Here’s an interesting question for you to ponder: Which position requires more continual training and development in order to perform at a high level—a dental hygienist or a hospital executive? No, it’s not a trick question. The answer is the hygienist, who, like nurses and other caregivers, is required to invest a certain number of hours each year in continuing his or her education. That makes sense, of course; you’d like to think that the people caring for patients are skilled in the latest and greatest techniques and technology out there. There is no mandate, though, that requires executives to keep improving their management or communication skills. Does that seem strange to you? Shouldn’t administrators be pushed into continually developing and evolving their skills, too? We sure think so.
This is something that particularly hits home for Britt, whose wife is a dental hygienist. To Britt’s credit, however, he has pushed himself to keep learning, both by pursuing his PhD (while working full-time) and by joining the American College of Healthcare Executives—the only professional association around that caters to health care administrators. In other words, whether he was required to do so or not, Britt saw the value in continuing his education—something he pursues to this day.
Paul, too, is familiar with the impulse to continually further his education. When he finished law school, he knew he wasn’t headed for a career as an attorney; rather, he was working with his brothers to start a company of their own. Unfortunately, there is no such thing as going to CEO school. So Paul turned to books written by the great business leaders of the day as a way to carve out a learning track for himself. Just as important, he also identified some of those leaders as mentors, hoping to shorten his own learning curve—something we’ll come back to in more detail later in the chapter.
We know there are other executives out there who expect to spend a lifetime seeking learning and wisdom. In general, though, we feel that the health care field hasn’t done enough to emphasize training and learning among its leadership. Other leaders in the industry, like Jim Hinton, CEO of Presbyterian Healthcare Services, share this feeling:
I think health care has been a little reluctant to embrace training by saying, “Hey, here’s how we do it.” We’ve sort of assumed that if you have a doctor from Johns Hopkins and a nurse from University of Chicago and a physical therapist from Cedars-Sinai, and they’re all working together in one room, they all must know the best practices for taking care of that patient. Well, they don’t, because they were all trained in different places.
I think the same thing applies to beliefs about management. We sort of let people manage the way they want to manage. That’s an opportunity for us to grow.
We firmly believe that leaders must grow and develop through both experience and education in its many forms. Clinicians and caregivers must seek new information and bring new skills and perspectives to the organization—why not the executives and administrators who lead that organization?
Going back to school—or at least exposing yourself to new ideas and skills, like knowing how to manage—should be an imperative for just about everyone out there, whether you are required to or not. Everyone should make a commitment to becoming a lifelong learner. That’s how we make new leaps in our personal evolution, maybe in ways we never thought possible. Think about the story of the late Steve Jobs and how a class in calligraphy he took in his single year of college shaped the future success of Apple. After taking that class and immersing himself in a unique art form, Jobs made sure Apple always had a wide array of beautiful fonts available for its software—something that became a key differentiator in the company’s early battles with Microsoft and other competitors.
“So what does that have to do with those of us who work in health care?” you might be asking. Well, just about everything. Your job as a leader is not only to commit yourself to a lifetime of learning but also to create the kind of culture where everyone you work with pushes themselves to do the same. That means creating new frameworks and opportunities for the people you work with to expand their own view of the world around them—and quite possibly to see new opportunities they wish to pursue.
That’s why, while it might seem strange on the surface, the leadership team at Presby has participated in painting sessions and in conducting a symphony orchestra as ways to get people to both think outside the box and inspire new ideas. And that’s why Paul holds Saturday morning professional development sessions taught by members of Beryl-Health’s leadership team, where his employees can learn how to write a resume, conduct a job interview, or dress for success with a wardrobe bought from Walmart. It’s amazing to see how many people, a number of them single moms who make about $30,000 a year, come in on their own time to take advantage of this opportunity to improve their skill set. People attend these sessions, which begin at 7:00 a.m., because they’ve never been taught these basic skills and they want to learn. Driven by a sense of pride in wanting to grow as a professional, they show up enthusiastic and ready to move forward.
“Wait a darn minute!” you might be saying. “Why would you help your employees learn skills that might lead to them getting another job?” Ah, don’t you get it by now, grasshopper? We’re on a mission to drive our employee engagement levels through the roof. Look, we know that our society as a whole has changed and that the notion of lifetime employment, where we all work for a single employer our entire lifetime, is a thing of the past. Most people today want the chance to grow and move. Why would we want to impede that? Rather, we want to inspire people so when they do go somewhere else, they make a big and important impact—and perhaps even remember us as part of their history and progress. This is about sending a message that we do, in fact, care about our employees’ success—now and into the future, regardless of whether they happen to be working for us in our organization. And we can tell you that the payoff is actually much higher in terms of employee retention rates, because when you make these investments in your people—as opposed to worrying about the threat of losing them—they appreciate what you’re doing for them. In the end, many of them stay because of it.
