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Creating a Cultural
Blueprint for Your
Invisible ArchitectureThe Hospital Cooperative
August 10, 2015
Joe Tye, CEO and Head CoachValues Coach Inc.
Copyright © 2015, Values Coach
Inc.
There is an invisible barrier on
the potential of your
organization
leadership
From the Pulitzer Prize winning book
Leadership by James MacGregor Burns
Managemen
t is a job
description
Leadership
is a
life
decision
In today’s complex,
turbulent, and
uncertain world we
need leadership in
every corner, not just in
the corner office.
When Sally and I were in the
market for a second home in
Arizona our criteria were:
Spectacular back yard
Low to zero maintenance
Affordable
And this is our primary
residence, the house
where we lived for 20
years and raised our two
children – photo taken
April 2013…
Lesson #1
Things aren’t
always what
they seem.
Lesson #2
What you really
want might be
closer than you
think.
Lesson #3
You must be
willing to
jettison old
baggage to
move forward.
Lesson #4
There is almost
always a way to
create a win-win.
A word about the
assumptions we
make.
What do you get
when you break the
word “assume” into
its constituent
parts?
Question #1
When did the
healthcare
crisis begin?
Florence Nightingale firsts include:• Medical records
• Laundry and housekeeping
• Infection control
• Nutrition service
• Pharmacy
• Materials management
• Patient library
• Medical triage
• Nursing uniforms
• Chaplain service
Question #2
When will the
healthcare
crisis end?
Healthcare Crisis
YOU
Companies that study
employee engagement*
consistently find:
~ 25% fully engaged
~ 60% not engaged
~ 15% aggressively
disengaged
* e.g. Gallup, Avatar, Press Ganey, Modern Survey
Engaged: Spark Plugs
35
Not Engaged: Zombies
36
Disengaged: Vampires
aka Pickle Suckers
37
Dilbert Disease
Hates boss, despises
coworkers, avoids being given
real work to do; biggest fear is
losing the job.
If that’s not neurotic,
what is?
Source: Curt Coffman and Kathy Sorensen: Culture Eats Strategy for Lunch
Disengagement Entitlement
Disengagement effects…
Clinical
quality
Patient safety
Patient
satisfaction
Productivity
Marketing
image
Turnover (good and bad)
Job security
Disengaged people,
especially disengaged
managers, are a
defect
What is the lost
productivity – or put
another way what is the
dollar value of the
opportunity cost – of all
those wasted hours?
$500,000,000,000
The real tragedy of disengagement >>>
It has a life-diminishing
impact on the
disengaged.
“Disengagement [is]
one of the chief causes
of underachievement
and depression.”Edward M. Hallowell, M.D. in HBR, 12-10
Cynthia Pearsall
Mina Ubbing
CeCe Peters
We can do better than this.
We can BE better than this.
The journey from mere
Accountabilit
y to a culture of
Ownership
From the Information Age to the Conceptual
Age “The ability to encapsulate,
contextualize, and emotionalize
has become vastly more
important in the Conceptual
Age.”
Daniel Pink: A Whole New Mind: Moving from the Information Age to the Conceptual Age
Bean
Cou
nte
rPo
et
Left Brain Counts
Right
Brain
Creates
Linear
Relational
Rules
Values
Plans
Inspires
Measured
Seen
A Given
A Choic
e
Inert
Contagious
Process
Attitude
systems
Culture
What you do
Who you are
Boring!
Chaos!
Please turn to page 20
of the Cultural
Blueprinting Toolkit
workbook
Ac
count
able
Joe’s word association game
What other words do
you associate with
the word
accountability?
Not trusted
Rules
ConsequencesBlame
April 15More stick than carrot
Looking over your
shoulder
Punitive Feet to the fire
Accountability
Doing what you are
supposed to do because
someone else expects it of
you. It springs from the
extrinsic motivation of
reward and punishment.
The
Accountabilit
y Continuum
Hierarchical
accountability…
Someone else looking over
your shoulder.
It is the accountability of
a parent over a child
A boss over a
subordinate
It’s the accountability of
command and control
Hierarchical flows downhill!!!
The metaphors
we use for
hierarchical
accountability :-o
Cultural accountability
is when a group of
peers hold each other
accountable.
Cultural accountability
is what prevents
people from lighting a
cigarette in a public
place.
Cultural accountability
is far more powerful
than hierarchical
accountability – for
better and for worse.
At its best, cultural
accountability creates
positive peer pressure to
treat others with
respect…
Refrain from toxic
emotional negativity
and to perform at the
highest professional
level.
