Working the graveyard shift at a hospital is hard work. Not only do you have to confront the inevitable challenging and life-threatening cases that come in through the ER, but you also have to manage your life away from work in what can seem like an upside-down world. Spending time with loved ones can seem like a thing of the past; it’s frustrating when your spouse and kids are heading out the door in the morning, right when you’re coming home to grab some sleep. It’s also easy to feel forgotten and unappreciated, since most of the hospital executives stick to more traditional nine-to-five working days. How are they supposed to know whether nightshift employees are doing a good job or not when they’re not even there? When you add all that up, it’s easy to feel a bit disenchanted with your job.
Imagine, then, that you are a nurse in charge of the midnight shift of the burn unit, or maybe even a security guard whose duty is to scrutinize every character walking in and out of the building. Now picture this: A middle-aged guy with a big, goofy smile on his face is pushing a gigantic tray of cookies through the hallways on a gurney. This guy—who looks an awful lot like the hospital’s chief executive—stops by to offer you one of those cookies.
“We’ve got chocolate chip, oatmeal raisin, sugar cookies with sprinkles…Take your pick!” he says. Then he takes a few minutes to stop and chat, asking you about how your shift is going and whether there is anything he could do to help.
As you chomp away on your delicious treat, you can’t help but smile back at this strange guy and tell him the truth: both the good and the bad. And you know what, he seems to be actually listening. “I’ll see what I can do about that,” he says regarding one of your concerns. Then, after shaking your hand, patting you on the back, or even giving you a hug, he’s off—but not before saying, “You know what? I really appreciate what you’re doing.” And you know what? You actually believe him.
If we’re being honest, most of us would admit to being a bit cynical when it comes to work. When we hear our employer say he or she is going to do this or that, we roll our eyes, thinking, Yeah, right—I’ll believe it when I see it. It’s even worse when your employer says something like “We really care about you” or “We couldn’t do it without you.” Whatever, man—just sign my paycheck, is probably what you’re thinking.
But wouldn’t it blow your mind if in fact your employer actually meant what he or she said about caring? What if—gasp!—your boss even seemed to truly want to know how your family was doing? Do you think that would change how you feel not only about your boss but also about your entire work environment?
The point is, we can talk all we want about having a strong mission, vision, and values, and yes, it’s crucial that we give permission for people to have fun at work. But if we as leaders and colleagues don’t actually give a darn about the people we work with, all we’ve done is prove the cynics right. All we’ve shown them is that we talk the talk, but we don’t walk the walk. When we do more than talk—when we demonstrate that we care about our people in the totality of their lives—those same people become infinitely more engaged in their jobs. The question, then, is this: Can you teach someone to actually care?
But first, what does it mean to “care”? To us, caring is a very important word that connotes love, kindness, and compassion. And it’s our belief that just about everyone demonstrates that they care, in many ways throughout the day—whether that comes from caring for your family members, for your coworkers, or for the patients assigned to your ward. Here’s how Ron Swinfard, CEO of Lehigh Valley Health System, put it:
I participate in every new employee orientation. I use a presentation to show people my background, the one-room schoolhouse where I went to school. The slide says small-town values. This is the new paradigm for CEOs.
We wholeheartedly agree with Ron, and that’s why we like to see the term health care separated out into two words—health and care—so that it properly emphasizes the critical role those of us in the profession play in looking after those who need our help. Isn’t that what you do when you live in a small town? And isn’t any hospital community really like a small town, made up of all sorts of different people who know one another, see one another, and work with one another every day, for years on end? When you are able to consider someone else as a neighbor in a small town, you will find it easy to care about that person’s well-being.
To that same point, consider the following story told to us by Melody Trimble, CEO of Sparks Health System:
One time I was walking the halls of the hospital when I saw a man who looked rather tattered and torn. My heart went out to him, and I felt compelled to wish him a blessed day. The man then asked me to stop. While I admit to being a little scared at first, I walked up to him with a smile. He said, “You know, I was going to kill myself today. I was just hoping someone would be nice to me.”
