Creating and Nurturing Culture in Healthcare with Joe Tye | E.4

Lisa Miller (00:15):

All right. Welcome, Joe Tye, to the Healthcare Leadership Experience Podcast. I'm really grateful to have you on our show today, so welcome.

Joe Tye (00:26):

Thank you. It's a privilege to be here.

Lisa Miller (00:28):

That's great. If you're hearing us on the podcast you won't see it, but some of you will see us on video, I have Joe's new book, which is absolutely fabulous. I'm about three-quarters of the way through it. It's Building a Culture of Ownership in Healthcare. And we're going to talk a little bit about your book and also about what you're experiencing as you provide leadership and guidance to healthcare leaders across the United States. So I just want to jump right in. In your book, you talk about invisible architecture. Can you explain that a little bit in more detail about that framework?

Joe Tye (01:13):

Sure. When you walk into any hospital, any building, your first impression is created by the bricks and the mortar, but that's not your lasting impression. If I'm a patient in a hospital for four days, I'm not going to go home and talk to people about the carpeting and the wallpaper, as beautiful as it might be. I'm going to talk to them about the things that you really can't see. How was I treated? How did they make me feel? How did I perceive them treating each other? And so we use a construction metaphor for what we call the blueprint behind the blueprint, invisible architecture.

Joe Tye (01:46):

And in that construction metaphor, the foundation is core values. And every organization should be clear about three things; who you are, what you stand for, and what you won't stand for. And that should be reflected in a statement of core values. And all too often, the statement of core values is sort of a generic ... It could be put up on the wall of any hospital and not seem out of place. And the challenge is: How do you come up with something that is authentically reflective of who we are and what's unique about us? Something that would be a valuable tool in recruiting, for example.

Joe Tye (02:33):

On that foundation of core values, and I'll give you an example of each if we have time, on that foundation of core values, the superstructure is culture — which we define as the personality, the character of an organization. And in a great organization, there's not a gap between values and culture. It's like if you have a building that's well-constructed, you don't see a gap between the floor and the wall, or there aren’t bubbles in the wallpaper. In many organizations, there's a gap between the stated values and what people actually perceive. Any time you hear that horrible metaphor, nurses eat their young, for example, if a nurse has that kind of an experience, that hospital is not living its values because I guarantee somewhere they talk about integrity, respect, dignity, fellowship. And that's not reflected if the organization allows bullying, allows uncivil behavior.

Joe Tye (03:35):

And that gets me to that interior finish in our construction metaphor, which is attitude in the workplace — how we treat each other. And we have a culture assessment survey where we ask people to estimate what percent of all paid hours in your organization get wasted on toxic emotional negativity. And the numbers are horrifying. They run from typically a low of around 10%. We've seen as high as 25%. And of course, you can apply that percentage to the hospital or health system's annual salary, wage, and benefit budget — and they're spending millions, tens of millions, in a big system, hundreds of millions of dollars paying people to bitch, moan, whine and complain, the other BMW club.

Joe Tye (04:25):

And if you build a building, you have an incredibly structured process. You have interior designers, architects, consultants, you have committees working on carpet color. People are out in the parking lot with masking tape, moving stuff around. And then you move in the invisible architecture without any sort of a plan typically. And what we challenge people to do is to create a blueprint for what you want to go inside that beautiful building.

Lisa Miller (04:58):

It's such a great metaphor. And in fact, I think it really brings it right to light because hospitals, for the most part, have all gone under a renovation and understand that they're looking at furniture, they're looking at the walls, the cleanliness. And I think it's such a great analogy just to line that up, that there's an architecture — an invisible architecture. I know number three is the buildings that are finished. Do you want to continue with that?

Joe Tye (05:28):

Sure. When you build a building, the work is done — but there's still ongoing maintenance. With the invisible architecture, I think that's even more important that your commitment to culture, for example, is never ending, that you need to continuously be investing in leadership development, in staff development. Culture should be part of every new employee orientation. It should be part of every daily huddle. Even simple things like we have this self empowerment pledge, it's one promise for each day of the week, where we've seen that incorporated into the daily staff huddle. Over time, it starts to become part of your cultural DNA. Or the pickle pledge, I will turn every complaint into either a blessing or a constructive suggestion. After a year or so of people knowing that, when someone starts whining or complaining, somebody else is going to go, "Put a quarter in the pickle jar."

