Culture: Solving for Why Mitch Wasden Ed.D CEO OHSU Healthcare

OHSU: Oregon Health & Science University 1. $3.0 Billion in Clinical Revenues 2. 1,200 Employed Physicians 3. 14,000 Employees 4. Nationally Ranked in 13 Specialties by US News & WR 5. #30 in NIH Funding - $300M+ in research spend annually 6. Received $1 Billion from Nike Founder Phil Knight for Cancer Research 2

SURVEY Q1. How many of you have strategic planning retreats? Q2. How many have strategic plans? 3

Culture eats strategy for breakfast. Peter Drucker- 4

SURVEY Q3. How many of you have Culture retreats? Q4. How many of you have Culture Plans? 5

Culture eats strategy for breakfast -Peter Drucker If culture is that powerful, why do we have strategy retreats and strategic plans, but NO culture retreats and culture plans? 6

RESULTS FROM LEADING WITH CULTURE 7

Benefits of Engagement in Culture Create 22% higher productivity (Gallup survey of 1.4M employees) Doubles the rate of success of an organization Lower absenteeism 25% lower turnover Higher quality 41% fewer patient safety incidents 41% fewer quality incidents (defects)

Results at Ochsner Medical Center-Baton Rouge How identity drove results from 2007-2012 Hospital: From 15 th percentile patient satisfaction to 90 th (3 years running) Clinic: From 50 th to 95 th (3 years running) Employee engagement from worst in the 8 hospital system to #1 in the 8 hospital system RAMI/RACI from worst in system and city to tied for 1 st From unprofitable to profitable

Results at MU Health Care How identity drove results from 2012-present Hospital: From 15 th percentile patient satisfaction to 89 th Exceeded budget 5 straight years, margins from 4% in 2012 to 8.75% in 2016 Employee engagement increases for four consecutive years from 14 th to 60 th percentile UHC/Vizient Ranked MUHC #9 in the nation in 2014, tracking in top quartile. Market share growth from 19.6% to 26.7% in four years 1,200 PDSA/QI projects done per year by 5,500 employees

KNOWING + DOING = SKILL USELESS USEFUL KNOWING KNOWING DOING DOING SKILL! 11

BKD Model: Work is MEANINGFUL when we see our identity in it. USELESS USEFUL MEANINGFUL WORK KNOWING KNOWING BEING DOING SKILL DOING DOING MEANINGFUL WORK KNOWING 12

WE LIVE IN COMPLEX TIMES 13

Exponential Intellectual Property Applications Doubling every 2 years 4000 3500 US Patent Applications 3000 2500 2000 1500 1000 500 EU Patent Applications 0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Source: USPTO and EU PCT and EPC 14

Explosive Risk - Bankruptcy Doubling every 10 years 4.0 3.5 Personal Bankruptcy/1000 persons 3.0 2.5 2.0 1.5 1.0 0.5 0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Source: Administrative Office of the US Courts and Census Bureau 15

World Population (Billions) Booming Population Growth 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0 100 300 500 700 900 1100 1300 1500 1700 1900 2100 Source: World Population Growth: Historical Trends & Future Prospects, Charles Hirschman 16

Our Mental Dilemma 25 YEARS AGO: 5 15 YEARS AGO: TODAY: 20 100+ MEMOS/WEEK VOICEMAILS/ DAY EMAILS OR TEXTS/DAY What is noise and what is signal? 17

Complexity in the Healthcare Industry The healthcare industry is the most complex form of organization we have attempted to manage in human history. Peter Drucker-

IDENTITY AS A BUTTERFLY EFFECT Cultural Identity is the Butterfly Effect Butterfly effects explain how tiny actions can cause huge results The problem is these actions are nonlinear and so are difficult to flow chart out. As a result we often discount them.