At its worst, cultural
accountability creates
negative peer pressure to
not be an overachiever...
And to participate in
chronic complaining,
bullying, gossiping, and
other forms of toxic
emotional negativity.
Personal accountability
is holding yourself
accountable.
No one has to hold your
feet to the fire when
you are willing to walk
across hot coals
on your own.
You cannot hold people
“accountable” for the
things that really
matter.
Nobody ever
changes the oil in a
rental car!
Ownership
Doing what needs to be
done because you expect it
of yourself. Ownership
springs from the intrinsic
motivation of personal
pride.
22,844,690 views 86,976– avg 5 stars
108
Invisible
Architectur
e“Invisible Architecture” is a trademark of Values Coach Inc.
Invisible Architecture™
is more important
than bricks & mortar
The Blueprint
Behind the
Blueprint™
Invisible architecture
is to the soul of your
organization what
physical architecture
is to its body.
3 stages
Th
e F
ou
nd
ati
on
Core values define who
you are, what you stand
for, and what you won’t
stand for
A great statement of organizational
values:
Defines expectations
Taps into emotions
Inspires action
Aligns with personal
values
Integrated DNA Technologies Inc. values (excerpt)
Be yourself,
Unless you’re a jerk
118
From the statement of values
“These values, which guide
Mayo Clinic’s mission to this
day, are an expression of the
vision and intent of our
founders, the original Mayo
physicians and the Sisters of
Saint Francis.”
From the statement of values
“Staying true to our core values
during thirty-plus years in
business has helped us create a
company we’re proud to run
and work for.”
Have you ever been to a Texas Roadhouse?Passion, Partnership, Integrity and Fun
From the Cypress Semiconductor values
(excerpt):
CYPRESS IS ABOUT WINNING
We do not tolerate losing.
We thrive on competing against the world's best.
WE MAKE OUR NUMBERS
We make 20% profit.
We each set goals and achieve them.
We ship 100% on time and get zero returns.
Values Behaviors Outcomes
Continuum
The desired
Outcome is
Trust
The required
Behaviors are
Honesty and
Reliability
The motivating
Value is Integrity
The 3-minute
values clarification
drill…
Memorial Hospital of Converse CountyDouglas, Wyoming
Posted version
Compassio
n
Advocacy
Respect
Excellence
Posted version
Compassio
n
Advocacy
Respect
Excellence
Group version
Integrity
Enthusiasm
Loyalty
Stewardshi
p
Ownership
Fun
From…
Compassion
Advocacy
Respect
Excellence
To…
What values would
you come up with?
A statement of values does
not have to be a boring
brass plaque
A tough love message
By not expecting people to
know your core values by
you are implicitly making an
assumption that they either
don’t care or are not smart
enough to learn them.
Besides, if 5 year old kids
can learn the Pledge of
Allegiance by why can’t
you expect adults to learn
core values?
140
“People who are clearest
about their personal
vision and values are
significantly more
committed to their
organizations.”James Kouzes and Barry
Posner:
A Leader's Legacy
Organizational values define
strategies while personal
values define culture.
Nobody learns
everything they
need to know in
kindergarten!
When a critical mass
of people connect
with and act upon
their core values,
they will have a
positive impact on…
Th
e S
up
ers
tru
ctu
re
Culture is to the
organization what
personality and
character are to the
individual.
Which diner is most
likely to earn your
repeat business and
have you recommending
the place to friends and
neighbors?
or…
This is not a trick
question…
It’s the reality of
competing today.
Same business
Different cultures
People pay to
shop at
Costco…Ecstatic employees
People shop at Wal-
Mart because they
don’t have to dress up
like they do for the
Dollar Store.
Same business
Different cultures
Nap
Rap
Same business
Different cultures
“No single
person owned
any decision.”Valukas report on the
GM safety scandal
Same business
Different cultures
Those who think culture can’t change will be demolished by those who are doing it!
Culture is to recruiting
and retention what
marketing is to gaining
and earning customer
loyalty
>>>>>>>>>>>>>>
Modern Healthcare cover story 1/19/2015
“Nurse shortage
looms”
10 Reasons Culture
Eats Strategy for
Lunch
Reason #1
People are
attracted by
and loyal to
culture, not
strategy
Southwest
Airlines didn’t
earn the highest
loyalty in the
industry with its
bags fly free and
fuel price
hedging
strategies
Reason #2
Culture
provides
resilience in
tough times
“The only assets we have
as a company [are] our
values, our culture and
guiding principles, and
the reservoir of trust with
our people.”Starbucks CEO Howard Schultz in
Harvard Business Review, July-August
2010
Reason #3
Culture is more
efficient than
strategy
Nordstrom people don’t go
above and beyond the call
of duty because it’s in a
policy…
Nordstrom has only one rule…
Reason #4
Culture creates
competitive
differentiation
Les Schwab sells the same tires
you can buy anywhere else – but no
one can compete with their culture
“Advertising is a tax
you pay on having an
unremarkable culture.”