Lisa Miller (06:39):

Yeah. I love that. You were talking earlier about the patients even seeing how employees treat each other. And a few years ago, we still do this. I remember this one particular assessment we were helping with, and we were going through some of the Press Ganey scores. But we weren't just looking at the scores — we were looking at the comments. And I have to tell you that from this point on, I go right to the comments. And the comments are just... they actually line-up to your invisible architecture. And you don't realize that the patients are watching the behavior.

Lisa Miller (07:21):

I remember one comment was something to do with two nurses arguing, and they wrote that. And just it speaks to exactly what you've said — people are watching how they're treating one another, and it does matter, and they are picking up on it. But I think there's so many different ways that a hospital can really understand really what's going on in different forms. And just we wanted to hear the voice of the patient really, and then doing that work and building that architecture like you talk about.

Joe Tye (07:58):

I'm a big fan of the DAISY Foundation (DAISY Awards for Nursing Excellence). Well over a million nurses have been nominated for DAISY awards — and I guarantee not one of them was for something that's in the job description of something they learned in nursing school.

Lisa Miller (08:14):

I agree.

Joe Tye (08:15):

It's always related to the invisible architecture somehow.

Lisa Miller (08:22):

Yeah. And I'm going to give you a personal story. I just thought about it. My daughter was in the hospital in this last year. And it's tough, as she was nine at the time, and she had some seizures. And they've gotten it under control, but I will tell you the woman in dietary came in and just hit it off with my daughter. And she had Disney pins all over — and my daughter loves Disney. And just every day, she would look for ... I'm going to remember her name in a minute. She would look for her. We ended up bringing one of our Disney pins from a trip to give it to her. But that person made my daughter's nine-year old having to sleep in a hospital for several days, that's culture. She was so impactful, that made a difference in my daughter's life. And I just think that you don't realize all those things that really do matter. And I agree with you, there's so many stories that I can give personally of nurses that have changed my family's life because of — they did go the extra mile that wasn't in their job description.

Joe Tye (09:29):

Yeah. And those are the things that people remember years later.

Lisa Miller (09:34):

Yeah. I still have a picture of the woman on my phone with my daughter with Disney pins. So I want to jump to another chapter in your book, which I love, is chapter four, for those of you who'll get the book. Again, it's Building a Culture of Ownership in Healthcare. And it's called A Superstructure of the Organization of Culture. But really, it's the ten reasons why culture really does eat strategy for lunch. So we've all heard that comment, but culture eats strategy for lunch. But you go into a lot of detail — and I love your details. Can you just speak a little bit about that from your perspective in healthcare?

Joe Tye (10:13):

Sure. If you think about the organizations you really admire and compare them with competitors that maybe you don't, it's always culture. It's not strategy. It's not ... Southwest Airlines compared to United Airlines, Costco compared to Walmart, USAA compared to Wells Fargo, they're in the same businesses — but what's different is culture, what's different is how they treat each other, how they treat their people, how their people treat each other. And that is something that requires constant ongoing work.

Joe Tye (10:53):

Herb Kelleher, the late Herb Kelleher, the founding CEO of Southwest Airlines, whenever he was asked, "What is your most important job?" He said, "Protecting and nurturing our culture." And it shows.

Lisa Miller (11:10):

Yeah. It definitely shows. Can you speak a little bit more about that? Because you have such tremendous experience as an administrator. Right? You were in the C suite as a hospital administrator. And I'm going to ask you later on what got you here and the why behind your story to do this great work. But sometimes we talk about culture and we talk about, okay, we're going to have these programs. But we don't talk enough about it staying as a priority. Is that a challenge that you see, that maybe hospitals need to have more of this, what you said earlier, which is a commitment to keeping that culture important? Do you see that as the biggest opportunity that maybe ebbs and flows, and we don't invest enough in that?

