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Open Mike - 2011

Culture at Group Health: 7 questions for Scott & Michael March 9, 2011


Scott Armstrong & Michael Soman, MD
Scott Armstrong and Michael Soman keep the conversation going. What does respect for people look like in your team? Respond to Open Mike.
Scott and I kicked off some fresh thinking about culture and respect for people at our Leadership Conference about five weeks ago. Recently, we sat down to check in with each other about it. We know that culture shifts don’t just happen overnight. It takes small steps over time. And, it takes an ongoing conversation. Here’s what we’ve been talking about.

Where are you getting new ideas for work around people and culture?

Michael: I think we're willing to get ideas anywhere. A wonderful source of fresh ideas is our staff. Right now I’m in the middle of a series of meetings—by the time I’m finished I’ll have done about 30 meetings with close to 300 of our clinicians—they have great ideas. And we’re looking at other companies and industries too.

Scott: I agree with Michael that the best source of fresh ideas is our people. For the last few years we’ve been more disciplined in our rounding and understanding how work is done. It’s now time to extend our focus when we’re with our staff beyond Lean tools and process boards, into time spent learning more about what it’s like for people to work here. Why do they show up every day? What can we do to create an environment where they feel like they’re really doing their best work? Outside of Group Health, we’re looking at how other employers—typically not health care organizations—are creating a great place to work.

Michael: Scott said an important thing about us intentionally not looking closely at other health care companies for examples. I don’t think there’s currently much innovative people-thinking at other health care organizations. I know of a hospital system in the Midwest that’s looking at some cool environmental things like the lighting and the mood of buildings, but not culture.

Scott: I’d add that learning about Barry-Wehmiller gave us a chance to get outside of the box that limits our thinking and imagine what we might do, but we aren’t looking to do exactly what they are doing. I still believe that if you’re talking about making a workplace the best it can be, the best source of new ideas is going to be the people who work here. [Several Group Health and Group Health Physicians leaders visited the Barry-Wehmiller Companies in St. Louis to learn about their cuture work]

Is a people strategy created by the people within an organization, or by its leaders?

Michael: Here’s what I think: leadership sets the tone, and Scott and I did that at the Leadership Conference in February, and we’re continuing to do it at every opportunity. We need to clarify initially by our words, and then by our actions, that it’s important, so that it will be important to others. Group Health is the people. It’s not buildings and plans and Epic. People create the culture; we set the tone.

Do we have too many different cultures already for this to work well?

Scott: I’m sure we’ll learn more about that as we go forward. But I think there are certain consistent features of working at Group Health that we want all staff to experience, to understand and advance. Sure, there will be variation in how it feels from area to area. Functions are different, and interactions with out customers are different. But there are basic, consistent principles of who we are and what we stand for that we want to be much clearer about.

How do you move from something that sounds like a checklist or plan, to something that’s actually ingrained in everyday behaviors?

Michael: Really you’re talking about culture, one where people are valued in a variety of ways—including putting high expectations on each other and holding each other to them. Where people are given the support to find solutions to problems, making them feel valued and respected—and they pass it on. We’re early on in this. One of the easiest and most accessible ways to respect people is to ask them how they feel about their work. It’s a powerful first step.

Scott: As leaders we can have some influence in a workplace, but it takes time to act on a new way of thinking, and build that through changing hundreds of actions. Whether it’s policies and the way we build them, or the way we spend our time at work, or the things we recognize and reward. It’s an endless list of small things over time.

Have you had recent moments where you chose to do something differently because ‘respect for people’ is on your mind?

Michael: I was meeting with specialists at Bellevue yesterday and I heard a passionate, unanimous belief in something that’s not working. I thought wow, I’ve been hearing this topic for over a year and it would be absolutely disrespectful at this point to hear this passion and not translate it into action. So in the last twelve hours I’ve had conversations with people who actually have operational accountability around the topic, so I can at least kick off a rapid assessment of what should happen next.

Scott: Yesterday we announced changes to our policy for spending dollars in departments to recognize our staff. And while the memo is just a memo, I think it’s hard to overstate how dramatic the change is that the memo represents. We’re going from specific rules about how much we can spend recognizing people, to asking managers to simply use your good judgment. It’s just one step, and we’ll really start having some traction when we’ve got ten other things like it, or a hundred.

Think about past efforts like this at Group Health. What’s different now?

Michael: We've both been here for a few of these efforts. We’re trying hard to avoid an initiative-based “event” where Scott and Michael say to someone else ‘you’re in charge’ and tell them to go make it work for us. So it’s different because it’s a tone set from the top, but now we actually have a management system to support it. We have a way of carrying something from the board room to the exam room and everywhere in between. We both believe that our business success depends on it. We’ve got very ambitious goals that we can’t succeed at without engaging and empowering the people of Group Health. And finally I think there’s recognition that front line improvement is where we’re going to get the bulk of dramatic improvements at Group Health.

Scott: We’ve been on an exciting journey for the last several years, and we’ve learned a lot. We’ve seen evidence that our results can be improved by paying attention to incrementally improving work at the front lines of our departments. So unlike anytime before, this focus on our work environments is a very natural continuation of a learning process. It’s not just a cool thing to do because employers are supposed to do it. It’s another component of something that we already have confidence in and momentum and excitement around. We’re doing it with a conviction that’s heartfelt. We really believe it will help Group Health be an organization fulfilling its mission for decades to come.

You kicked off this work at the leadership conference on February 1, 2011. When February 1, 2012 rolls around, what’s the biggest change you hope to see?

Michael: I think we’ll see a real spread in Front Line Improvement, or FLI, which is a structured, cross-functional team method for creating the flows and care environments that really work for the people in a site. At any given site, the FLI team rotates membership so everyone gets exposed to it. It happens really fast—process walks, testing solutions, implementing. More doing, less debating. I predict the culture will be changing to one of ‘we solve problems’ and ‘we’re heard and valued’ and that our Gallup scores will show it.

Scott: We should see a new and clear investment in developing the level of skills we’re going to need from people. To make Front Line Improvement really work, we’re going to need more consistency from our managers and chiefs and supervisors—the people who are so influential in what local work environments are really like. My hope is that a year from now we’ll have gotten really smart about a consistent curriculum to help staff create and sustain that work environment.

What are your questions about people and culture at Group Health? Tell us what's on your mind.Print

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