If someone doesn’t feel as though he or she is a fit within the organization, though, we’re not only giving that person the tools to find a path to a better future, but we’re also hoping the person will spread the same kind of thinking he or she has learned while working in our organization—kind of like a bee moving from flower to flower, germinating each one as it goes. That’s what we call a true win-win-win scenario.
Educating oneself can be a demanding task to undertake, especially if you’ve fallen out of practice; it’s not unlike going to the gym to work out a set of muscles you have long neglected. Plus, to be effective, a training and development exercise has to be engaging and fun. As soon as it starts to feel static and boring, you’ll just be spinning your wheels. That’s why, if you can make education more of a social enterprise—one that helps you build a sense of camaraderie with your fellow students—you’ll find the entire experience far more enriching. Steve Moreau, CEO of St. Joseph’s Hospital of Orange, has explained how he empowers these kinds of interactions:
We do something called “crew training.” It’s something we learned from the airline industry. There were a number of catastrophic events because of the authority gradient between the pilot and the crew, and a lack of communication within the cockpit. And we have a similar environment in our operating suites or our interventional areas. So we learned that crew training was fundamentally important, and I personally went through crew training. We require every single physician who comes onto our campus and does any procedural work, and all our nurses who do any kind of procedural work, to go through a whole crew-training program.
One of the questions we ask physicians who join us is “How many of you have ever been in a learning environment with nurses at your side?” And almost none of them have ever raised their hand. And the nurses have never been in the same classrooms and learned together with physicians. They are very much isolated. This is a joint learning opportunity, where they learn how important it is to communicate with the people around them. The nurses are there to keep the doctors out of trouble; the nurses are there to keep the patient out of trouble. The physician needs to understand they’ve got a whole team that is designed to be able to support them. They need to respect that team, and they need to involve the nurses in it. It has to do with acknowledging them; it has to do with eye-to-eye communication; it has to do with the time-out process and saying we’re all here to accomplish this goal today.
Given the traditional barriers between physicians and support staff, then, when you go about creating training and development opportunities for your colleagues, make sure not to neglect ways you can build a social element into the experience. When Britt was at Medical City, for example, he created something called Medical City Dallas University and dubbed himself, of course, the “chancellor.” To make it fun, the whole concept was played out with a sense of humor in mind; the other leaders were called “deans,” and conference rooms were “lecture halls.” The point, though, was to create an environment where people could have fun learning.
Every month Britt would invite a different guest speaker to discuss interesting topics. There were also opportunities to take the “class” on “spring break,” so to speak, by taking a road trip: holding class on a rented boat in the middle of a lake or sharing some lessons learned while out on a golf course. In order to create a great learning environment, you sometimes have to get people out of their comfort zone—and away from their phones and beepers—as a way to help them really engage in the act of learning. The idea is to find unique and exciting ways to combine purposeful fun with education.
Similarly, Paul has built a training and development program at BerylHealth that has come to be called the Dashboard of Leadership. The program, which BerylHealth has held eleven times, lasts for ten weeks and requires lucky participants from all across the organization to spend four hours every Wednesday working through exercises and the like. To enroll in the program, BerylHealth employees need to be nominated by their peers—something that is perceived as an honor by most participants. In this way, the program also functions as a reward and recognition tool—an experience many BerylHealth employees count among their highlights of working for the company. The sessions are taught by members of the leadership team, including Paul, so it also becomes a great way for leaders to connect with a wide cross section of the company’s top performers.
The Dashboard program has also become a great learning tool for Paul. When he teaches his session on understanding the core values of the organization, he conducts an exercise during which he breaks up the group into four groups of three. Each group is asked to grab an easel and a piece of paper, and they are given forty-five minutes to sketch an oceangoing vessel—anything from a sailboat to a cruise liner to a submarine—that represents, in their opinion, the status of the company. What’s more important than the shape of the vehicle they choose, though, is the condition that it’s in. In other words, Paul is able to gauge how his employees perceive the state of the company—whether it’s sailing along nicely or headed for a disastrous encounter with an iceberg.
