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)

The Difference Between Ideology and Core Values


I sit in a lot of meetings, read a lot of books, and spend time on social media platforms like twitter to get my daily news. Through these mediums, I have found that there is a difference between ideology and core values that are seldom understood and often confused with one another. The goal of this post is to clarify the difference and provide examples.

Let’s start with core values. Core values are essential for leaders who are looking to make change in our world. They are general principles that guide a leaders conduct and decision-making. Core values inherently have humility and an understanding that issues are rarely “black or white”. In other words, core values are an approach to issues and are designed to be applied to any situation as a guide.

For example, let us say that one of your core values is to put the employees interest first. You can use this core value as a lens to guide your thinking and decide between a variety of options. If the company is facing a down quarter, do you consider layoffs, dip into a rainy day fund, or borrow money? If your core value is people first, you may consider the second and third option more seriously. However, your values may say that the company is over staffed and the long-term interest of its employees rests on laying off unneeded positions that are weighing the company down.

Regardless of the ultimate decision in this example, core values allow leaders to make decisions within a context that they have previously, pre-crisis, identified as important.

Core values allows a leader to navigate issues in a prioritized way, considering nuances and thinking deeply.

Leaders with an ideology are often confused with having core values but that is not correct – one does not necessarily correlate with the other. An ideology is a set of rigid beliefs that can limit options and constrict decision making into the small box of dogma.

Unfortunately, some of the best examples of ideology are seen in politics and often tied to identity. For example, partisans (Democrats and Republicans) often accept the party line and promulgate it, sharing distributed talking points on social media. At times, if a political opponent proposes a good idea, it is immediately spun and rejected, if a political ally proposes a bad idea, it is welcomed and elevated. If an idea from any source, even a good one, falls outside the acceptable ideology it is ridiculed and rejected.

Dr. Frances Lee from the University of Maryland discusses the issues with ideology and partisanship in its impact on the US Presidency. In her research, she finds that often the members of Congress not in the President’s party oppose any proposal by the President simply because giving the President a “win” would hurt them politically.

However, if they were guided by core values, and not ideology, perhaps Congress would be better able to put together workable plans to address some of our country’s greatest needs. Being guided by core values would allow legislators to guided by principles that indicate where compromise is acceptable and allow for creativity and consideration of many options, rather than dismissing trade-offs completely. Ideology does not allow compromise because it is understood as morally superior.

The concept reaches far beyond the world of politics. In business, leaders can also get stuck on an ideology. Sticking to a business model as the environment and technology change is its own form of run-away ideology. Blockbuster and Kodak come to minds as example companies that couldn’t adapt because of how much they believed in their business model.

The world is increasingly complicated. Limiting a decision to an ideology oversimplifies complexity and can create tribal politics in organizations or groups. Core values embrace complexity, allow for explanation, and maintains proactivity.

What are your core values? How do they play out in your work? In how you treat others? In how you approach difficult decisions?

Please let me know so that we can continue the discussion!

KEY TAKEAWAY: Core values are essential for leaders to aid in navigating tough decisions proactively. Ideology can be dangerous in limiting decisions to pre-conceived notions and dogmas. How do you define your core values and how do they help you set priorities and make decisions?

Systems and Processes

A few weeks back I wrote about the importance and power of having a well-defined vision. While it is necessary to craft a vision statement that people can understand and follow, that in itself is not sufficient.

Without a way to bring the vision to life that can be understood and acted upon by others, the leader is in essence the pilot of a plane with no stairs or jetway to actually get followers on board or let alone any fuel to get it moving towards its envisioned destination.

Systems and processes are the ways to get people on board and collectively helping reach the envisioned destination.

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Some people in formal leadership roles think that directives are all it takes to get people to do what they say. If only it were that simple, leadership would be far easier. Instead a far more complicated and nuanced approach is necessary, one that combines the best of psychology, marketing, discipline, and repetition.

I think these two quotes from Kevin Kelly sum up the idea of balance between vision and empowerment well:

“The first thing I told our staff is that we would be in command and out of control” -Kevin Kelly (from Blink by Malcolm Gladwell)

Without some element of governance from the top, bottom-up control will freeze when options are many. Without some element of leadership, the many at the bottom will be paralyzed with choices.” – Kevin Kelly

In excellent service-oriented businesses, systems and processes are designed to make sure that the directives from the “command” part of the organization are followed in a customized and adaptable manner at the customer level. Under this model, being “in command” means setting a vision and creating systems that are memorable, exciting followers to achieve the vision, while empowering them with the autonomy to adapt processes and customizing approaches that align with the vision.

Football provides a helpful example: San Francisco 49ers Coach Bill Walsh is credited for creating an offensive system called, “The West Coast Offense”.

