Lead with your middle
Many of the changes at Scripps were operational in nature. But the system also needed a cultural overhaul, and cultures aren’t changed from the top down. They’re not changed from the bottom up, either.
Van Gorder says cultures are changed in the middle. Your middle managers are high enough on the ladder to be visible to their entire company segment, but low enough that they can still have frequent personal contact with employees on the lower rungs.
Middle managers can reach every corner of your organization. With that in mind, Van Gorder places a top priority on getting his hospital-level management on board with his new decentralization plan.
“I’ve been in a lot of organizations and I’ve seen no way that a CEO can write a memo to change culture,” Van Gorder says. “At the other end, there is no way a ground level employee can change a culture. So my hypothesis was that, over time, the middle managers would become the agents for culture change.”
Van Gorder constructed a panel of 25 of Scripps’ middle managers and placed them in a yearlong program of periodic full-day sessions. Each session contained several hours of open discussion with Van Gorder, during which he encouraged frank discourse and tough questions about the health system’s future.
“Every time we’d do this, they’d all come in a little timid, a little unsure about what they could ask me,” he says. “I’d usually chide them, tell them that they’re not a very good class because they’re not asking tough questions.
“There were only two parameters we had for the question-and-answer sessions: We didn’t allow personnel-related questions and we didn’t allow questions about anything related to a confidentiality agreement. Everything else was fair game. What that does is, eventually, it starts getting people more comfortable with me and each other, and it gets people to be more transparent with information.”
If you’re going to get your middle managers on board and allow them to become agents for the organizational changes you are planning, first you have to give them a reason to get on board. You do that by giving them a chance to understand why a decision was made, how it impacts them and how they can help carry it forward.
“What I’ve always said is that people need to understand why decisions are made in an organization,” Van Gorder says. “I started out as a clerk in the emergency room and I spent many years thinking, ‘That is a crazy decision; why would they do that?’ It builds kind of a distrust of the intelligence behind decisions that were made, a distrust of the overall direction of the organization. But if people understand the parameters of a decision, they might understand the decision and be able to own it better.”
After a year of meetings with middle management, Van Gorder began to see a change in attitude throughout the Scripps system. Managers began to take a wide-angle view of decisions, looking at cu
lture and strategy from the perspective of corporate management instead of just from the perspective of their own organizational units.
“I now had a group of 25 people who understood that the center of the universe didn’t exist in each of their business units,” Van Gorder says. “They began to understand that the greater Scripps was a pretty robust organization and that there are experts throughout the organization that they can tap into. Rather than doing something all by yourself, maybe somebody has already done it at one of our sister campuses.”
From there, Van Gorder put a message in his middle managers’ minds and sent them out to their respective campuses to spread the word.
“I told all of my middle managers that they are my agents for culture change, and what I expected from them is to go into their hospitals and talk about how we have a whole system here to help you,” he says. “No. 2, I told them to demand more from the people they work with. Senior management should be delivering more to you and you need to deliver more to the people who work for you.
“Truthfully, even though it was a cool thing to say, I wasn’t sure if even I believed it. But they proved me right, and they brought the whole organization together.”