This real story from a real person confirms the power of true kindness. As the saying goes, “Hey, you never know…” We never know how we impact the lives of those with whom we work and live. And that is the sort of caring we need to make sure our employees sense from us—because that sort of caring reminds them that they, too, must be caring in their jobs. Because none of us ever know what kind of impact we may have, at any moment, on the patient experience.
So, back to the question at hand: Can you teach someone to care? The answer, we feel, is that most people do intuitively care already—they just need to be shown that it’s okay to show it. Not only that, but also that they will be rewarded for demonstrating how much they care. And you don’t have to be a clinician to show that you care. You can be, for example, an executive, a cook in the cafeteria, or a janitor.
The solution, just as we discussed in the last chapter, is for leaders to step in and open the door for everyone to act, in large and small ways, on those innate caring feelings. We need only to lead by example and to give our people permission to care. That’s why you can find a hospital president wandering the halls of a three-million-square-foot hospital from midnight to 3:00 a.m., delivering cookies and connecting with staff members. Taking the time to show that you care requires purpose and action—you can’t fake it. When you do take the time to demonstrate that you care, however, appreciation, respect, and a sense of camaraderie soon follow. From there, it becomes a self-fulfilling and virtuous cycle; those caring feelings go viral.
Consider the following tale shared by Jim Hinton, CEO of Presbyterian Healthcare Services in New Mexico:
There’s a story that I tell at our new employee orientation sessions every other week, and it has to do with a nurse who was caring for a patient in our cardiac area. The patient’s family flew in on short notice from a rural part of New Mexico. They didn’t have a chance to pack any clothes. And so, after a couple of days, the nurse noticed that the family members were wearing the same clothes. So she walked in one day with a stack of scrubs and asked if the family would like to change into the scrubs so she could take their clothes home overnight, wash them, and bring them back in the next day. I tell that story because, to me, it exemplifies the kind of backflips that our employees will do to help a family or a patient in need.
When you see a coworker with that kind of dedication to caring for patients, it is almost contagious.
Now, it’s important to acknowledge that not everyone shows how much he or she cares in the same way, and the two of us are perfect examples of this. Britt, for instance, is a big hugger—he isn’t afraid to lay a bear hug on just about anyone. In that way, he is able to break down physical barriers between people, which means that many of his employees return the favor by planning sneak-attack hugs on him whenever they can catch him off guard. Britt attributes his own managerial style to the weeks he spent in a hospital as a fifteen-year-old after a fire burned some 20 percent of his body. While the pain was excruciating, Britt’s most prevalent memory of that time is the love he received from the people taking care of him. While he wasn’t born with a scientific mind (far from it!), he knew he had other talents—such as his naturally friendly personality—that he could use as a way to bring that same kind of love, kindness, and caring to people. And he did so, caring for people around the world first as an LDS church missionary and more recently as a hospital CEO.
Paul, if you recall, is far more introverted than Britt. He’s just not as comfortable going up to people and giving them a good squeeze, or even stopping to chat about their weekend and ask how their kid’s Little League game went. He’s just not wired that way. And that’s totally okay, because he finds other ways to demonstrate the values he learned from his parents—namely, the Golden Rule of treating others the way you’d like to be treated.
For example, Paul has come to rely on a system that reinforces the sense of caring at the very core of his company: a program he helped create, called Beryl Cares. The Beryl Cares committee manages a website and database that keeps track of everything from important dates (birthdays, anniversaries, and such) to any news relevant to each employee, such as any deaths or sicknesses in the family or even a recent accomplishment (finishing a marathon, for instance). When an important event or date occurs, the system sends Paul and the other company leaders an e-mail with the information along with a picture of the person involved. Despite living in our age of instant electronic communication, Paul spends fifteen minutes every morning putting together handwritten notes on Beryl Cares stationery for a variety of celebrations, condolences, and events that are important to the members of his “family.” He sends the notes to the employees’ homes. While writing the note doesn’t take a substantial amount of time, it’s a moment that he can dedicate to a BerylHealth family member when that person might need it most.
