by Chip Heath
In fact, they did decide to host another All-Staff Assembly the next year, and the next—it has become a cherished annual tradition.
That meeting started something big at Sharp. Fueled by the action teams, change seemed to happen on all fronts at once. Measurement systems changed, policies changed, habits changed. And as a result, the patient experience began to change. Sharp staffers found ways to deliver extraordinary service.
The landscaping crew had noticed that some patients didn’t receive visitors or flowers, so they started pruning roses, putting the blooms in a small bud vase, and walking them into the patients’ rooms. (They called the program “This bud’s for you.”) Caregivers were trained to greet patients, introduce themselves, and explain their roles—solving the problem that had frustrated Rhodes during her father’s stay. At Sharp Coronado Hospital, departing patients received a loaf of banana bread, “baked with love.” And after they returned home, many patients were surprised to receive handwritten cards from the caregivers who had served them, thanking them for the chance to be part of their care.
In the five years following the first All-Staff Assembly, Sharp hospitals’ unit patient satisfaction scores shot up in the national percentile rankings from as low as the teens to as high as the 90s. Physician satisfaction rose to the 80th percentile. Employee satisfaction rose by 13% and turnover declined by 14%. Net revenue increased by a half-billion dollars. In 2007, Sharp won the Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for quality and performance excellence.I
Did this transformation happen in a day at the convention center? Hardly. It took many years and the efforts of thousands of people. But the All-Staff Assembly was the first defining moment of the change.
And it was a moment with a character unlike others we’ve encountered. In the last section, we saw that moments of pride come when you distinguish yourself as an individual. As a result of achievements or courageous actions, you are made to feel special. But for groups, defining moments arise when we create shared meaning—highlighting the mission that binds us together and supersedes our differences. We are made to feel united.
How do you design moments that knit groups together? Sharp’s leaders used three strategies: creating a synchronized moment, inviting shared struggle, and connecting to meaning. We’ll explore all three and how they can be applied to groups ranging from religious devotees to lifeguards to janitors.
2.
Think of the last time you laughed in a group. Why were you laughing? The answer is pretty obvious: because someone said something funny.
Actually, that obvious answer is mostly wrong. The researcher Robert Provine and three assistants roamed around college campuses and city sidewalks, eavesdropping on conversations. When someone laughed, they jotted down what was said just before the laugh.
Provine found that fewer than 20% of the comments that sparked laughter were even remotely funny. In contrast to the jokes we laugh at from comedians, most laughter followed “banal remarks” such as “Look, it’s Andre.” Or “Are you sure?” Or “It was nice meeting you, too.” Even the funniest remarks they recorded may not draw a chuckle from you: Two highlights were “You don’t have to drink, just buy us drinks” and “Do you date within your species?”
So why do we laugh? Provine found that laughter was 30 times more common in social settings than private ones. It’s a social reaction. “Laughter is more about relationships than humor,” Provine concluded. We laugh to tie the group together. Our laughter says, I’m with you. I’m part of your group.
In groups, we are constantly assessing the reactions and feelings of the group. Our words and glances are a kind of social sonar. Are you still there? Are you hearing what I’m hearing? Are your reactions like mine? Laughing in groups is another way of sending positive signals back and forth. We are synchronizing our reactions.
This “synchronization” effect explains why it was so important to hold the Sharp All-Staff Assembly in person, with everyone together at the same moment (or as close to that ideal as they could get while still caring for patients). “The magnitude of an organization cannot ever be replicated via a memo,” said Sonia Rhodes. “When you have 4,000 caregivers sitting in an audience who get up every day to help people’s health care, to heal their lives, that’s powerful. It’s physical. . . . The hair on their bodies stood up. It was a shared experience.”
The staffers who attended the All-Staff Assembly absorbed some critical messages from the situation: This is important. (Our leaders wouldn’t rent all the buses in a city for something mundane.) This is real. (They can’t back off the things they said when 4,000 of us heard them.) We’re in this together. (I see a sea of faces around me, and we’re all on the same team.) And what we’re doing matters. (We’ve recommitted ourselves to a purpose—caring for those in need—that is bigger than any of us.)
Notice how many peak moments are, like the Sharp meeting, shared social moments: weddings, birthday parties, retirement celebrations, baptisms, festivals, graduations, rites of passage, concerts, competitions, and more. Or think about political rallies and marches—we crave the personal contact, the social reinforcement, even though it’s with strangers. Occupying the streets together says: This is important. This is real. We’re in this together. And what we’re doing matters.
“Reasonable” voices in your organization will argue against synchronizing moments. It’s too expensive to get everyone together. Too complicated. Couldn’t we just jump on a webinar? Couldn’t we just send the highlights via email? (Recall the Sharp nurse who said, “We were used to getting changes through an email on Friday afternoon.”)
Remote contact is perfectly suitable for day-to-day communication and collaboration. But a big moment needs to be shared in person. (No one dials in to a wedding or graduation, after all.) The presence of others turns abstract ideas into social reality.