INSIGHT #1 YOU CAN ONLY MANAGE COMPLEXITY WITH SIMPLICITY 20

Group Behavior: Complex Flocking Behaviors 21

What complex flocking birds can teach us 3 individual instructions creates group order: 1. ALIGNMENT: Steer toward the average heading of the flock (see the vision) 2. COHESION: Steer toward the average position of local flock mates (stay close to your team) 3. SEPARATION: Avoid crowding other birds (but not too close need for autonomy) 22

3 Rules make Order from Chaos 23

INSIGHT #2 YOU MUST CREATE IDENTITY WITH THE BRAIN IN MIND 24

Identity is behind every action Identity is the butterfly effect, that small thing that creates large scale change IDENTITY - drives - ACTION - drives - RESULTS VS. 25

Ingredients for a Mental Identity Map IDENTITY MAP: I am a Mizzou Fan 1) Emotion Pride/Joy 2) Instructions Shout: Go Blue! Yell at the other team Wear Maize & Blue 1) EMOTION How we feel about the identity Emotion is encoded on each mental map The stronger the emotion, the more quickly it can recruit the mental identity map (for good and bad) In a new context, identity maps generally recruit.05 to 8 seconds before we are consciously aware of them affecting our behavior 2) INSTRUCTIONS The brain creates a list of instructions regarding behavior associated with that identity 26

When we perceive a situation through identity filters, reality is obscured Every situation recruits new identities which want to be validated or enhanced. Only occasionally do we drop identities that don t serve us. The Identities cloud reality and keep us from seeing things clearly. Recruited Identities Activated by the Situation Mother Doctor Stressed Victim Possible Identities The Situation You are running behind schedule and have three more patients before you can leave. One of your partners told the receptionist to send any walkin patients to you so they can leave early for a social function. You then walk into the room to see the patient Fear based identities keep us from seeing clearly given they are more clouded than power-based identities (due to a limbic hangover) 27

INSIGHT #3 WE ALL THINK IN IDENTITY NARRATIVES 95% OF THE TIME 28

The Narcissist Test When you see a group photo that you were in, who is the first person you look for? 29

Science has proven the brain broadcasts on 2 channels CHANNEL 1: NARRATIVE Plays our favorite program called Me and My Story We are always the main character We broadcast on this channel 95% of our waking hours High ego needs CHANNEL 2: DIRECT EXPERIENCE We broadcast on this channel 5% of the time We are not the main character but rather feel at one with the story line and those in it. No ego needs 30

Why can you listen to an hour lecture and only recite back 7% of it s content but remember almost 100% of the stories that were told? 31

INSIGHT #4 MAKING THE SCIENCE OF IDENTITY PRACTICAL 32

The Practice: Culture Building through Attention Density PROGRAMS THAT ENFORCE IDENTITY Power of One Awards Linking behaviors in evaluations Reciting the identity at the start of staff meetings Making the phrases part of the public language Power of One stated at the end of e- mails signatures, memos, etc 33

The Power of One: Together we Imagine, Inspire, Engage, & Excel Imagine Inspire Engage Excel Invent the future Simplify complexity Connect to the mission Lift others 10/5 Rule Assume positive intent Say Do Ratio 1:1 Reach higher

INSIGHT #5 OTHER ORGANIZATION WHO HAVE DELIBERATELY FOCUSED ON CULTURE AND BEHAVIORS 35

Culture as a trade secret 36

INSIGHT #6 EMPLOYEES FOCUS ON WHAT THE LEADER FOCUSES ON. SO FOCUS ON THE DESIRED ORGANIZATIONAL IDENTITY. 37

Leader as a museum curator 38

Museum Curators make choices about what they want people to focus on... Leaders make choices about what they want people to focus on... 42

CULTURE AND MISSION EMPLOYEES 45

What employees focus on Employees focus on what the leader (curator) is focused on... If you don t want employees to focus on something (drama, victim mentality, etc ) get it out of the gallery. 47

What to Expect It will take 18 months to get 12,000 people to memorize 1 sentence It will feel cool in the first six months, stale from 7-12 months, and then become who we are at 12-18 months Employees will never model it if the leader doesn t model it and recite it at huddles, reward for it, and hire for it. 48

Strong Identities Drive Higher Performance MOUNTAIN TRIBE VALLEY TRIBE 49

You were not his mother 50

Education is not the filling of a pail, but the lighting of a fire. W.B. Yeats 51

52 Thank You