If you work with people, work on culture

In my current role as a patient experience leader for a health care system, a large part of my focus is on culture. If you are already familiar with this blog, you have already seen me discuss culture a lot in the context of leadership and in book reviews. I talk so much about culture because it is what makes systems and processes work reliably and without constant auditing.

For years, I have been working to put the pieces together in terms of how to build culture. Using ideas from authors like Simon Sinek, Malcolm Gladwell, Joseph Michelli, and Adam Grant (to name a few), I have created my own definition of leadership and have advocated for articulating a vision and creating systems and processes to bring that vision to life. However putting the pieces together both from research and experience, has at times has felt like a struggle.

Culture CodeThen along comes Daniel Coyle, author of the best-selling book The Culture Code. In this book, Coyle has compiled a clear and well explained definition around the common characteristics of organizations with exceptional cultures that lead to consistently excellent outcomes. Using examples from organizations like Pixar, the San Antonio Spurs, the famous Upright Citizens Brigade improv group, and Navy SEALs, Coyle shows us what these organizations do differently that allows them to deliver results for the enterprise and its people.

The three over-arching characteristics that every group has in common are:

  1. Build Safety
  2. Share Vulnerability
  3. Establish Purpose

Under each of these simple two-word ideas are many different anecdotes, research studies, and case studies that show not only what these concepts mean, but what building them entails for leaders.

He also delves into the nuances of these concepts that may vary depending on the business. For example, in the book he compares organizations that build a culture for high service reliability (Union Square Hospitality Group – think Shake Shack) vs. creativity and innovation (Pixar).

Health care service delivery is an example of a setting where the culture must be built for high service reliability. Much of this work involves creating genuine connections with patients and their families, which helps determine how to meet their needs both including bridging the gaps in their understanding of their condition, the treatment, the workings of a hospital, and the health care system at-large.

Coyle covers the impact of empathizing with the patients in order to the increase their health outcomes and covers how to create an environment for the staff that promotes empathic behavior.

In the book, Coyle discusses a Harvard neurologist named Marci who researched the impact of listening in the medical setting. She studied non-western healers who used methods that were scientifically questionable, yet found that some practitioners had remarkable results.

To explain these outcomes, she says, “What these healers all had in common was that they were brilliant listeners. They would sit down, take a long patient history, and really get to know their patients…They were all incredibly empathic people who were really good at connecting with people and forming trusting bonds. So that’s when I realized that the interesting part wasn’t the healing but the listening and the relationship being formed. That’s what we needed to study” (Coyle p.154).

In health care, we tend to think of communication as “provider to patient”, with the patient simply answering the provider’s questions. As I take a few steps back think about it, wouldn’t someone want to feel known as a person, and not just by a diagnosis? Just listening to the patient gives the provider an opportunity to create that relationship.

Culture in the health care setting, because of the nature of the work at times being life-or-death, is especially important. Guides like The Culture Code help us build those cultures in a safe and sustainable way.

KEY TAKEAWAY: The best companies are deliberate about building their cultures. In health care, specifically, culture can deliver superior patient outcomes if there’s a focus on the caregivers and seeing the patient as a person, rather than a diagnosis.

The Culture Code is available for purchase on Amazon for $28.00 (does not include Prime discount)

A Snowball in June

The Institute for HealthCare Improvement (IHI) is one of the preeminent think-tanks in the healthcare industry today. The IHI created and coined the term “triple aim” which is a framework around how to reform the healthcare system in the United States.

The triple aim states that healthcare in the United States should evolve to:

  • Improve the patient experience of care
  • Improve the health of populations
  • Reduce the per capita cost of healthcare

So according to this idea, the industry needs to get much better at its core work of improving patient health and experience while reducing cost. How do we do better without more investment and spending?

The answer is that this question relies on the premise that healthcare in the United States is already optimized from an operations and cost perspective. In reality, it is far from it. As a country, our healthcare costs are among the highest and our outcomes are in the middle of the pack. We can and should do better, but it must be done through creative thinking and approaches that find ways to do more with less.

I gave a speech in 2016 when I was chair of the Committee for Montgomery about this kind of thinking as it applies to state and local governments who face similar challenges around how to do more without spending more money*.

In the speech, I tell a story about my father using creative thinking to stop a bully from beating up his younger brother (my Uncle Todd z”l).

Watch the speech to Committee for Montgomery here:

Creative thinking, design thinking, and innovation are what will save healthcare in the future. This type of innovation is currently happening in other places in the world, like in India as well as here in the United States. We are reading now about mergers between retail and insurance companies and new models of patient care with the new JPMorgan-Berkshire Hathaway – Amazon initiative led by Atul Gawande. These new models could be rungs on the ladder to reach the triple aim depending on how they approach their work.

But, we need to do more. As an industry, we are still big and slow. In other industries, like tech, companies have departments reserved for disruption and innovation. These “skunk work” groups gather people from various sectors, industries, occupations, and nationalities to work on the “next thing”. In healthcare, many companies have rested on their laurels and rode out the current system. Those days are no more.