But the caring culture of BerylHealth extends beyond Paul’s relationship with his employees; it connects each and every coworker. That’s how, for instance, everyone at BerylHealth was able to rally to the cause of two patient experience advocates, twin twenty-year-old brothers, whose apartment burned to the ground with all their belongings in it. With the help of the Beryl Cares committee, folks rapidly rallied around the brothers—raising $1,500 (which the company matched), holding bake sales to raise additional funds, and even offering to donate vacation time to help the two young men get back on their feet.
It is truly powerful to see how much people care about one another and how quickly they will unite and even sacrifice to do things for one another. Andy Leeka of Good Samaritan Hospital explained how it works—kind of a titfor-tat, you watch my back and I’ll watch yours situation—by sharing a story about Maria, an environmental services worker who brings in homemade tamales for Andy and the other associates from time to time:
I know Maria. I know her family. I know about the tragic death of her son and attended his funeral. When her $400 was stolen that she was going to use to purchase groceries, I handed her $400 from my wallet to replace it because I am going to take care of her. I am going to take care of Maria, and Maria is going to take care of me. Maria is going to take care of the patients, the lobby of the hospital, and enthusiastically take on duties not even assigned to her. Maria is not going to allow a patient, visitor, employee, or volunteer to slip and fall if something spills on the floor. And Maria is not going to walk by trash in a hallway or allow areas or our hospital to become dirty. Maria and I are committed to a safe and clean hospital. I am committed to Maria.
As Andy points out, people who work closely together benefit when they care about one another’s well-being. Sometimes people will even step up all on their own to take care of one another. A great story along those lines almost happened by accident: A few years ago, Paul’s lease on a company car (a 2000 Toyota Camry) was about to expire. But Paul decided that rather than turn it back in, the company would donate the car to a lucky employee—someone chosen by his or her peers. Now, the cynic in you is thinking that just about everyone would have put his or her own name in the hat and lobbied colleagues to help him or her land a gently used car. But when we tallied the votes to name the winner, there was one name (let’s call him “Michael”) who collected far and away the most votes. Unbeknownst to Paul and the other BerylHealth leaders, Michael didn’t have a car—he had given his to his mother, whose own car had recently broken down. Michael had been forced to walk seven miles to get to work every day—and another seven to get home!—all under the blazing Texas sun. We all thought he’d been looking trim (in fact, he had lost forty pounds in just a few weeks), and now we knew why. More important, his peers knew the answer to his problem, and they stepped up to deliver a grand and heartfelt gesture.
Do you think being recognized by the team made an impact on Michael and the kind of engagement he felt toward the company and his coworkers after that? This is the kind of thing that can happen, regardless of the field you work in, when you give people the freedom and the opportunities to show how much they do care about one another. But in the health care field, where patients are in crisis and employees face trauma and tension every day, it can mean the difference between simply doing the job and truly loving the job.
If we want to encourage this above-and-beyond level of caring in our people—and we should want exactly that, both for the success of the company and for the best possible patient experience—it’s absolutely critical to find ways to reward employees for their outstanding work. By recognizing the care that goes into each employee’s performance, we can demonstrate that we have noticed the employee and that we care about him or her.
What’s interesting, though, is that the rewards people really want, contrary to popular opinion, are rarely financial. In fact, the rewards many people value the most are those that they don’t even collect for themselves. At Medical City, for example, there was a first-generation U.S. citizen named Bob who helped start a program called Our Children Matter. Bob and his partners in this effort devised a program where employees could essentially reward the accomplishments of their children. Kids who earned straight As, were accepted into a prestigious college, or achieved Eagle Scout rank got to come into the hospital and, in front of a big crowd, receive what looked like an Olympic gold medal. And as much as the kids up on stage beamed, it was their folks who really shone in the wake of the recognition their kids were receiving from their other “family members”—their fellow employees. It was a beautiful thing to see.
