Unconventional Leadership

by Nancy M Schlichting

  Set People Up to Be Their Best

  People want to succeed. My job as a leader is to create a culture where people can reach their full potential. In order to deliver on that, certain interconnected elements must be in place. Below, I offer a laundry list of things that I believe add up to this awesome ideal; in truth, the composition is more like that of a Rubik’s Cube or mosaic than a list. There is no particular order here—these items feed into each other to carve space for people to be their best.

  Say Yes

  Many people at Henry Ford know that my favorite word is yes. I think of myself as both a cheerleader and a positive enabler, and I work to enable the disrupters as well as the everyday innovators. Whether we are talking about investing in leading-edge robotic operating rooms or using 3-D printing to design patient-perfect heart valves, I believe that individuals need room to build whatever they are most passionate about. And it is not just major innovations that need a runway for takeoff. Many of the small wins we scored during our turnaround came from employees. That makes “yes” the most important word in my vocabulary.

  Saying yes and relinquishing control requires a leap of faith. For example, a nurse in our dialysis center—an artist—came forward to her manager with an idea to paint her own colorful cartoons on the disposable hospital gowns worn by staff—that was an easy yes–our leaders know that is what I would say! People loved bringing art into the clinic and it cost us next to nothing. Now she does it every day and we use the gowns elsewhere in the system as well. The staff can’t wait to see what she draws, and the gesture delights patients. It’s reflexive to say no when an idea is off center, unusual, or expensive, but part of my job is reduce the risks of trying new things by being open to them. After all, people seldom come back twice with an idea. If a leader turns them away they aren’t going to step up again. Supporting people’s work (and dreams) is an important part of providing them with what they need to remain engaged and performing at their peak.

  Be Apolitical

  Many people consider political maneuvering to be an inherent part of organizational life. Forming coalitions, playing favorites, and doing backroom deals is a means for gaining support and getting things done. Some leaders even go so far as to encourage internal competition as a way to keep people on their toes. However, I work intentionally not to do that. I don’t actively engage in or encourage politics. I don’t wine and dine key board members in order to garner support for a proposal or plan. I take people to dinner to get to know them or to thank them for their effort, but I don’t entertain unless it’s authentic—something I want to do, not for personal gain.

  More importantly, I don’t play favorites. People can’t be their best if they need to worry about “sucking up to the boss” or aligning themselves with the winning side. When I ask a question, I want an honest answer—not a political one. To me, avoiding politics means that I treat every person in the organization in the same way. One of our doctors said to me: “Nancy, I appreciate that you have equanimitas.” That is exactly what I am trying to do and I believe that it sets the right tone for the rest of the organization.

  Create a “Safe” Environment

  I am not referring to hospital safety, but instead to an environment that is prepared for honesty, the free flow of ideas, and, more than anything else, a robust dialogue about mistakes that occur.

  Years ago, when I was at Riverside Methodist in Columbus, Ohio, a chief nursing officer told me that he was firing the nurses who made mistakes. He wanted to run a tight ship, send the right signal, and so forth. I thought, “Oh great, you’re creating a culture where no one will come forward and tell us when an error occurs.” There is no perfect environment in health care, or anywhere else, just as there are no perfect people. When you’re dealing with hundreds or thousands of individuals delivering care each day, all with their own human frailties and challenges, you need an environment where people feel comfortable reporting problems and mistakes. From what I’ve seen, there are, unfortunately, many hospitals that vastly underreport problems. The minute I see “no problems” reported, that is when I know there’s a problem. It means people are not speaking up.

  In addition to tracking and correcting the errors human beings inevitably make, you need to consider that the system or procedure may be the problem. People sometimes make mistakes, not because of their own ill intent but because a poor process creates space for mistakes. Without honesty and accurate reporting by individuals, there’s no way to know when a process is broken.

  Get Buy-In from Staff

  Getting twenty-three thousand employees, physicians, and additional volunteers on the same page is critical. At the end of the day, my job comes down to guiding everyone’s efforts in a common direction. To do that, goals need to be clearly communicated, and they need to resonate broadly. We’ve made some big bets on projects and investments in recent years: we built the expansive West Bloomfield health and wellness facility, invested over $300 million in the Henry Ford Hospital campus, built an outpatient center in our downriver market, and invested $350 million in a new electronic medical health and records system. If people at Henry Ford did not feel connected to these priorities, it would have been impossible to see these special projects through while running day-to-day operations.

  In almost every case, we made these projects system-wide priorities that everyone could support. For instance, as we built the West Bloomfield center we set up a warehouse complete with mock operating rooms, emergency rooms, and patient rooms. We encouraged patients, family members of patients, physicians, nurses, and support staff to come in and critique them—and thousands did. They told us what they liked and disliked, and how we could do better. When you get people involved and invested they think: “Okay, I’m a part of this.” In our case, it wasn’t just the West Bloomfield team that felt a strong sense of ownership—the entire system owned that project. The same was true during our recent IT installation. We rolled it out all across the system and had leaders from each hospital helping the others. When you’re setting big priorities, it’s vital to give people ways to engage even beyond their own business units.