One possible positive example of progress in this area is with Florida Hospital in Orlando, FL. Recently, they shed some light on a secret project they are working on called “Project Fulcrum”. This area of the company is designed to disrupt, which will ultimately help Florida Hospital thrive as the environment changes.

More healthcare systems should be using outside-the-box thinking, in a “formal” department with authority, resources and the ability to test their ideas within their companies and work with partners. Only through this work will the industry deliver on the promise of the triple aim.

KEY TAKEAWAY: To achieve the triple aim, the healthcare industry needs to be deliberate and strategic in investing time and energy around innovation. Simply expecting a company will be able to adopt to a new environment when it arrives is not a viable strategy.

*Innovative approaches to budgeting in state and local governments is not the topic of this post. However, there are some in the public sector that are achieving the aims of better outcomes at lower costs. I was privileged to hear from leaders from the City of Fort Collins, Colorado who won the Malcolm Baldrige National Quality Award. I was thoroughly impressed with their budget process that helps to achieve these goals. I encourage you to read more about it by clicking this link.

Oreo, Omaha. Icing, Pittsburgh. Ready? Go!

I hope you enjoy this special, Thanksgiving day, blog post!

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The challenge: You have 20 minutes to advocate for, explain, and practice a brand new way of doing an activity. After that, you will engage competitively with another group for an hour. The goal is to win.

Every year, I face this challenge at the Paul Blank Invitational Football Game (otherwise known as PBI). The PBI is an annual tradition, where alumni from my high school get together to play football on Thanksgiving. What started out modestly as a backyard game, has evolved considerably to include a live scoreboard, a DJ, professional photographer, national anthem singer, and halftime entertainment. Most importantly, the game has raised thousands of dollars over the years for a local charity.

Preparation has become quite serious too and the challenge gets harder every year we age, for obvious athletic reasons.

Frustrated by the disorganization of the play-calling, the lack of a general game plan, and limited playing opportunities, I took it upon myself to design a system that would help our team communicate quickly and simply. I spoke to friends of mine who had played football on the D1 college-level and watched YouTube videos like this one:

What I found was that teams created short-hand, coded systems that communicated a great deal of information in a short amount of time. I thought it would be best to do the same, limiting time to huddle where much time was wasted on the field, not to mention how teams would usually get delay-of-game penalties in their first few drives due to their lack of organization and having worked together as a team before.

The system I put together went like this:

We will use the same formation on every play:

    • 5 offensive linemen
    • 2 wide receivers on each side of the field
    • 1 running back who would line up next to the quarterback
    • 1 quarterback
  • We would not huddle. The quarterback would call plays from the line using the following system:
    • For pass plays:
      • When the outside receivers heard the word “Oreo”, that would be their queue. The word to follow would tell them what type of passing route to run.
      • Routes were coded by the first letter of the name of a city.
        • For example: “Seattle” would mean run a slant route because the city name and the pattern name both start with the letter “s”
      • When the inside receivers heard the word “Icing”, that would be their queue. The word to follow would tell them what type of passing route to run.
      • To give an assignment to the running back: the quarterback would simply whisper to the running back either “block” or would tell them what kind of route to run.
    • For running plays:
      • Saying a word that started with the letter “R” like “Rudy” would mean a run to the right.
      • Saying a word that started with the letter “M” like “Martian” would mean a run to the middle.
      • Saying a word that started with the letter “L” like “Lucy” would mean a run to the left.

Not to put too fine a point on it, but using this system, we won games two years in a row by the scores of 33-20 and 54-12.

Here’s a look at the play sheet I put together for the system we created (Player Names Redacted):


Other than re-living a brief moment of schoolyard-football glory, the point of the story is that we had success because we had a simple game-plan that allowed everybody on the team to understand and participate.

As leaders, we have a responsibility to create a system, context, the environment, and processes to empower our teams to understand what we are trying to accomplish and participate in helping to reach that goal. To do that work, I have found success not in micro-managing or overly prescribing check-lists or processes designed by people who are not customer-facing.

Instead, everyone on the team, or in the organization, must truly believe that they are essential and required partners to accomplished shared organizational goals. That work can be done through simplifying the objective and empowering people to accomplish it. The framework here was “Oreo, Omaha. Icing, Pittsburgh”, but the variations of occasionally huddling or sending a receiver in motion were the way the players on the field made it their own.

The results speak for themselves.

Happy Thanksgiving and thank you for reading!

KEY TAKEAWAY: Leadership is not as simple as having a title and giving directives. Getting the whole team passionately moving towards a common goal requires giving them a simple game-plan that they can understand, contribute to, and help achieve. Leaders are responsible for creating an environment of partnership with staff to achieve large scale organizational goals.

Design Thinking in Health Care

man wearing black and white stripe shirt looking at white printer papers on the wall

Photo by Startup Stock Photos on Pexels.com


Design thinking describes the empathetic development process for a new product or service. Design thinking is user-focused and includes important time for observing how people interact in the environment where the product or service will be launched.