What’s interesting is that when Paul began conducting this exercise, BerylHealth was going through tough times—a reality that was reflected in the drawings made by the Dashboard participants at the time. In these drawings, the skies were dark and stormy and people were jumping ship. Competitors, drawn as sharks, circled the boats ominously. The level of creativity was amazing! Today, Paul can chart the progress of BerylHealth’s growth by looking back at the eleven sets of drawings he has collected—one for each year of the Dashboard of Leadership. In addition to being a great social exercise for the participants, these drawings have been a valuable training tool for Paul to use each year. Thankfully, the skies are blue now and no one has jumped ship in quite a while.
Bob Kelly, president of New York–Presbyterian Hospital, has come up with another way to socialize the learning process:
We have set up several programs—one is called Building Tomorrow’s Leaders, where we took thirty high-performing managers and put them into an eighteen-month program. There are classes two days a month; participants get a project, they work in teams, and they’re doing some other things. And I make it clear to the senior management team that I expect the thirty best people in the organization to be included in this program; you can nominate whomever you want, and if you didn’t nominate anybody, that’s okay. But don’t come to me at performance time and say, “Joe’s the best and he has to get a great raise.”
What Bob was saying is this: If “Joe” is “the best,” don’t just give him more money—take advantage of his talent by helping him to take that next step. Rather than nominating someone for a great raise, nominate him or her to become a great leader. In other words, it’s all about creating the kind of culture that rewards those who are driven to keep learning and improving.
Another tremendous way to build a social learning experience is to foster the creation of book clubs within your organization. The size and composition of such clubs, and how you go about handing out assignments and discussing the books, depend a lot on your organization. At BerylHealth, for instance, there are both leadership and cross-functional book clubs. At Presby, on the other hand, Britt has some seven clubs made up of fifteen participants each. In either case, the idea is to pick pieces of literature—anything from Who Moved My Cheese? by Dr. Spencer Johnson…to High Five! by Ken Blanchard (a personal favorite of Britt’s, who just happens to be a huge hockey fan)…to Why Is Everyone Smiling? by (you guessed it) none other than Paul Spiegelman.
While the content of the books is obviously an important part of holding a book club, often you reap the true value of these experiences during the resulting conversations and dialogue between your colleagues. For instance, when Britt invites book club members to his office to discuss the latest assignment, he finds the experience far more educational when the participants begin to interact and riff off one another’s points rather than look to him for guidance. Sure, he sometimes needs to set ground rules, and when someone seems afraid to raise his or her hand, Britt raises it for that person (by calling on him or her). But that’s okay. Once people begin to understand that they have a voice and opinions to share, they begin to build off one another—often applying real experiences from work as “case studies” in order to make the book’s points more compelling. And because these groups are often made up of people from different departments, the book group serves as a fantastic way to cross-populate and learn from different disciplines within the organization. Britt has also come up with a fun way to put an exclamation point on such events: Everyone in attendance signs each of the books, as a way for everyone to remember the experience and whom they shared it with.
Paul has instituted a book club for about seventy BerylHealth employees; participants are given about two months to finish a book. He also gives them three questions to answer after they’ve finished reading; the answers serve as the prompts for a discussion at the next BerylHealth employee forum. Here’s the rub: If an employee didn’t take the time to read the book and answer the questions, he or she can’t attend the forum. You can guess who are the ones who don’t want to participate by reading the book, right? The ones who don’t want to attend the forum. And it’s no surprise to discover they are the least engaged employees in the organization. What Paul has found, though, is that attending the meeting is seen by almost everyone as a reward and an opportunity, and guess what: A vast majority of the time, people are actually excited to read, learn, and participate in bringing about change and offering new ideas that stem from the exercise. They share answers and ideas generated by reading the book, and even use them to stimulate great dialogue at the forum meetings.
Conducting a book club, then, is really about imposing a certain kind of discipline on the organization, and in this effort, everyone from the individual to the organization as a whole wins.
You see, we can’t do it all alone, but by reaching up, down, and across the organization, we can strengthen the team as a whole. Here’s a dirty little secret of the business world: Most people are either too shy, embarrassed, or something else altogether to ask a more experienced businessperson for help. That’s a big mistake and a huge missed opportunity when it comes to personal development. The more an individual can expose him- or herself to people who have achieved success—and who are willing to share some of the lessons they learned along that path—the more that person has advanced his or her own cause.
