Unconventional Leadership

by Nancy M Schlichting

  My job is to be an enabler of innovation, and I am proud of what we’ve accomplished. Almost anyone will tell you that “yes” is my favorite (and customary) response when someone comes to me with a new idea. I have engaged the board for funding on numerous occasions, and I don’t mind sticking my neck out. And I take it as a good sign that I don’t know everything that is going on here from an innovation standpoint. Sometimes I kid that I’ve lost all control of the organization because we are constantly developing so much that is new. One day in the cafeteria, for example, a woman came up to me to introduce a new employee. I said, “Well, where are you from?” She had moved here from Seattle to join our Global Health Initiative. I said to her, “I didn’t know we had a Global Health Initiative.”

  Now I know that the program focuses on improving health care for underserved populations in places such as India, Peru, and Haiti. It has grown since that first conversation and I have learned much more about it. (For instance, we bring the best practices that we establish abroad back to Detroit to eliminate health-care disparity here.) But at the time, the initiative had acquired its own funding and proceeded without me knowing about it at all.

  One of the key drivers that keeps innovation flowing for us is that we don’t overanalyze and over manage it. Creative individuals need room to breathe. I put myself in that category, which is why I tend to identify with people who don’t always follow the traditional path. I believe in trusting my instincts, attracting talented people, and giving them the structure and support—and sometimes the space—to do what they do best.

  One of the things that I know about culture is that it can change on a dime. You have to manage it constantly. You cannot assume innovation will flourish simply because it has for decades. You have to always cultivate that culture. You have to continue to attract leaders who are going to carry on and provide the flexibility that allows employees to be entrepreneurial. Entrepreneurship can get swallowed up in a large organization. At a large health system like ours, it has to be part of our values. Learning and continuous improvement are also core values for us, and they reinforce innovation. When we are firing on all cylinders creativity emanates from everybody here—we are all trying to do a better job each day. I try very hard to enable that perfect condition. When it comes to innovation, my customary response has always been “Yes.”

  CHAPTER FIVE

  Make a Large Company Feel Small

  One’s own workers ought to be one’s own best customers.

  —Henry Ford

  When I first arrived at Henry Ford, the head of human resources carried a small notebook. He brought it with him to meetings and kept it out on his desk. On the cover in black lettering it read: “Head Count.” I was the only one who was appalled by this convention. Everyone else was accustomed to the notebook and phrase. It was common management parlance but it stuck in my craw like nothing else. I remember saying to him in a serious tone, “I don’t ever want to hear that term again when we’re talking about people.” To me, the term head count refers to cattle or sheep. Maybe to chickens. But not ever to people. People are not interchangeable, and they are so much more than a number.

  I thought that was the end of it—but it wasn’t quite. I hired a new head of HR, who came over from Chrysler, and guess what? She started talking about head count. I said to her, “Kathy, we’re talking about people here. That is not a phrase I have any interest in using in this organization.” I never heard it again.

  Now, obviously, I am a stickler about this. Yet, it is surprising to me that my perspective is unconventional—although I have found that it is. Organizations are forever focusing on many things at once—numbers, strategy, competition—and they forget that people are their foremost competitive advantage and responsibility. This is something that is ingrained in me and it has been the centerpiece of my leadership style from the beginning of my career. “People first” is my mantra, just as it was during the turnaround at Henry Ford and all through the Baldrige journey. HFHS is made up of twenty-three thousand individuals who are the caregivers, innovators, scientists, teachers, support staff, and leaders. Without them this organization would be devoid of character and, literally, empty.

  Perhaps being in health care has colored my perspective more than if I were at the helm of a manufacturing company. After all, our service is caring for the sick. Without fundamental people skills, none of us in health care can be truly superb at what we do. That’s where “people first” comes in—I believe that my job is to foster an organization that cares for the caregivers. It’s one of the things that differentiates us from other health systems. Today, because of the work we’ve done, it’s rare to find an employee at Henry Ford who isn’t engaged in a positive way about creating a “people first” culture.

  Henry Ford himself may have been more of a pragmatist than I am—I’m not entirely sure—but I do know that he stepped up and acted in ways that are relevant to creating a people-centered approach. First, of course, was offering the $5-per-day wage that helped establish the American middle class. That innovation stemmed the high turnover that so concerned Ford and expanded the market for Ford automobiles, even as it provided workers with a fair wage. Second, he paid considerable attention to the health and well-being of his employees when he built Henry Ford Hospital. He banned smoking by employees at the hospital, for example, which was a risky and unheard-of restriction at a time when smoking was ubiquitous.1 He also built a beautiful solarium so people could benefit from the light and fresh air. And if you talk to the historians here, or to the Ford family, they will tell you that he created a culture where people felt like they were part of the family. Finally, Henry Ford Hospital was conceived with the common man in mind. Ford wanted to make sure that his autoworkers, the people who represented the working class, were able to access high-quality health care.