To understand design thinking and the empathic process used to develop new products, there are a few really good resources on the internet. The most well known pioneer in design thinking is David Kelley, who was a close friend of Apple founder Steve Jobs and developed the first computer mouse. Kelley founded a company called IDEO, which takes on clients who want to develop a better product or service.

Kelley has been featured on national broadcasts regarding IDEO and design thinking. In this interview with Charlie Rose, he explains how it works and talks about his relationship with Steve Jobs:

IDEO was featured on 60-minutes for their work helping to redesign the grocery cart using design thinking. The video is a good high-level overview of the process. How it works:

There are many more resources on the internet for design thinking. IDEO has an online University where they offer courses on design thinking that start from $199 (I have not taken their courses, so I cannot say whether or not I would recommend them). Stanford University has the Hasso Plattner Institute of Design, or the “d school”, which is the most prominent academic program focused on design thinking in the United States. They have many resources too for the public to understand design thinking, such as this helpful overview.

Applications in Healthcare:

In healthcare, design thinking can be used in ways ranging from how the patient and their families experience care at the hospital, outpatient office, etc to how the physical building is laid out and designed, to how the equipment is laid out and designed for clinicians. In essence, the possibilities are endless.

As an administrator, the main thing that design thinking is helping me focus on is the patient experience.

Take for example Doug Dietz. Dietz builds imaging equipment for GE and realized that children who had to be tested on his machines were so scared that 80% of pediatric patients had to be sedated to administer the test. To fix this problem, he launched the “Adventure Series” at GE (pictured below), and made the machines look more kid-friendly. As a result of this new design, fewer children are sedated and tests are done correctly the first time, which adds capacity for other patients to use the testing machines.


An Example from the GE “Adventure Series” – photo courtesy GE Healthcare on Flickr

I recently read an article about healthcare disruption in the American College of Healthcare Executives magazine. My favorite quote from the article was from Ian Morrison, PhD, author, consultant and healthcare futurist. He said,

“A lot of outsiders to healthcare view the field as ripe for disruption because it is profoundly dysfunctional. Most entrepreneurs who get into healthcare do it because they or a family member have had a bad experience and were so frustrated that they thought they could start a company and do it better”

Dr. Morrison is right and his statement describes the empathetic nature of design thinking. We can and should do a better job of making the dysfunctional system less-so for our patients by empathizing with them and their experiences in the hospital. Only through empathy are we truly delivering able to help sick patients get better. Those elements need to baked-in to what we do every day.

KEY TAKE-AWAY: Empathy is at the heart of design thinking. Applications for design thinking are everywhere, especially in healthcare. By observing and understanding how people interact with your product and service, the better you can make it.

Book Review: Leader of One

leaderofoneOne of the hallmarks of the Executive MBA (EMBA) curriculum at the University of Maryland Robert H. Smith School of Business is the opportunity to work with an executive coach throughout the program. As a student, I was privileged to be coached by Dr. Gerald Suarez, a veteran of the Presidents Bill Clinton and George W. Bush White Houses, and author of Leader of One.

Before he matched as my coach, Dr. Suarez gave our EMBA cohort an 8 hour course in design thinking about planning with the future in mind. A gifted story-teller, Dr. Suarez held our attention for the entire day. He introduced us to design thinking, keeping the mission first, and the importance of empathy.

Naturally, when we were given a copy of Leader of One, I went home and read it over the course of the next few days. The book advocates creating a future shaping perspective rather than a short-term, quick fix orientation to accomplishing our life and career goals. The book is a deeper dive into Dr. Suarez’s design framework which is a cycle of: Contemplation (what) – Desire (why) – Design (how) – Creation (when).

In each section of the framework, Dr. Suarez introduces core concepts and important lessons about how to look both inward and outward when planning to achieve our goals. At the end of each section, he includes a compilation of questions that force the reader to reflect.

Throughout the book, he covers concepts like developing a strong sense of self, understanding your purpose and meaning, design thinking, finding your “ethical north”, and developing trust.

In addition to the variety of anecdotes throughout the book, my favorite thing about both the book and in working with Dr. Suarez as a coach was his insistence on going deep. Many books and philosophies are based on symptoms. For some, we focus on our de-railers and look for strategies to overcome them. Even in a strengths-based approach, we leave out what is going on underneath the surface of our consciousness.

Dr. Suarez, both in his book and in coaching, starts with reflection to perform a diagnosis before treating symptoms, defining the mission, and staying fired up. He insists that the reader takes time to reflect and go down to that “next level” to understand their subconscious and work to contemplate an “ideal state” in the future and then create it.

For the modern professional, the opportunity to slow down and engage in self-reflection is critical. Reflection prevents us from waking up one day in the future feeling like we have neglected our families for work that is more occupying and distracting than rewarding and aligned to our purpose.

Leader of One is an important read for the aspiring or current leader. My advice is to really take the time to internalize the lessons in the book. If you do, you are on your way to creating your future rather than letting that future reactively shape you.

TAKE-AWAY: For the most important things in life, there are no quick fixes. Take the time to go deeper and learn more about yourself, define your personal mission, and pursue it. 

Leader of One is available for purchase on Amazon for $24.95.