It’s important to note that this was the sort of program that could have been taken over by the hospital—as executives, we could have stepped in and taken control of it or co-branded it in some way. But we quickly realized that the greatest thing the leadership group could do was actually to step aside and remove any obstacles to making the program as organic as it needed to be. We let the hospital employees run the program for their colleagues—that was how we showed we cared about what was important to the employees. It was their “baby,” and hijacking it would have taken away some of the beauty of the program.
Another example of ingenuity in recognizing the realities and concerns faced by our people comes from BerylHealth—in particular, the “Ask Paul” link on the company website. Through this link, employees can post anonymous questions to Paul and the leadership team. The idea, of course, was to give employees the chance to air their biggest complaints or get answers to their most pressing questions—to allow them to discuss things they might not be willing to ask in person. But you know what? Rather than pepper the senior leaders with questions about the strategic direction of the company, the bulk of the submissions centered on topics like “When is the toaster in the break room going to be replaced?”
The point here is that what’s most important to you may be vastly different from what your employees are thinking about. That’s why, when we wanted to start promoting an increase in BerylHealth’s tuition reimbursement program (for high-performing employees who wanted to gain further education), we eventually shifted gears and created an annual scholarship program for children of employees. It is difficult to describe the emotions that parents experience when their employer helps fund their child’s education and invest in their future. We quickly found out that connecting to an employee and his or her family via contributing to a college education can have a profound effect on how that employee views his or her job. When your people have that kind of encounter with the company, it’s easy to imagine how they will answer the question “Does my employer really care?”
As we said earlier, to show that you really do care, you can’t just talk the talk—you have to walk the walk. That’s why, for instance, you could find Britt driving from the hospital in his 4x4 Jeep to the regional train station at 5:30 a.m. to pick up a group of nurses stranded by a nasty winter ice storm. No, he didn’t do it just to make sure they got to work like they were supposed to. He did it because they wanted to get to work to help patients rather than be stuck inside a freezing-cold train station all day.
During that same ice storm, you could find Paul and his senior leaders manning the phone banks at Beryl-Health, knowing that many of the company’s regular advocates were forced to stay home with children whose school days had been canceled. Rather than hiding out or becoming invisible on what could be a difficult and chaotic day, Paul and his team stepped up to show that they were there for their people, that they understood family comes first. Think of the last time you actually had a boss cover for you at work, especially without laying a guilt trip on you. Come to think of it—has this ever happened to you? And more to the point, have you ever done something like this for any of your people?
Of course, on the path to showing that you care, you can also find yourself making missteps along the way. Britt, for instance, once wanted to take some time off-site with his chief nursing officer, to really listen and show that he cared what she thought. He hoped they could take some time to reconnect. But life in a hospital is busy, and you rarely have a moment for lunch, let alone getting off campus. So he never thought twice about taking her to his favorite restaurant—which happened to be Wendy’s. Yes, that Wendy’s. Now, as far as fast-food restaurants go, Wendy’s ranks near the top. It’s fast, and who doesn’t love a delicious Frosty? Unfortunately, it never occurred to Britt that his CNO might be taken aback by his choice, that she might figure he didn’t want to splurge on a nice lunch. Fortunately for Britt, his CNO eventually got the full story. And now, whenever Britt suggests they go out for a bite to eat, the CNO always insists on going to Wendy’s, because she came to understand why he chose it in the first place. For him, it wasn’t about the venue; it was all about the time and relationship. So when you demonstrate that you care about employees, it is necessary to explain your actions and understand how those actions will be received.