3.
The anthropologist Dimitris Xygalatas studied two rituals performed as part of the Hindu festival of Thaipusam on the island of Mauritius. In the milder, “low-ordeal” ritual, devotees prayed and chanted for several hours inside and outside a Hindu temple. In the “high-ordeal” ritual, devotees engaged in “body piercing with multiple needles and skewers, carrying heavy bamboo structures, and dragging carts attached by hooks to the skin for over 4 hours before climbing a mountain barefooted to reach the temple of Murugan.”
Afterward, Xygalatas and his team offered both sets of people—low- and high-ordeal devotees—200 rupees (about two days’ salary) to complete a questionnaire. Once they received the money, they were presented an opportunity to donate anonymously to the temple. The low-ordeal devotees donated an average of about 81 rupees. The high-ordeal devotees were substantially more generous, giving an average of 133 rupees, or two-thirds more than the low-ordeal group. More interesting still was the behavior of a third group of people, “high-ordeal observers”—people who had walked alongside the struggling high-ordeal followers but hadn’t suffered physical hardship themselves. They were even more generous, giving an average of 161 rupees (or 80% of everything they received for the survey).
The researchers concluded that perceived pain increases “prosociality,” or voluntary behavior to benefit others. They argued that extreme rituals—and specifically the shared experience of pain—can be seen as “social technology to bind in-groups together.”
Such extreme rituals are at the far end of a spectrum that has, at its opposite end, corporate ropes courses, which simulate danger in order to spark bonding within work teams. On the surface, these experiences seem markedly different: One is horrific and psychologically unbearable, and the other is a sacred religious ritual. What they share is struggle.
If a group of people develops a bond quickly, chances are its members have been struggling together. One study found that when strangers were asked to perform a painful task together—in one case, submerging their hands in tubs of ice water to perform a “sorting task”—they
felt a greater sense of bonding than did strangers who had performed the same task in room-temperature water. And this bonding happened even though the task was pointless! (Fraternity hazing is a good example of a pointless and painful bonding ritual.)
Imagine the bonding that emerges among people who struggle together at a task that means something: Activists fighting to protect a forest from clear-cutting. Start-up cofounders scrambling to meet the next payroll. Religious missionaries, in a distant part of the world, enduring daily rejection in the service of their faith.
What’s the practical lesson here? Should we foist hardship on our employees for the sake of creating defining moments? Not quite. But it’s worth observing that people will choose to struggle—not avoid it or resist it—if the right conditions are present. The conditions are: The work means something to them; they have some autonomy in carrying it out; and it’s their choice to participate or not.
Those are the conditions that Sharp honored in calling for volunteers to join “action teams” to improve the patient experience. The work was meaningful: serving patients better. The teams were given autonomy, often entrusted to formulate the health system’s policies in a certain domain. Participation was voluntary. And volunteer they did: 1,600 people came forward. A mass movement of people willing to struggle together.
If you want to be part of a group that bonds like cement, take on a really demanding task that’s deeply meaningful. All of you will remember it for the rest of your lives.
4.
To create moments of connection, we can bring people together for a synchronizing moment. We can invite them to share in a purposeful struggle. The final strategy centers on connecting them to a larger sense of meaning. In many organizations, our daily obligations—the emails, the meetings, the to-do lists—can numb us to the meaning of our work. And that sense of meaning can be the difference between a great performer and a mediocre one.
In his forthcoming book, Great at Work: How Top Performers Work Less and Achieve More, University of California, Berkeley professor Morten Hansen surveyed 5,000 employees and managers to understand the makeup of star performers. Among other findings, he discovered 17% of the employees “completely agreed” with this statement: “What I do at work makes a strong contribution to society, beyond making money.” These people with a strong sense of meaning tended to have the highest performance rankings by their bosses.
In his research, Hansen also explored the distinction between purpose and passion. Purpose is defined as the sense that you are contributing to others, that your work has broader meaning. Passion is the feeling of excitement or enthusiasm you have about your work. Hansen was curious which would have the greater effect on job performance.
He grouped employees into categories. For instance, people who were low on passion and low on purpose were ranked by their bosses on average at the 10th percentile of performance:
HIGH PURPOSE
LOW PURPOSE
HIGH PASSION
LOW PASSION
10th percentile
That’s lousy but not too surprising: If you are unenthusiastic about your job and feel it lacks meaning, you’re not likely to overachieve. The opposite was true as well. When people had high passion and high purpose, they were stars:
HIGH PURPOSE
LOW PURPOSE
HIGH PASSION
80th percentile
LOW PASSION
10th percentile
Again, pretty predictable. But what if employees were strong on only one trait: passion or purpose? Who would perform better, the passionate or the purposeful? Let’s start with the passionate:
HIGH PURPOSE
LOW PURPOSE
HIGH PASSION
80th percentile
20th percentile
LOW PASSION
10th percentile
That’s a shocking finding: People who were passionate about their jobs—who expressed high levels of excitement about their work—were still poor performers if they lacked a sense of purpose. And here’s the final piece of the puzzle:
HIGH PURPOSE
LOW PURPOSE
HIGH PASSION
80th percentile
20th percentile
LOW PASSION
64th percentile
10th percentile
The outcome is clear. Purpose trumps passion. Graduation speakers take note: The best advice is not “Pursue your passion!” It’s “Pursue your purpose!” (Even better, try to combine both.)