The basic system for the West Coast Offense was clear and memorable to everyone, “Control the ball through the short pass, always looking for the big play.”

The West Coast Offense is the system. The coaches and players created processes to make the system work. The video above shares the intentional processes needed to be successful in making the West Coast Offense work.

In the video, players describe Bill Walsh’s obsession with the quarterback’s (QB) footwork. Each play was timed by the QB’s footwork. For instance, when the play called for the QB to drop back 3-steps, the QB had to complete those three steps at the right cadence, because if he moved too quickly, the wide receiver (WR) would not be open yet to catch a pass. On the other hand, if the QB moved too slowly, the WR would be covered again and would still not be open to catch the pass. The QB’s steps were part of a process that made sure the QB and the WR were able to connect and communicate during the course of the game.

Walsh famously scripted the first dozen or so plays of every game, creating additional processes for his players to implement to further the success of his West Coast Offens system.

While Walsh was incredibly involved in the planning aspect of the work, he never was out on the field playing. He needed the plays and nuances (processes) to work in a way that the players could follow and execute. The processes were only viable because Walsh had the vision (win a Super Bowl), a system (the West Coast Offense), and processes (QB footwork, practices, scripting plays etc). All three of these aspects are not only important, but necessary for excellence.

Too many organizations in the service sector begin immediately with process and control through scripting without establishing the vision or system. For the front line team members, all this creates is a very long script of disparate tasks that seem isolated due to a lack of a system and therefore difficult to remember. So much more is possible through establishing direction, a clear system or philosophy to reach that direction, and empowerment.

KEY TAKEAWAY: Start with vision, then move to systems, then processes. Leaders in business often must be in command to meet objectives, but cannot create a service-oriented culture through processes alone. Empowerment is essential to creating processes that work and are sustainable. 

No vision, no mission

We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too. –President John F. Kennedy speech at Rice University September 12, 1962


That quote from President Kennedy is one of my absolute favorites. The reason why is that in this quote (and the entire speech), Kennedy lays out the case for human space travel and does it extremely effectively. Setting aside the rhetorical expertise for a moment, Kennedy’s biggest impact is his vision: “We choose to go to the moon”.

Think about that for just a minute.

Leaders have problems getting followers, employees, even those closest to them to join them in going just about anywhere. Have you even been a part of a new system implementation, a go live, or even an office move? It’s hard to get people aligned to a vision of moving across the street let alone sending a man TO THE MOON!

In this speech, actually in this quote, Kennedy succinctly tell us “where” we are going and “why” we are going there. He articulates a vision that we will go to the moon, because it is a challenge that we are up for and need to meet, even though it is hard.

This quote was my first lesson in the power of vision and how having one is supremely vital in any organization. Leaders must articulate a vision and convince people that it is the right way to go and that they should be a part of it.

A popular saying in the non-profit world is, “no margin, no mission”. In other words, if your organization is not financially sustainable, it is not in a position where it can actually work to fulfill that organization’s mission. In my mind, the same lesson is true for a vision: “no vision, no mission”.

Without a clear vision, the organization is similarly not positioned to fulfill the mission. Without a vision, organizational alignment is nearly impossible to achieve. Lacking a clear vision allows everyone to interpret and act on the mission independently, not collaboratively with other team members. One employee may define an activity that advances the mission far different than another employee or even the way the “big boss” defines it. This is where organizations tend to drift, when the future is opaque and the bridge describing “how” we get from today’s reality to accomplishing the mission is undefined.

Groups of people, being countries or organizations, like to know where we are going. It is not only comforting, but helps people make sense of the actions you take as a leader. It changes the conversation from, “I don’t know why the boss is doing this. Maybe just to make my life more difficult” to “I can see how what the boss is doing fits into where we are going”. It gives purpose to work and an important destination to focus on.

There is popular literature on whether a vision should be for 6 months, 1 year, 5 years, 10 years, etc. There is also much discussion of whether the vision should be attainable or aspirational. My advice: Don’t over-think it. Start with the ideal state. Define when you may realize that ideal state and the work backwards from there to create a strategy to attain it.

Success in leadership requires defining a vision of an inherently uncertain future to create meaning and alignment in an organization. Without those elements, organizations (countries, even) tend to drift. Do the work to create a vision and tell everyone about it. Don’t be shy. The next step is finding people to help bring it to reality. When you do that, then you will truly be a leader.

The very essence of leadership is that you have to have a vision -Theodore Hesburgh

KEY TAKEAWAY: Creating a vision of the future is a vital tool for leaders to add meaning and alignment for daily activities. Don’t overthink creating a vision, do your best work to develop an ideal state in the future and then create a map to achieve it. Work collaboratively to reach it. Good luck!