True Believers at Methodist Hospital

    "My experience was that the values component never truly became part of the corporate culture. I came to Methodist because of its reputation, not because they were starting this process," says Pluckhorn, who is now senior vice president of human resources for the entire Methodist Hospital System, which includes the Methodist Hospital and four smaller hospitals in the Houston area.

    Pluckhorn was so concerned that he decided to facilitate the first round of focus groups himself. Six meetings and 135 people later, he was converted.

    Pluckhorn says the employees’ response was overwhelmingly positive. Their only skepticism: Could management be trusted to follow suit? Would they also be held accountable? The answer has been a resounding yes, but it’s only part of Methodist’s renaissance as one of the country’s most successful health care networks.

    "You can’t always identify a clear line of sight between cultural change and operational performance," says Tom Daugherty, the Methodist clergyman who directed the values initiative and is now retired. But the numbers do tell a story.

    With the values initiative in full flight, turnover dropped from 24 percent in 2002 to 15 percent in 2004, a 38 percent decline. Vacancy rates went from 6.7 percent to 3.1 percent during the same period. Patient and employee/physician satisfaction levels are the highest in the company’s history.

    Employees say that about 90 percent of the time, the values that they want to see in their workplace are largely the ones they do see, says Cindy Vanover, Methodist’s new project director for spiritual care and values integration.

    While Daugherty and others at Methodist don’t claim a direct connection, they do believe that the focus on values plays a role in recent accolades the hospital has enjoyed. Methodist was named one of the top 100 hospitals in the country by U.S. News & World Report. Also, industry benchmarking company Solucient cited it as one of the top 15 major teaching hospitals "based on superior performance in reducing mortality, complications, length of stay and expenses."

From secular to spiritual
    The genesis of Methodist’s cultural crossing came in 1998 when the board decided that the network had become too secular, had lost touch with its faith-based roots and had become like any profit-making outfit. The board appointed a spiritual care committee, which researched a number of other hospitals and returned with two recommendations: Integrate spiritual values across the entire system, and hire someone to oversee that process. The person they tapped as vice president of spiritual care and values integration was Daugherty, who had spent most of his ministry in the health care industry.

    Despite getting the job, "there was still some confusion on the board as to just what was being attempted here," he recalls. "My job was to flesh this process out practically and operationally."

    Daugherty began by discussing with senior management their thoughts on spirituality in the workplace.

    "Houston is an international community, and (the Methodist Hospital) has a very diverse workforce--racially, ethnically and religiously," he says. "We were seeking a common ground of understanding. We wanted the process to be inclusive."

    The executive team established an employee committee from all five hospitals in the Methodist Hospital System (comprising more than 8,600 employees) and hired a facilitator. In a matter of months, Daugherty says, the group created the company’s first vision statement and "belief statement" and rewrote the mission statement, all developed around a central theme: the integration of spiritual values throughout the entire system. Working with senior management, it distilled the process into a set of core values, signified by the acronym ICARE: Integrity, Compassion, Accountability, Respect and Excellence.

    Coincidentally, it also became apparent that while the company had a record of financial success and a distinguished research history--including Dr. Michael DeBakey’s pioneering work in open-heart surgery--problems were surfacing.

    "Methodist was showing some red numbers for the first time," Pluckhorn says. "There was institutional bureaucratic gridlock, and we were slow to respond to changes in the health care industry. We had begun to believe our own myth. We needed to move the company from a structured, paternalistic mindset to a more businesslike approach."

    This didn’t affect the values quest, but just as the process reached a milestone in mid-2001 with the release of results from Methodist’s first "cultural assessment" survey, Tropical Storm Allison blew in, drenching Houston with 36 inches of rain in nine hours. The impact on Methodist Hospital, the flagship facility, was devastating, Pluckhorn says. Basements flooded. Patients were transferred to other hospitals.

    Although the hospital never officially closed, it was essentially not operational, and aside from a small number of employees who were asked to work periodically, the vast majority of the hospital’s 5,400 workers could not come to work for 10 weeks.