  I’ve been in work environments where each group owned their own projects and everyone else heard about it secondhand. As a result, people resented investments made in other parts of the organization. I’ve learned to be clear about the priorities and why they are important. Part of making this work involves answering the why questions: Why are we putting the money into this? Why does it strengthen our position in the marketplace? Why is this helping us?

  If people understand the larger context, it’s easier for them to buy in. With that idea in mind, we include our communication team in the planning and execution of every new strategy. We use multiple channels in the rollout because we know that not everyone reads the employee newsletter or looks at the e-mail exchanges or participates in social media. I get personally involved and we mix it up in terms of our communication channels: I do videos, blog posts, and town hall meetings. I’ve got an interview technique for our vodcast, where I bring leaders in, and we sit down and talk about an initiative. People see the ideas exchanged in a more interactive and interesting format.

  Take Training and Development Seriously

  The last über agenda item for setting people up to be their best is creating training opportunities. Typically, training is the first place most organizations cut when they are strapped for cash. But we’ve always maintained funding for training programs, regardless of any ebb and flow in our overall financial performance. This is a fundamental way that we demonstrate a commitment to our people. We’ve never pulled back on employee development, leadership development, professional training, or availability of courses in Henry Ford Health System University. This includes making mentoring a priority for everyone. I have had a number of amazing mentors who helped me throughout my career, and I am always mentoring multiple people in the organization. I expect the same from every other leader.

  As a result,
there are so many examples of people who started their careers in housekeeping or dietary but who are now nurses or leaders in the organization. Training and development fosters loyalty and keeps people engaged and growing.

  Setting People Up to Succeed

  Setting people up to succeed is a big job. I have touched on some of my priorities above, but following is a longer list, from the Gallup Q12 survey that we use at HFHS, comprised of success factors that I believe can make a real difference.

  An employee . . .

  Knows what is expected of them at work

  Has the materials and equipment needed to do their work right

  Has the opportunity to do what they do best every day

  Receives recognition or praise for doing good work at least once a week

  Perceives that their supervisor, or someone at work, cares about them as a person

  Perceives that someone at work encourages their development

  Perceives that their opinions seem to count at work

  Understands how the mission or purpose of the company makes them feel their job is important

  Observes their associates or fellow employees being committed to doing quality work

  Has someone talk to them about their progress at least twice a year

  Has had an opportunity within the past year at work to learn and grow

  Inspire People

  People need to feel inspired in order to be at their best in a pressure-cooker environment like the one we experience in health care, or myriad other high-stress industries. The three ways that I think about inspiring and being inspired are through leadership, philanthropy, and aesthetics.

  As a leader, I know that my actions have a direct and immediate impact on people across the organization. There is a ripple effect that occurs based on my words and actions. Every leader knows that “bad leadership” is the number-one reason people leave their jobs to work elsewhere. Such moves have little to do with financial compensation—people want to be inspired.

  There are a lot of ways that I try to inspire confidence and high performance, but one thing that I feel is especially important is to take every person seriously. This is something that became apparent to me when I was twelve. I was in eighth grade when I started writing to colleges. My sister was getting ready to go away to school so I took the opportunity to think about my own future and express my interest. I wrote to a number of schools but the only one that responded was Duke University. And guess where I went to school when the time arrived? Yes, Duke University. Why? Because they took me seriously.

  Giving proper weight to people’s ideas and concerns is just one of the many ways that I as a leader try to inspire people to be their best. Offering opportunities for philanthropy and volunteerism is another way. This is particularly true in an organization such as Henry Ford, where our strong connection to the city of Detroit defines us and sets us apart. Philanthropy, then, is one of our core activities and it is part of what sustains our business. As part of our mission to give back to the city, we have a number of campaigns through which employees donate their time and money. Leaders across the company are expected to step up—and they do so wholeheartedly in order to set the right example for everyone else.

  The numerous ways in which we give back to the community are a key part of what draws people to work here. And many of our charitable and philanthropic programs are noteworthy: we have school-based health clinics across Detroit, for example, together with mobile vans that deliver preventive care and medical treatments to kids and families. Employees and physicians take a lot of pride in these programs, as well as in the many other ways we engage the community. We have a Community Giving Campaign that routinely raises over $3 million each year for HFHS, United Way, and Black United Fund, with 60 percent participation by employees and physicians—number one in the country. We also endorse special campaigns that encourage all employees to generously support charitable causes in the community to the best of their ability, from the American Heart Association Heart Walk to walks for the American Diabetes Association and the National Kidney Foundation. I view these philanthropic initiatives as ways to build community partnerships and employee engagement. As a result, we have thousands of HFHS walkers at our events. One example that stands out is our commitment to the local Heart Walk; over 11 years, we raised nearly $4 million, and were recognized almost annually for raising more than any other health system in the country and often more than any company. This kind of achievement happens because people really believe in what we are doing, it aligns with their values, and they find a sense of joy and purpose in helping others. That’s inspiring.

