The Issue: Reform in the Era of Health-Care Reform

Imagine trying to turn around a struggling hospital that just four years ago was facing multimillion-dollar losses, despite an annual government subsidy of $10.7 million. Add to this financial nightmare pervasive apathy among employees and physicians alike, complacency bordering on inertia, and an absence of accountability for results, even within the institution's leadership ranks. Layer atop this set of circumstances the question of health-care reform in the U.S., whose outcome even the most knowledgeable are hard-pressed to predict, and you've got an impossible confluence of leadership challenges. But it's a task that Dr. Karen Bankston, senior vice-president of Cincinnati-based Drake Center, took on. With a determined spirit and an abiding belief that the hospital-based Drake could become an institution to be admired, Dr. Bankston decided the real issues were ones of culture and accountability. Her efforts to transform the culture to a high-performance organization have paid off. I began working with Dr. Bankston and her leadership team at Drake in the summer of 2008. Together, we embarked on a journey that is both improving the patient and employee experience at Drake and making a difference in the bottom line.

Different Levels of CareTo understand the scope of the task of culture change at Drake, you have to appreciate the complexity of the organization. The Drake Center can best be described as a conglomerate offering several levels of patient care services. It provides long-term, acute-care services to medically complex patients, such as those requiring advanced wound care or neurorehabilitative services. Drake also provides skilled nursing services for patients who are residential as well as for those who are in transition. Typically such patients have orthopedic needs, ongoing intravenous requirements, or are recovering from an extended illness. In addition to three outpatient facilities, the Drake enterprise also includes an assisted living center, Bridgeway Pointe, which offers 102 apartments and care for dementia and Alzheimer patients, as well as assisted living services for patients under the age of 60. All the facilities have a medical model of service delivery. Drake, which had two prior owners and later became part of the Health Alliance of Greater Cincinnati, is once again in search of a new business partner. It was through a conversation with Dr. Bankston about the importance of harnessing the skills, passions, and values of employees to orchestrate cultural change that our work began in earnest with the senior leadership team. These executives participated in a leadership development process designed to connect them with their own skills and archetypes of passion, which were then aligned with their organizational roles and strategic objectives. When this same process was applied to the management level five months later, we started to see an immediate shift in Drake's culture, but it was clear that more was needed. I met with Drake's chief nursing officer, the head of operations and quality, and the head of human resources to craft the next steps.

Eclectic TeamIn a move designed to turbocharge the process, Bankston and her senior leaders agreed to create an internal change-process team that comprised front-line employees who dealt directly with patients in a variety of capacities. Managers nominated potential change team members, who were then invited to participate in an interview process for team selection.

"It was necessary to include people who are actually doing the work, because no one knows the job better," says Bankston. "We provided individuals selected for the team with a chance to better understand themselves and others, so that they could leverage their differences for the good of the organization." This process is instilling a strong sense of shared responsibility and collaboration broadly across disciplines in the organization and is seeding change leaders throughout the enterprise. In any large-scale cultural change process, success requires ownership at every level. That way, progress is independent of any one individual; instead, it's embedded in the way the organization does business. The result at Drake is an eclectic core team with 11 participants of varied backgrounds and institutional history, including an IV nurse, a pharmacist, a psychologist as well as employees from food and environmental services. Despite their educational, professional, and tenure differences, this is a team united by a common commitment to the future of Drake and a desire to create a culture of which they can be proud.

They are tackling the institution's toughest problems, and nothing is sacred in this culture crafting exercise. The change-process team is addressing all issues that affect the quality of patient care and employee satisfaction, including: response time to patient call lights, communication with patients and their families and among co-workers, teamwork at all levels, respect among colleagues and for the patient/family unit. The team is also defining new interviewing and post-hire evaluation processes for all individuals entering the Drake culture. Since the focus of the Drake transformation is on accountability and leadership at every level, everyone who joins the organization will now be evaluated by peers prior to a hiring decision and again within the first months of their employment. This is a change process with teeth. If the interview team examining the potential new hire does not agree that the individual is a good candidate who will support the Drake culture, the person will not be offered a position, regardless of their technical skills or credentials. Hiring the right people is a pillar in Drake's change platform and an important factor in supporting the progress made to date. The transformation efforts thus far have resulted in Drake stemming the cash hemorrhage that threatened its survival and have achieved other vital indicators of success, such as a 10-point increase in overall patient satisfaction scores and a 70% increase in patient referrals.

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