  I am not asserting that Ford was a humanist, because there would be plenty of ways to refute that. What I am saying is that something about his worldview, which was unique in his time, is enormously appealing to me, namely, the idea that we need to take care of the workers in our community as well as those within our organization. If we do, they will be in a better position to pay it forward as they take care of others. Our vision at HFHS is to transform lives and communities through health and wellness—one person at a time. To me, that means putting systems into place to take care of the people in the organization. As Henry Ford knew, that is as good for organizational performance as it is for individual people.

  Henry Ford’s example was not the sole thing that fueled my passion for putting people first. When I was completing my administrative fellowship I remember running into Sam Tibbetts, the chair of the American Hospital Association. He asked me, “Nancy, why are you in this field?” I came up with a fast answer about why I was interested in health care personally and so on. His response to me was, “You know, Nancy, health care is all about people.” We talked for a while and I have never forgotten that formative conversation. It has guided me. Health-care professionals care for individuals in anxious, life-threatening situations and at the most desperate of moments. Their work affects people’s lives. That fact impacts caregivers as well as patients. It is easy to come in to work at the hospital, get into a routine, and think of the job as normal. However, it is never really normal. When it comes to creating high-quality care across the health system, it’s very clear to me that the way we take care of our employees connects directly to the way they take care of patients and their families. That idea is at the core of everything I do, and I am grateful that it came to me early on.

  My philosophy, which informs my work at HFHS and at other systems and hospitals, bubbles up in five ways, which I will elaborate on here because they come together to provide an actionable framework for putting people first.

  Treat doctors like housekeepers: with enormous dignity and respect

  Care for the caregivers

  Set people up to be their best

  Inspire people />
  Make it personal

  Treat Doctors Like Housekeepers: With Enormous Dignity and Respect

  My parents were living in Lynchburg, Virginia, during my college years, so I spent one summer as a rotating intern at Lynchburg General Hospital. I worked in numerous departments doing frontline jobs, which helped to inform my understanding of—and empathy for—the challenging situations our staff are faced with every day. I was an ER clerk, a billing clerk, a human resources assistant, and so on. During my time there, when I was twenty years old, a prisoner walked up in shackles. I was the ER clerk and I remember registering the man. I was extremely nervous and trying to act normal, but my hands were shaking ever so slightly. These are the moments that stick with you. After that, when I finished college, I worked in a Florida hospital as a unit assistant, which was basically a combination of unit secretary and nurse aid. It was a minimum wage job that paid $3.50 an hour. I also worked as a switchboard operator on the weekends to make a little extra money. Both of these positions gave me more insight into the operations of a hospital than I could ever have realized at the time. I recall my time at Imperial Point Hospital in Fort Lauderdale vividly, not only because I learned so much so quickly, but also because it was the first time I saw a patient die in the ICU. I still remember his name.

  Those experiences, as well as others, make me appreciate every person I have ever worked with in health care. But even more than appreciation, I developed a strong respect. That is what my “people first” focus is built on—respect. From what I’ve seen, there are very few people high up in the executive ranks of heath care who have been minimum wage workers in the industry. I think my earliest experiences in health care are at the core of the way I look at the world. When I was at the lowest rung, even with a college degree, I realized that every job is important and each one is difficult. The result is that I have respect for people, regardless of their title or job description. I tend to express that idea in this way: treat doctors like housekeepers—with incredible dignity and respect.

  If you are consistent in your style of leadership, and are respectful of everyone; if you take the high road and constantly answer the “why” questions; if you treat people like adults, not children, and look them in the eye, you can avoid a lot of the bureaucracy and politics inherent in large organizations. This approach allows you to get to the heart of the matter—that organizations depend entirely on their people and vice versa.

  What’s more, respect is less about what you say and more about what you do. The most difficult times to put this into practice, for me, have been when performance is down and jobs are being eliminated. Looking people in the eye and talking them through the situation honestly is one way to show respect. If they are losing their job, explain why and tell them what is going to happen and when. Tell them about the supports that are in place for them and show some empathy. Another way to show respect is by fighting to protect as many jobs as you can. That can be very risky for any leader but it puts people above everything else. At Henry Ford, we made the difficult decision to close the Warren campus of our Henry Ford Macomb Hospital in early 2012, which could have meant layoffs for seven hundred people. That would have been the simplest way to handle the problem and was a logical plan. Instead, I was able to rally support to freeze job openings so that the displaced people could transition into open jobs across the system, as qualified.