Robert Stephens, Founder of Geek
Squad
Your culture is
your brand!- Tony Hsieh
Reason #5
A brittle culture
can doom even a
great
organization (or
product)
As witnessed by one
of the most highly
publicized funerals
of our time…
The fingers are all
pointing in the
wrong direction
What really killed
Hostess was a culture
of labor-management
hostility.
Reason #6
When strategy
and culture
collide, culture
will win
Nardelli’s hard-fisted GE
strategies increased
sales, profits, and stock
price…
At the cost of violating its
people-centric values and
ability to compete for the
best talent.
Home Depot’s board
wanted so badly to get
rid of Nardelli that they
paid him a quarter of a
billion dollars just to
make him go away!
Reason #7
Cultural miscues
are more
damaging than
strategic ones
Not fixing Dave Carroll’s
guitar cost United $millions
Reason #8
Culture
provides
greater
discipline than
disciplinary
action does
Reason #9
Culture provides a
level of risk prevention
that cannot be
attained with strategy
alone.
Wal-Mart’s culture of
low price at any cost
has come at a huge
cost to the company.
Wal-Mart has spent
nearly $500 million
on the investigation
of bribery and other
ethics scandals.
Sam Walton would
be rolling over in his
grave!
Reason #10
Culture will have a
significant impact on
your future bottom
line.
Describe your culture
(current and ideal) in
just 6 words.
This is a lot harder than
you’d think – especially if
you avoid boilerplate
slogans and make in real
and authentic.
202
From managers
sitting in the same
room at one large
medical center’s
leadership retreat
203
We love patients
and each other
204
We are ALWAYS
here for you
205
Multiple
priorities, limited
resources, great
expectations
206
We’re entitled,
hating it,
and staying
207
Beatings will
continue until
morale improves
Southwest Airlines Motto
Servant’s Heart, Warrior
Spirit, Fun-Loving
Attitude
Cypress Semiconductor Motto
The Marine Corps of
Silicon Valley
Entrepreneurial small business
We’re tough
We’re focused
We win
The Florence Challenge
Emotionally
Positive
Self Empowered
Fully Engaged
What 6 words would
you use to describe
the culture of your
hospital?
Please turn to page 103
of the Cultural
Blueprinting Toolkit
workbook
Exercise #4-2 in the Cultural
Blueprinting Toolkit Workbook, pages
103-106
Use the Culture
Mapping Schematic
to define culture
change strategies
This tool will help you
create a tactical
roadmap for specific
activities to achieve
desired culture
change.
Desired
out
com
es
Esse
ntia
l
char
acte
rist
ics
Prove
n
stra
tegi
es
There is no right-or-
wrong, cookie cutter
answer to how you
navigate the Culture
Mapping Schematic…
It’s like the tumblers in a
bank vault – the idea is to
align the why, what, and
how of a particular
strategy.
One final point:
Cultural work can’t be
just a “flavor of the
month”
Culture doesn’t change
unless and until people
change
Th
e
Inte
rior
An enthusiastic
workforce gives you an
incredible source of
competitive advantage
in a world where 75% of
workers, on average,
are disengaged!!!
234
A positive workplace
culture begins with
intolerance for toxic
emotional negativity.
235
Emotional climate is
determined by what
you expect and what
you tolerate…
236
And over time, what
you tolerate will
dominate over what
you say you expect!
Have you defined
your ZTBs?
Do you have the
courage to enforce
them?
238
“One toxically negative
person can drag down
morale and productivity
of an entire work
unit.”
239
“It is a leadership
responsibility to create a
workplace environment
where toxic emotional
negativity is not
tolerated.”
240
Unfortunately, we
are swimming
against a strong
current that’s going
the wrong way…
241
The simple promise
that will change your
life…
And change your
organization…
Work sucks
then you
die
The Pickle Challenge
has taken on a life of
its own!
245
Grinnell Regional Medical Center
The Pickle Challenge
Caveat: You will get
resistance to The Pickle
Challenge.
It will be most vociferous
from people who could most
benefit from taking it to
heart.
The Florence Challenge
Emotionally
Positive
Self Empowered
Fully Engaged
Therapy pets can even
sign!
Building a
culture of
ownership
Do you have to start with the
right people on the bus?
