Get everyone involved
Creating the culture that would be embraced by all employees
meant that the process would have to involve people from each of
the organizations that made up Texas Health Resources, which
had fiscal 2006 net operating revenue of $2.3 billion.
“Our first desire when we came together was to acknowledge
and appreciate what each organization brought,” Hawthorne
says. “Rather than just toss it out, let’s acknowledge this history, but, at the same time, let’s talk about what it means to be a
new company.”
Hawthorne brought teams of leaders from all three systems
together to talk about how they each performed certain tasks
and asked each group to choose the best solutions. In some
cases, the group might choose an entirely new approach none
had tried before, and he gave them the freedom to make those
choices. Those groups, called COPICs, which stands for clinical
and operational performance improvement councils, still meet
regularly today. Each group had leaders from similar areas
across the 13 hospitals.
“It began to create within the organization more of a creative
approach to things, rather than just relying on the old way,”
Hawthorne says. “That was moving the culture into the new
realm.”
Each team prepared its own agenda of critical issues.
“It was their responsibility to discuss and find a common
response, and then to execute that across the organization so that
we would create a standard of practice, so that whenever you
entered one of our hospitals, you would see a common outcome,”
Hawthorne says. “Now, that’s been a real challenge, as you can
imagine. People do have a tendency to hold on to their pride of ownership. How do you break that up if there is no accountability? We tried to create accountability by developing strategic plans
that call for specific outcomes at certain periods of time. The only
way those outcomes can be achieved is if everybody is focused on
that achievement.”
One example was creating a payroll system. Human
resources and finance managers met and created a common
payroll system, paychecks and benefit plans among all of the
hospitals.
“What we became was one employer,” Hawthorne says.
The COPIC teams presented their major recommendations to
the System Performance Council, a group made up of the
health care system’s leadership, which evaluates major decisions, offers feedback and approval.
“My belief is that those who are doing the work provide the best
solution to the issues around that work,” Hawthorne says. “It may
not necessarily always be the solution I may have selected, but if
they do it collectively and find it to be the best outcome, then I
think we’ve done it in the right way. If they’ve done it unselfishly
and if they’ve done it in an unbiased way, if they truly have looked
at it from the standpoint what’s best for the system versus what’s
best for my individual entity, then we do get the best outcome.
“On occasion, they will step back after a period of time, which
they have the opportunity to do, and say maybe we didn’t make
the right decision. But that’s part of it, too. I think that kind of
decision-making down deep in the organization gives us more
empowered leaders and, ultimately, better outcomes.”
Hawthorne says clear communication on the organization’s
guiding principles kept the teams on message. Employees
know not to make decisions or suggestions that violate those
principles. For example, among those guiding principles is the
health care system’s faith-based structure, which includes
chapels on hospital property and chaplains on staff. Another
guiding principle is creating and holding green space around
the hospitals because Hawthorne says that patients who can
see trees and greenery from their windows enjoy the view, and
it may aid in their healing.
“On occasion, we have had some of the engineering groups or
COPICs decide that they have wanted to put in more driveways
or parking lots or eliminate some of the green space around new
buildings,” Hawthorne says. “Those I have had to take a position
on. The other issue where we have things that are nonnegotiable
are around our faith-based values — the fact that we are a faith-based system and the fact that we will have pastoral care programs in our hospitals and chapels in our hospitals. It’s one of
those things that on occasion, we have people who may want to
modify that or change that, and those are things that get vetoed.”