  I remember getting into a big debate with several of my colleagues. Our head of HR, who also happens to be a friend of mine, called me about the plan and said, “Nancy, I’m not sure we can do what you’re asking us to do.” I said, “Yes, we can. But we have to really want to do it. It’s a lot more work but we can’t lay these people off.” In the end, the executive team agreed it was the right thing to do. We were in the midst of terrible regional unemployment. Many of our employees had spouses who were out of work. Putting more people on the street would have been devastating.

  It took a tremendous amount of support from leaders across the system and considerable trust from the employees affected. In the end, however, every person who wanted to remain at HFHS was placed in a job. This kind of conviction and difficult decision making (Warren was one of three hospitals we closed over a fifteen-year period), combined with efforts to do the right thing for employees, shows how we put people first in the toughest of times.

  Every business decision has a people component. Respecting each individual means minimizing the negative impact on those working within the organization. We are not in a production assembly line like Henry Ford’s, making cars. We take care of people. Every job in health care is critically important. Sometimes a housekeeper comes into patients’ rooms and interacts with them, and sometimes the front-desk clerk creates that first impression—in many ways these staff members are as critical as the physician performing the surgery. Every interaction counts and every person makes a difference.

  Care for the Caregivers

  When I talk about people, I’m referring to employees and physicians, as well as our patients and other customers—but I always start internally because it is so important that we care for the people who take care of others. The jobs that physicians and other employees do are not only high on the difficulty scale, as I’ve said, but they are also stressful, emotionally draining, and physically demanding. It’s hard for caregivers to do this work in a positive way every single day when they’re dealing with so much complexity of emotion.

  With caregivers in mind, I knew as part of our No Harm Campaign we needed to look beyond patient care and strengthen the safety standards for the people working here. Employees in the health-care field are, after all, at risk for a wide range of hazards including back injuries caused by lifting patients, assorted sprains and strains, and dangerous infections, such as HIV and hepatitis, caused by accidental needle sticks. In addition, workplace violence is a major concern, as is depression induced by the high-stress environment. Many nurses and doctors go home at night worrying about their patients. They wonder, “Did I make a mistake? Did I make the right call?” It’s important that we create an environment where people can do and feel their best. In this case, putting people first means creating systems to care for the health and well-being of caregivers.

  As part of this effort, we focused first on encouraging self-reporting of injuries. We’ve long had access to worker’s compensation information, but we didn’t have much additional data. So, our head of human resources created a campaign that encouraged employees to report illness and injury. We added educational highlights in newsletters and e-news, developed an injury dashboard, and appointed a system safety officer to align safety functions to include employee harm. We also developed a workplace violence steering committee and a related internal crisis team to respond to emerging situations. As a result of our efforts to increase incident reporting for employee safety events, we achieved a 67 percent increase while decreasing actual harm events.

  We also needed to find evidence-based ways to measure and respond to reporting by employees. Therefore, surveys and metrics guide our efforts to move the needle. For example, we mined the data and found that employee injuries from sharp instruments decreased by 14 percent in 2009. In addition, we saw a further 30 percent decrease in 2011.

  Operational design is another critical tool for improving employee safety. In 2011, for example, we integrated five employee health clinics under one umbrella to increase efficiency, create consistency and standardization across the system, and promote access to care for employees. “Employee safety” became aligned with “employee health” efforts in 2011 to enable a more proactive and preventive approach with an intent to increase near-miss reporting while reducing injuries. Other efforts included developing mandatory education modules for employees and partnering with the public relations group to provide safety education.

  A related way we care for our caregivers’ well-being is by promoting work–life balance. Seventy-six percent of our employees are women, and many of them are mothers
of young children. Others, including men, are often caring for a sick spouse, a disabled child, or an aging parent at home and then they come in during their shift to provide care for patients. Work–life balance is different for each person, of course, so we train managers and leaders to encourage employees to take care of themselves. As part of that, we teach “AIDET + 1” to all of our caregivers and have extended the training to apply to other employees. AIDET is a standard way of introducing oneself to a patient. The “+1” is about mindfulness of self and team. We teach staff to acknowledge that they have a lot going on in their lives and need to help and support one another. Part of the “+1” is focusing on building teamwork in units and departments and communicating with each other by first getting to know the “backstory” of the people on their team. Getting to know and understand each other helps us improve how we care for patients.

  Finally, an important part of taking care of one’s self is spending time with family or friends. I remind people to prioritize important occasions in their personal lives. Whether it’s a special event at their child’s school or even an important soccer game—they should be there. I badger them, as well, to take all of their vacation. Some leaders work long hours in order to make themselves seem indispensable—so much so that they don’t take time off, let alone encourage others to do so. I’ve never fallen into that trap. I believe that it is important to be refreshed, spend time with family, and have a life outside of work. When people come back after taking time off, they’re ten times stronger. I set a positive example by using all of my vacation and by encouraging physicians and employees to do the same.