  The final way I believe it is possible to inspire people is through the healing arts. When I started as CEO at Henry Ford Hospital, our chair of surgery, Dr. Scott Dulchavsky, took me on a tour of Detroit Receiving Hospital. I recall that it had one of the most spectacular art collections I had ever seen. I remembered art displayed prominently at other institutions I had worked at as well, from Memorial Sloan Kettering in New York to Duke University Hospital, but Henry Ford Health System had next to nothing at the time. I saw that as an opportunity to do better. Together, Scott and I began working on a process to bring a few signature pieces to Henry Ford Hospital. We met with local artists. We started a board philanthropic fund to support the healing arts. We worked with the Detroit Institute of Art to secure art on loan. We’ve even worked with the Detroit Symphony to bring music into Henry Ford.

  This is something that’s near and dear to me because I am personally inspired by the arts. Based on the feedback I’ve received from employees and patients, I’m not alone. The art we have on display now across the health system and the music we’ve brought in for our staff, patients, and guests is just beautiful, and their mere presence creates a better atmosphere. It has really transformed the environment for delivering and receiving health care.

  Make It Personal

  When my mother met someone, she would forever remember the person’s name. She had perfect recall about what people told her concerning their family and personal interests. She would ask questions and really, truly listen to the answers. It was her way of connecting with people, and I have made it my way. It is more conventional in a large health-care setting, and far easier, to default to an institutional feel, and surrender to a big-company culture where people fend for themselves. There are so many regulations and guidelines to attend to on a daily basis. New patients come and go constantly. Employees and physicians have technical specialties that can make personal communication difficult. But you have to combat an uncaring culture by forging an authentic personal connection with people. There is simply no better means for establishing a cohesive and loyal workforce than by connecting with people personally.

  I do this, in part, by being fully present. The long and short of it is that I talk to everyone. I have gotten to know many, many employees by name, and people approach me with relative ease. When I walk down a hall, employees at all levels and pay grades stop to chat with me. This is true for security guards, nurse’s aides, and cashiers, as well as our busiest physicians. Doctors, like everyone else, want to be loved and respected for the crucial work they do. Therefore, I talk to doctors—all the time—and they tell me what’s on their minds. I take what they tell me to heart and I constantly cultivate those relationships.

  By being fully present and easily accessible, leaders touch people in ways that they often don’t fully understand. To me, being accessible means making it easy for people to reach out to me. Everyone knows my e-mail address because it is the shortest one in the organization. I also started a blog not too long ago, and it has become interactive. In the blog, we ask people to give us their stories or ideas on particular topics. This serves to encourage a give-and-take dialogue.

  I connect with people, as well, by personally recognizing their contributions. We have numerous awards and employee recognition events that have endured over many decades and I attend them all. My personal favorite is
the annual dinner in honor of employees who have been with the organization for fifteen or more years. (We recognize individuals every five years, all the way up to fifty-plus!) Despite cost-cutting measures and organizational changes that have occurred through the years, we always make this a major event. If needed, I would pay for the night myself—that’s how much it means to employees and their families.

  The other recognition program I’ll mention is one that I created at Akron City Hospital called SuggestQuest, which challenged people to step up with ideas to make things better. Over the years, we delivered some big financial awards to clinical teams and individuals who proposed improvements that either saved money for the hospital or enhanced the patient experience. And we made a big deal out of these awards—with the whole team, myself included, gathering around to present the prize. This might seem insignificant in an environment where lives are on the line, but I can tell you that it makes an impression on people when the COO walks up with balloons in her hand to make a personal presentation. It is well-deserved recognition delivered with a personal touch. It not only rewards innovation but it also encourages people to perform better when the pressure is on.

  Part of the success of “making it personal” is a willingness to really listen to staff. That may mean reversing a decision that negatively impacts them, something that a lot of leaders refuse to do. Fairly recently, we announced the closing of our child-care center. It was losing $300,000 a year and we only had twenty-two employees with children enrolled. It turned out that the employees who used it really needed it in order to work their shift. The issue went viral and there was a mini uprising. We addressed the situation as a team and we were able to turn it into something positive. Now, the employees who are most affected are helping us with marketing strategies and we’re working together to recruit new families and keep the center open without health system funding. What I heard after we backed off on closing the center was that people felt heard. Child care is a major issue for parents. It’s personal. Reversing a decision and thinking through new options requires effort and sacrifice; in cases like this it goes a long way toward creating an environment where people feel that their personal needs are being met.