You can’t always
choose who you
have on the bus!
You can’t just
throw all the
“wrong” people off
the bus!
You can create a bus that
everyone wants to ride
It begins with a
shared vision…
270
Essential
qualities for
promoting a
culture of
ownership
Commitment
To the values,
vision,
and mission of the
organization
Commitment is
most important
when the going
gets tough...
“We need to see
opportunities where others
see barriers. We need to
be cheerleaders when
others are moaning doom-
and-gloom.”
“We need to face problems
with contrarian toughness
because it’s in how we
solve those problems that
we differentiate ourselves
from everyone else.”
“Brick walls are not
there to stop you, they
are there to make you
prove how much you
want something.”
Randy Pausch: The Last Lecture
Engagement
With patients,
coworkers, and
with the work itself
At Best Buy, a 0.1%
increase in employee
engagement generates
a $100,000 increase in
gross store revenue*
* Harvard Business Review, October 2010
Initiative
A “Proceed Until
Apprehended”
mindset
283
Can one person
who takes
initiative change
your
organization?
287
MMFI!
Belonging
Making everyone
feel like a partner
and not just a
hired hand
The root of the word
integrity is “integer”
– one unified whole
The incredible
invisible man
Fellowship
Fostering a
“support group”
culture of respect
and caring
293
Pride
In the organization,
in the profession,
in the work, and in
you yourself
Pride is reflected in the answer
to that universal icebreaker
question:
What do you do?
What do you do?
Thanks for asking!
I’m good at what I do.
I love what I do.
I’m proud of what I
do. What I do is
important.
What could be more boring than
industrial ventilation systems?
299
BigAssHospital.com
Passion
Enthusiasm,
positive attitude,
and joy reflected in
everyday actions
Remember CeCe?
If you think such
a profound
change is
impossible, let
me remind you
>>>>>>
And where is your
smoking section
today?
>>>>>>>
308
Across the highway!
If we could do it
with toxic cigarette
smoke, why can’t we
do it with toxic
emotional
negativity?310
“I got a whole new team
and didn’t have to
change any of the people
because they changed
themselves.”
Paul Utemark, CEO
Fillmore County Hospital
Geneva, Nebraska
10 key lessons we’ve
learned through our
work on cultural
transformation…
Lesson #1
Launching a movement is
a lot harder than starting
a program – it is also
much more likely to
achieve a lasting positive
impact.
314
Lesson #2a
Achieving critical mass
requires approximately
30% population
commitment.
Lesson #2b
You need enough people
moving fast enough to
escape negativity,
pessimism, cynicism, and
inertia of the past.
Lesson #3a
Top down direction and
support
AND
Bottom up passion and
innovation
Lesson #3b
People must believe
senior leadership
believes in and is
committed to the
cultural vision.
Lesson #3c
Middle management’s
mere support is not
enough – they must be
gung ho champions for
change.
A tough love message…
Lesson #3d
The privileges of being a
manager also entail
certain foregone
freedoms
Lesson #4d
Engage the medical staff
in a meaningful and
proactive manner
>>>>>>>>>>>>>>>>>
The Twelve Core Action Values
The Twelve Core Action Values
Lesson #4a
Embrace the skeptics,
marginalize the cynics,
and plow through
resistance
Lesson #4b
Engage potential critics
in a constructive
manner – encourage
them to think like
partners in the change
process
Lesson #5a
Sustainability requires a
growing core of
passionate “Spark
Plugs” who have a
personal stake in
cultural transformation.
Lesson #5b
Personal stories
resonate better than
scripted lectures.
Lesson #6a
Avoid identification of
the change process with
any single individual or
“program.”
Lesson #6b
Create initiative
coherence by being
clear about how various
projects reinforce one
another.
Lesson #7
Keep it visible: posters,
banners, screensavers,
newsletter articles, web
pages; include it at the
start of every meeting.
Lesson #8
Remember that
everyone listens to the
same radio station:
WIIFM.
Lesson #9
Balance urgency and
patience to sustain
momentum; be in it for
the long haul.
Lesson #10
In order to be
sustainable over the
long-term, the culture of
an organization must
rest on a solid
foundation of values.
A Key Point!
You cannot allow
people to opt-out of
positive culture
change!
“If we each do our
part, we will
change our lives for
the better.”
335
Wes Barnt Bob Dent Kyle Graham Katy Longbotham
“If we all do our
parts, we will
change our
organizations for
the better.”337
Midland Memorial Hospital Values and Culture
Initiative
“And in changing our
organizations, we can
change our world for the
better.”
340
The Triple Win
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