A Practical Lesson on Values and Culture

Some of the best advice I’ve ever received on organizational culture came from Ann Rhoades, the former Chief People Officer of Southwest Airlines. In 2007, six years after we started our practice, it was time to explore how to best make Sound the practice of choice for our people and focus on developing our culture. I was intrigued with how organizations like Southwest Airlines were able to create a culture that differentiated the passenger flight experience and developed happy and empowered people. I wanted to know how they did this, especially with the airline industry’s razor-thin margins, and competed successfully in the low-cost, regional market segment. I wanted that feeling in our organization. Ann’s advice to me was simple and clear. She said, “Rob, you don’t start out to create a culture. Instead, you begin by focusing on the people. Hire the right people and support your leaders. Design the work environment you envision for the organization. Define the organization’s core values and the specific behaviors that support those values, and be crystal clear on your organization’s mission and vision. Once you have those tenets in place, you must communicate−and never stop communicating. “You also need to define what behaviors support your core values and decide how you will measure how well the organization is doing in embracing the values based on behaviors you see. Then, you need to reward and recognize those behaviors. These are the non-negotiable cornerstones of your organization. The culture will come from that work organically.” The conversation I had with Ann that day hit me hard, or perhaps I was just in the right place to finally hear it. I realized that I had to stop trying to create a culture. Instead, our leadership team needed to do the hard work to define what was important to us. We needed to articulate the behaviors that demonstrated those values. And, we needed a way to consistently measure performance against those core values. Equally important, we had to be intentional about recognizing and rewarding behaviors that reflected our values. I could see that with these key building blocks in place, our culture would be shaped and, with time, would become a clear part of our identity. After that first set of lessons, Ann asked me questions about what the Sound Physicians’ organization valued. To answer those questions, we brought together a small group of physician and business leaders and huddled together for a few days defining exactly what we valued. One of our goals from that session was to not only define what we valued, but to clearly articulate what those behaviors looked like in our organization moving forward. The core values we defined originally are the same values we live by today: quality, teamwork, service, integrity and innovation. One thing was certain to the leadership team in 2007 – we didn’t want our values to end up being hollow words on a wall or our website. We wanted our core values to literally embody the essence of what Sound Physicians stood for. Our goal was to have teams and individuals embrace our values and start to shape who we were. Following that defining period, we started to incorporate our core values into performance assessments and implemented ways to provide feedback to our colleagues. In the healthcare field, it is not common for physicians to receive performance assessments. However, we knew that unless we set the standard by incorporating the values in our daily interactions and measuring against them, the words would be hollow. And, even more devastating, we wouldn’t build the organization we envisioned. It took a few years to fully integrate our vision, mission and core values into our work environment, but eventually we got there.

Living our values

The first time colleagues experience Sound’s culture is often in the recruitment process. They visit our website or read a job description and then eventually speak with one of our colleagues – typically a recruiter or one of our physician leaders. We are intentional about making sure that the vision, mission and values that define our culture are palpable; we want people to feel what Sound Physicians believes in. We have a great track record of attracting colleagues who embrace our values and want to make a difference for patients in the communities we serve. But the dialog about our vision, mission and core values doesn’t end with the recruiting process. New colleagues start with an in-person onboarding session. Providers and nurses spend time with senior leaders, sharing Sound Physicians’ vision, mission and core values. I am inspired every time I meet with a new group of colleagues. I love sharing the story about our history, as well as our core values, vision and mission and helping people understand what makes Sound such a great organization. However, orientation to the ‘Sound Way’ doesn’t end at onboarding. After 120 days, each clinician is evaluated on our core values and the behaviors that represent how we see quality, service, teamwork, integrity and innovation in action. It is at the 120-day milestone that providers are eligible to receive the distinction of becoming a ‘Sound Physician.’ Then, at 12 months, each colleague receives an annual evaluation, whether they work at the bedside caring for patients or are business colleagues supporting our practice. This is an ongoing dialog that helps reinforce the behaviors that represent our core values and what’s important at Sound. At the two year point, our clinical colleagues are eligible to become Partners in our practice. Our Partners are colleagues who are truly living our core values and have demonstrated a deep involvement in their local hospital practice and community. Becoming a Partner brings a greater accountability to shape their local practice – along with increases in compensation, which are aligned with performance achievements. Providers with five years of service are considered for Senior Partner status. This recognition comes with increasing levels of leadership and responsibility, as well as real equity ownership in our practice.

Instilling our core values

After taking a good hard look at our culture, which we referred to as “culture state 01,” we recognized that we need to make changes to ensure our core values were ingrained in what we called the future state of our culture, or “02.”  We gathered colleagues from around the country to help us make our “02” culture a reality. The 02 team determined we literally needed to “infuse life” into the organization in order to take it to next level of engagement and alignment. The 02 group was made up of a number of senior leaders who were all quite science-oriented. One perceptive person pointed out that “02” – or oxygen – was essential to life, and without oxygen, we couldn’t survive. That metaphor inspired the identity ‘Team Oxygen’ in 2012. Team Oxygen has a core team of 15 colleagues from around the organization who meet regularly and work on initiatives designed to further embed our values into the culture. Our strategy for Team Oxygen was to build a better practice and create the career of choice for providers and the partner of choice for hospitals. I’m involved in a small group within Team Oxygen that is focused on enhancing physician engagement. We are excited to roll out the next big idea in this area (stay tuned for a future blog post). Fundamentally, I believe that to deliver great care, it’s not really about where you went to medical school or where you completed residency. Sound’s clinical model today is defined by building a better work environment, where providers are proud of the care they give. We design programs that ensure the provider’s workload allows them time to drive improvements in quality and satisfaction and to also work on initiatives that are important to the hospital and community. We work to ensure there is good collaboration, communications are clear and priorities are aligned. At the core, we know that excellent teamwork across the team of providers, nursing and business colleagues is critical to our success. The future will involve ensuring that the work environment is not only set up for success, but that we demonstrate superior outcomes for a set number of disease states. Stay tuned on our progress.

Keeping core values at the forefront

One aspect of culture is to honor our core values through rewards and recognition. The idea to foster our core values and implement rewards and recognition came from Team Oxygen. Core values are recognized throughout the year. Our Chief Hospitalists and Medical Directors share core value awards at team meetings and our regional leadership conferences quarterly. Sound also has a tradition of recognizing great work by our colleagues through our kudos system, allowing anyone to send acknowledgements which are passed on directly to our leadership team and shared with the organization on our intranet. And, on an annual basis, we bring together clinical, nursing and business leaders to our National Leadership Conference and celebrate our individual and team accomplishments at the Evening of Honor awards ceremony. We held our conference last week in Chicago, and it was a privilege to present the Sound Core Value Awards with nearly 600 leaders present from across our organization. Spending time with our leaders and honoring outstanding colleagues absolutely energizes me. I clearly see the benefit of the core values foundation we created nearly a decade ago.

Final thoughts

I can see now how Ann told me the hiring the right people, putting core values in place and incorporating rewards and recognition against those values would shape Sound’s culture. She was right. And, in hindsight, it was a lot easier to do this work when we were starting out, when I knew everyone by name and had their phone numbers in my cell phone. I am mindful of the need to hold steadfast to our core values as a thriving and growing practice. We are seeing amazing improvements in health outcomes in hundreds of communities around the country as a result of our commitment to truly living our core values, and for that I am so grateful.