Passion is individualistic. It can energize us but also isolate us, because my passion isn’t yours. By contrast, purpose is something people can share. It can knit groups together.
How do you find purpose? Yale professor Amy Wrzesniewski, who studies how people make meaning of their work, said that many people believe they need to find their calling, as though it were a “magical entity that exists in the world waiting to be discovered.” She believes purpose isn’t discovered, it’s cultivated.
Organizational leaders should learn to cultivate purpose—to unite people who might otherwise drift in different directions, chasing different passions. Purpose can be cultivated in a moment of insight and connection. Consider a study of lifeguards conducted by Adam Grant of Wharton. At a community recreation center in the Midwest, Grant divided 32 paid lifeguards into two groups. The first group, the Personal Benefit Group, read four stories that described how other lifeguards had benefited, down the road, from the skills they acquired on the job. The second group, the Meaning Group, read four stories about other lifeguards rescuing drowning swimmers.
The difference between the two groups was striking. The Meaning Group of lifeguards voluntarily signed up for 43% more hours of work in the weeks following the intervention. The stories had increased their interest in the work.
Furthermore, the lifeguards’ supervisors, who did not know which set of stories the lifeguards had read, were asked to assess their “helping behavior” in the weeks that followed. Helping behaviors were defined as “actions taken voluntarily to benefit others.” The Meaning Group’s helping behavior increased by 21%. Meanwhile, there was no increase in helping behavior or hours worked by the Personal Benefit Group.
Keep in mind these differences in behavior were produced by nothing more dramatic than a 30-minute session, in which the lifeguards read four stories and talked about them. Truly a small-caps “defining moment.” But its impact was real. This intervention reflects a strategy we’ll call “connecting to meaning”—finding ways to remind people of their purpose.
Similar interventions in other domains have been effective as well. When radiologists were shown photos of the patients whose X-rays they were scanning, they increased both the raw number and the accuracy of their scans. When nurses, assembling surgical kits, met a caregiver who would use the kits, they worked 64% longer than a control group and made 15% fewer errors. Connecting to meaning matters.
Not all of us save lives or serve patients. Sometimes purpose can be less tangible. What’s the guiding “purpose” for the marketing collateral team or the server administrators or the benefits group in HR?
They all have a purpose, of course. Sometimes it’s useful to keep asking, “Why?” Why do you do what you do? It might take several “Whys” to reach the meaning. For instance, consider a hospital janitor:
• Why do you clean hospital rooms? “Because that’s what my boss tells me to do.”
• Why? “Because it keeps the rooms from getting dirty.”
• Why does that matter? “Because it makes the rooms more sanitary and more pleasant.”
• Why does that matter? “Because it keeps the patients healthy and happy.”
You know you’re finished when you reach the contribution. Who is the beneficiary of your work, and how are you contributing to them? The janitor is making a contribution to the health and happiness of patients. The marketing collateral team might be making a contribution to the confidence and success of the field sales team. The ben
efits staffers might be making a contribution to the financial security and peace of mind of their fellow employees.
When you understand the ultimate contribution you’re making, it allows you to transcend the task list. A hospital janitor’s task list, for instance, is pretty concrete: Sweep, mop, scrub, sanitize, repeat. But understanding the purpose of the work allows for innovation and improvisation. One hospital janitor studied by Amy Wrzesniewski made it a point to strike up small talk with any patient who seemed to crave conversation. The janitor had realized that many patients had no one to talk to. That’s purpose. “Combating patient loneliness” was not part of his task list, but it heightened the contribution he was making to patients’ health and happiness.
A sense of purpose seems to spark “above and beyond” behaviors. At Sharp, as we saw, once employees had been reconnected with the meaning of their work, they began to push beyond their job descriptions to create extraordinary moments for patients. One patient with cancer was undergoing her fifth or sixth trial of chemotherapy, but she was not responding. She wanted to throw her pregnant daughter-in-law a baby shower but knew she would never make it out of the hospital before the baby was born. So the staff arranged for her to throw the shower at the hospital. They reserved a nice jade garden for her and encouraged her to decorate and organize the space as she liked.
“One of the last memories that her daughter-in-law will have is that before her mother-in-law died, she gave her a baby shower that she had planned,” said Deborah Baehrens, manager of acute care at Sharp Memorial Hospital.
This was a remarkable moment for the patient, but imagine what it felt like for the staffers who made it happen. They came home that day feeling exhausted but fulfilled. We did something that mattered today.