You and your organization must truly walk the walk when it comes to caring. We can’t stress enough how important this is! You need to keep challenging yourself to do things that are unique and special. As soon as your employees begin to see through a charade of meaningless gestures—to grasp that, in fact, you don’t really, truly care—everything will come crumbling down around you. As Mike Packnett, CEO of Parkview Health in Fort Wayne, Indiana, told us:
Without employee engagement, you’re never going to get the kind of ultimate patient experience you’re hoping for. You’ll get something that is rather robotic instead. This is something I see and hear firsthand when I make rounds and hear how our new associates speak. But I think once we connect, once we can get any of our coworkers and physicians to connect their hearts with their heads on the idea that they all have such a huge part to play in the patient experience—once they get that, whether it be a housekeeper, a nurse, or a neurosurgeon, we’re all in it to have absolutely the best outcome for that patient and his or her family—they realize it’s all about the patient. They understand that this isn’t just about a patient satisfaction score or an employee engagement score. That’s the way we keep score, but it’s not about the score—it’s really about how it’s reflecting what our own patients are telling us.
No doubt you have been a part of company celebrations or birthday parties taken straight from the script of the movie Office Space, where you can’t find a smile anywhere and everyone present seems to be on autopilot. In those cases, employees simply don’t trust that their employer cares—they sense that the boss is just “talking the talk.” Rather than building up a sense of caring, these employers are in fact allowing it to erode. That’s why Dr. David Feinberg, CEO of UCLA Health System, goes above and beyond to make real connections with his people. Every week, he invites random staff members to lunch, so they can share a meal as they share their opinions on their work environment and anything that will improve UCLA’s care of employees, patients, and families. It is part of a broad effort, his desire to meet each of the company’s seven thousand employees. “I am on a quest, ten people at a time,” he told us. “And while I may not be able to name all our staff members”—we have to wonder, who could?—“I am fully committed to spending time with each person.”
BerylHealth, too, tries to go beyond the normal in caring for its employees, by sending them handwritten postcards, not just on the anniversary of their employment at the company, but also to congratulate them on their son graduating college or their daughter winning the state softball championship. When people get these notes, they recognize that Paul and the company care about them. They say to themselves, “Wow, how did the boss know about that?” When you can make the connection between you and your employee about something personal—when you make it your business to know about what’s important to them—the result is powerful.
Another case study in why caring matters comes from a hospital where an aspiring executive—let’s call him “Larry”—thought the most effective way to achieve success was to “beat up” on his team so they would do what he thought they should do. Now, that isn’t quite how he would have put it. No, instead he used plenty of corporate-speak like “We need to pick the low-hanging fruit” and “We need to stay focused and execute.” Some days it sounded as though he were reading from The Big Book of Corporate Clichés. Most disappointing of all was the fact that Larry was a really, really good guy. He had entered health care with a purpose, but somewhere along the way he got fooled into thinking that it was all about him.
It all culminated when, one day, Larry took it upon himself to gather his team of fifteen or so direct reports and share with them his personal goals for the organization. The point, he said, was to get each and every one of them to help him fulfill those goals. Now, by this point in the chapter, warning bells and flashing lights should be going off in your head, to the tune of Larry, what are you thinking? And you’re right: Larry’s mistake was in thinking that the people working for him gave a darn about his goals, especially when he didn’t seem to care a lick about theirs. Little did Larry know at the time, but he was about to go through a “learning moment.”
Fortunately for Larry, he had a boss who saw potential in him. That boss pulled him aside and told him the cold, hard facts: that Larry needed to begin caring about his employees before they would begin caring about him. That’s when the light bulb went on in Larry’s head and his dramatic transformation began. The more Larry began showing his employees respect and paying attention to their careers, the more they rallied around the goals of the organization. By learning to care about his team members, Larry actually strengthened both the organization and his own credentials as a leader.