    And yet the storm clouds had a silver lining. "It turned out to be a remarkable team-building experience. We even kept paying everyone," Pluckhorn says.

    A few months later, the board named Ron Girotto--who had been Methodist’s COO and CFO--as interim CEO. Pluckhorn says Girotto "really championed the values effort," and the process accelerated.

Making values real
    Daugherty and consultant Cindy Wigglesworth were aware of the need to integrate values into the day-to-day operations of the company, so they mapped out an education and tracking strategy. The 2001 survey, designed by consultant Richard Barrett, became the centerpiece of the tracking function, establishing a baseline for the organization’s values.

    The survey comprises three parts: identifying the individual’s values, identifying the values they see in their workplace (current culture), and identifying the values they want to see (desired culture). Each respondent chooses 10 values from a list of up to 90, which Barrett and his team customize for each client depending on their needs and their industry. The extent to which perceived and desired values match up is the measure of how healthy a corporate culture is. Tracking their alignment--or its absence--is a way to evaluate progress.

    As part of the integration strategy, the hospital system introduced a series of training sessions: "Spiritual Integrity at Work," "Healing and Dying Across Cultures" and a four-hour "Living Methodist Values" class. Each of Methodist’s employees, including physicians, was required to attend. The system did an employment satisfaction survey in late 2001.

    Wigglesworth’s role was to then turn the five ICARE core values into actual performance by helping work groups interpret the values as they related to their functions. She asked the various groups to identify three behaviors for each of the five core values. What would integrity look like? How about excellence? "Each work group ended up with 15 behaviors that were specific to their areas of expertise and responsibility," Wigglesworth says.

    The nurses in radiology, for example, defined accountability as "Don’t ask why; ask why not. Follow through and correct mistakes." The staff in IT data security boiled it down to "If I do not understand, I will ask questions. I will not talk down to others." On the matter of integrity, the retail pharmacy declared, "We will always do our best whether the boss is here or not." The council of CEOs from throughout the hospital system vowed to "challenge each other with respect."

    Daugherty considered this "work-group commitment process" a key accomplishment. "It took the words off the posters and put them on the floor," he says. "Every manager, from CEO to supervisor," met with every person who reported to them "to develop agreement on the specific actions that expressed those values."

    Joe Velasquez, director of central services for Methodist Hospital, says the values are indeed lived out by employees.

    "I worked at a lot of hospitals as a materials management consultant before I got tired of flying out on Monday and struggling to fly home on Thursday," Velasquez says. "I can say that this is the first hospital I’ve ever been in that really practices its values. All hospitals have values, but it doesn’t mean much--to many, the values are just the flavor of the month. Here at Methodist, it’s consistent; the values aren’t going to go away. They are an integral part of all that we do. That makes this a great place to work."

    Despite sentiments like that, there were still some concerns over the use of the word "spirituality" when describing the process. "The connection between spiritual care and values integration wasn’t understood by many," Daugherty says. "There were suspicions that the Methodist faith would be crammed down people’s throats, that some kind of litmus test would be used."

    Concern finally gave way to acceptance when employees realized that the process had nothing to do with religion. "We broadened the concept of spiritual care to mean the quality of the relationships between each other and with the people we served," Daugherty says.

Multiple Payoffs
    The ultimate challenge for Methodist, and for any company engaged in cultural renewal, was to convert the changes into measurable performance upgrades. Is all this work really making a difference? Vanover considers it a no-brainer. As a human resources coaching tool, she says, the values survey and its tracking function are "the most marvelous instrument ever invented."

    As Barrett explains it, the survey and tracking function are "extremely good for giving insights into what’s working and what isn’t at all levels--companywide to specific work groups."

    Vanover says the ability to track values at specific management unit and work group levels delivers both a feedback loop and a language for problem-solving.

    "We look for places where there are negative values or the lack of positive values," she explains, referring to the two sets of 10 values (current vs. desired) that come up in the survey data. "We then send an organizational development/human resources team when a problem is identified. The values give them a base to start from, working with managers who have the same sets of words that describe the state of their unit, both real and desired."