The problem is that most people don’t even ask. We know this from experience. When they talk to us, people often start with a preamble along the lines of “I know you’re busy…” But you know what? We’re not too busy to help people out. We, like many others out there, actually take great joy when someone reaches out for help, for advice, or (on the flip side) to serve as a mentor of sorts. It all starts with having the courage to ask. Maybe it’s a selfish thing for us, because it really does feel good when someone asks us—so why not take the chance? And we can tell you from experience that the mentor relationship truly does benefit the people who reach out. When you have the chutzpah to ask a more seasoned leader for help, you’ll reap unbelievable rewards.
Mentorship can exist in both formal and informal ways—but you need to make it clear to everyone in your organization that each person has an obligation to cultivate mentor relationships whenever possible. You, like Britt, might have a more formalized system in your hospital, where leaders of the next generation are essentially linked up with members of the senior leadership team and then given a curriculum of new skills to hone. This is a way to both create a sense of camaraderie and develop a succession plan for the leadership team. And don’t forget to keep an eye out for those who mentor, too; they are the teachers and coaches who are building great teams. True leaders surround themselves with engaging and talented people—the high-potential individuals in your organization. Invite someone like this to your next meeting, and see how the person glows when you stoke his or her interest and confidence.
Developing mentor relationships can be an informal and opportunistic endeavor as well. Back in the 1990s, Paul’s company was awarded a contract with a very large health care organization. The CEO had started that business with $150,000 and, in time, grew it into a $30 billion enterprise. Paul befriended the CEO during the course of their business relationship, which only lasted for three years. For some reason, though, they connected, and the CEO seemed to genuinely care and be curious about Paul’s little business that had served his company.
This CEO’s name was John—well, no, it wasn’t, but that’s what we’ll call him—and he left that company in 1997. But Paul stayed in touch with him and would either call or write a couple of times a year. In 2005, Paul visited John with a specific problem: BerylHealth’s unique employee-focused culture had resulted in a lack of accountability within the business, and Paul wanted to instill greater discipline in this area.
“Look, Paul,” John said, knowing that Paul didn’t have a formal advisory board. “Accountability starts with you. Why don’t you take one of those mentors you have, write the person a check for $20,000, and ask him or her to hold you accountable.” Paul thought about it for a few days. Then he took out his checkbook and wrote a check for $20,000, making it out to John. When he mailed it, he included a note that said “I want you to hold me accountable.” John called Paul up and said he’d do it. After that, they would connect for ninety minutes every month, on the phone or in person, to run down a nine-point agenda that would cover updates on everything from the company goals and financials to its biggest challenges and opportunities. Every year, Paul continues to write John a check for $20,000 (which he doesn’t need, but cashes nonetheless), and this informal mentorship has had an immeasurable impact on Paul’s career and life.
Paul was willing to ask for help, to opt in to a relationship with a mentor, and he got it in spades. But the story doesn’t stop there. A year after he signed that first $20,000 check, after Paul spoke to a group of MBA students at Baylor University in Dallas, he got a call from two entrepreneurs who had been in the audience and were starting up a self-serve yogurt business. He invited them to meet him in his office, where they filled him in on their plans. Paul gave them what advice he could. He also told them the story about John and the importance of mentors. A week later, Paul got a note from them in the mail, along with a check for $2,000 and a note that said “We want you to hold us accountable.”
Paul was impressed by their creativity and honored to be asked. He never cashed the check but gladly offered to help. Then, about six months later, twin brothers, one of whom had heard Paul speak to his MBA class at Texas Christian University, asked to meet with Paul to talk about starting a nonprofit aimed at improving educational opportunities for young people. When the two met, Paul shared the stories of John and the frozen yogurt guys, and a week later—can you believe it?—he received a check for $20 with a note that said “We want you to hold us accountable too!”
The point here, other than the fact that the next check Paul receives will likely be for $2, is that when people achieve a certain level of success, they want to give back and share their experiences. That means it’s time for you to make a list of your would-be mentors and start reaching out. After all, what’s it going to cost you? Probably nothing—other than a little bit of your time and a few stories about your experiences. You see, those experiences can be extremely valuable to others, and you can’t just hold that knowledge inside. We call it “the give and get”—we get value from our mentors, and in return agree to give back by acting as mentors to others.
So get your mentors in line and working for you, and commit to offering to do the same for others. It will be good for your business and good for your heart; it’s all part of the ethics of reciprocity, otherwise known as the Golden Rule. And as you’ll see when you turn the page to start the final chapter, we think following the Golden Rule is at the very core of employee engagement.