The lesson, of course, is this: If you as a leader want to improve your organization and achieve personal and professional satisfaction by moving down this road of caring, your efforts have to be purposeful and meaningful—they must be genuine and come from the heart. And you can’t develop goals that serve some selfish, egocentric purpose—they must be for the greater good.
Genuine, purposeful caring—you almost have to drive it into your brain to make a constant effort to care for your people before the organizational culture as a whole becomes steeped in it. Sure, you’re going to stub your toe every now and again by forgetting to send a card or celebrate an anniversary. But as long as it wasn’t intentional, and as long as you’ve built up a strong track record of success, you’ll find your employees to be forgiving. Still, you need to understand the risks, because you won’t get that many free passes.
While Larry saw the light about truly caring for his people, not everyone will be able to cast aside his cynicism—which creates additional challenges for leaders. A story from Britt’s early days growing up in Canada helps illustrate this. Many weekends, the Berrett family would load up their red canoe and head to the coast. Once there, they would arm themselves with “crab catchers”—poles with small baskets attached to the end—and then paddle about, looking for six-inch-long crabs, which they would scoop out of the water and into a bucket inside the canoe. The challenge was that the first crab would always start climbing out of the bucket, so you’d have to keep a close eye on him. But as soon as you added another crab or two, your problem was solved. Why? Because if one crab started trying to make his escape, clawing his way up the side of the bucket, the other crabs would grab hold and pull him back down.
The same thing exists within an organization. Oftentimes, people may try to take some initiative, to tackle something new and interesting, only to be dragged back down by the crabby cynics who aren’t interested in trying anything new. They may wonder why you’re trying to rock the boat—“Leave things as they are,” they might say while turning a blind eye to the threat of the status quo and to the lost opportunities before them. The sad truth is, there will always be crabs ready to pull you and your coworkers down, which is why you need to develop the moral courage as a leader to break free from their grasp.
When you do take the time and make the effort to connect with your workforce in meaningful ways, the payoff is tremendous. Not only will your organization perform more effectively (which is nice), but also you will experience a personal ROI that you might never have expected (which can be even nicer). When you begin to reach out and learn more about the people you work with, you will find a sense of personal enrichment and camaraderie that goes beyond what any financial bonus could provide. You will also develop a deeper understanding of your colleagues, and we guarantee that you will be amazed at what you learn. When you begin to appreciate the depth of these people’s lives—how they are building their families, taking care of kids and parents, fighting illness and other difficulties—it can be a humbling experience.
One such experience involved a BerylHealth employee—we’ll call him “Brian.” Brian was not only a great employee, but he was also a great person who, with his wife, had adopted two children from China as their own. One day, Brian, who was about fifty-five years old, received some shocking news: He had been diagnosed with stage IV cancer. It shook the company—everyone was upset by the news. But to his credit, when we held our holiday party a few weeks later, Brian insisted on attending even though he needed to be in a wheelchair to do it.
At the party, Paul made a big and unexpected announcement: Even though the company had failed to meet its financial goals for the year, he had decided to pay a partial bonus to each employee, because he thought it was the right thing to do. The resulting applause was, as you might expect, thunderous. But it was a letter Paul received a few days later that really blew him away. The handwritten letter was from Brian. After thanking Paul and asking about his health (Paul was recuperating from a pinched nerve in his neck at the time), Brian wondered if the bonus money announced at the party would be better spent elsewhere. “We’re all thankful to have jobs here,” Brian wrote. “And I’m not alone in thinking that perhaps you should reinvest it in growing the company.” How many times have you heard of an employee who wanted to give back a bonus—let alone someone so ill, who could probably use the money himself?
Brian’s story captures the theme of this chapter: that when you truly care about your employees, they will reciprocate those feelings both personally and in ways that actually improve the performance of the organization. You may not be able to find a line item that shows you how much caring matters, but your personal balance sheet will be much healthier as a result.
As we’ll discuss in our next chapter, caring and having fun can also have an impact outside the walls of your organization.