initiative called the Physician Leadership Institute. The name is a bit anachronistic, because only 50 percent of participants that have gone through PLI are physicians or advanced practitioners. The other half are our nurses, managers, most of our board, our CEO, have all been through PLI, which is a Friday, Saturday, once a month, for four months, program.

During that four months, individuals as teams work on process improvement projects for the areas in which they work. What's important to know about PLI is, from the beginning, it was a team-oriented, team-focused event. What we've learned after 10 years is individuals not only develop an understanding of rapid tests of change, communication, handling difficult conversations, leadership  — they come out culturally different. We have over 700 people, leaders within our institution that have been trained, and some outside institutions that send folks through our program. That's had a profound impact on our organization.

Over two years ago, we did an analysis of our graduates to find out exactly what they took away from the experience. What we discovered was that it was fundamentally cultural, but when we went deeper, it was, they had enhanced resiliency, which led us two years ago to Brian Sexton, PhD, at Durham, N.C.-based Duke University and his foundational and groundbreaking work in enhancing individual resiliency, primarily in physicians and nurses. We took his work and collaborated with him and said, "Let's put teams through your training, not individuals, and let's have them return to their departments and their units," because not everyone was clinical that went through our training,  "and use our Lean principles to implement the tools they've learned."

What we found was, it was a force multiplier, statistically on the work that he's done with individuals. We graduated 170 people through something called TRI, Team Resiliency Institute. The second cohort graduated just before the pandemic hit, and the timing couldn't have been better.

Q: How did Salem Health's investment in culture prepare the organization for COVID-19? 

RY: Along with everyone else, the most memorable part of this spring was the level of fear that was present, particularly in my younger colleagues. They'd never seen anything like this, and the fear was palpable. What I learned to say to people was this: "We will get through this together."

It resonated, because here within our system, we're taught to function as teams, and we have. What I've said to colleagues outside our system is, "We pulled together. We didn't fall apart." 


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