Joe Tye (12:01):

No, I think you're right on target. You often hear the term “program of the month”, “flavor of the month” — and it's never about the program or the flavor. We have worked with hospitals where what we do ended up being a program of the month. And we've worked with hospitals that have made significant permanent change. It's not that we did anything different one place or another, it's that the leadership team first and foremost made that commitment that this will not be a program of the month. We're making this investment in our organizational culture and our people.

Joe Tye (12:40):

And I think the second thing that people, leaders, have to recognize, the late Zig Ziglar put it this way: Everybody listens to the same radio station, WIIFM. What's in it for me? And people, you mentioned patient satisfaction scores, nobody's going to change their behavior to improve your HCAHPS. They'll improve, they'll change their behavior, if they see some personal benefit — which is why we talk about moving from a culture of accountability, which is very much top down, carrot and stick, reward and punishment, to a culture of ownership, where people are holding themselves and each other to a higher standard of behavior because there's a personal interest.

Lisa Miller (13:27):

I absolutely agree. Can you give us a little bit of the why? I mean, you have I don't know how many books, I think eight or nine books.

Joe Tye (13:34):

12.

Lisa Miller (13:35):

12, okay, 12 books. And you've invested so much in leadership and culture. Can you just give us a little bit about you and your story, and why you do what you do now? I think our audience would love to hear that, and why you're so passionate about culture and leadership.

Joe Tye (13:53):

Well, I'm actually a recovering hospital administrator. I was the chief operating officer for actually two large community teaching hospitals. And that's not what I was put on this Earth to do, and so I started writing and started doing more speaking, started Values Coach. Now I get the best of both worlds; I get to write, I get to teach the things that I am good at and was put on this Earth to do. But I also get to — at least in pre-COVID days — visit hospitals, make rounds, feel like I'm part of a leadership team when I'm there.

Lisa Miller (14:33):

So speaking of pandemic, you and I were speaking a little bit earlier about some of the challenges now that you're seeing. And can you talk a little bit about that to our audience? Because there is a greater burden, and there's probably more of a need for us to support and just give the healthcare frontline workers — or wherever they are in healthcare — give them more support. But can you talk a little bit about what you're seeing and maybe some advice of what hospital leaders can do in this time to support?

Joe Tye (15:13):

Yeah. I am very, very concerned about the next year or so. Last spring ... Actually, there's another metaphor I use as a history buff. In August of 1914, Europe went to war. And you see pictures of the soldiers marching off. They're all volunteers. The girls are throwing flowers. The bands are playing. They think they're going to be home by Christmas. November of 1918, the pictures, they're trudging back home. There are no flowers, no bands. And it sort of feels that way.

Joe Tye (15:48):

Last spring, the pandemic hit, and we're all in this together. We got this. People are sending pizza to the hospitals. And now, what you're seeing is a lot of burnout. In fact, you're not hearing burnout as much as PTSD anymore, or pre-traumatic stress disorder because people are looking ... You're hearing not, "We got this," but, "You mean we've got to do this again?" Or even, "We can't do this again." I'm just very concerned. And I think job number one right now for every healthcare leader is making sure, number one, that your culture is protected. Admiral Eric Olson wrote an article in the McKinsey Quarterly and he said, "You must not allow your culture to deteriorate. You can't not pay attention to your culture in a crisis, otherwise it'll go somewhere you don't want it to go."

Joe Tye (16:44):

And so I think it's imperative that leaders find a way to honor their culture. Somebody that I think is doing a great job of that is Toby Marsh at UC Davis Medical Center. Every single day, he's on LinkedIn. He's at DAISY Awards. He's at service awards. He's there with his mask, but he's out there visibly showing people that he cares. And I think maintaining visibility is essential, communicating effectively is essential. There may be a light at the end of the tunnel, but it's still going to be a long and dark tunnel.

Joe Tye (17:23):

The third thing is: How do you help people manage — not just the anxiety about work, but how do you help people with what's going on, on the home front? In our conversation earlier, I mentioned I was talking to the CEO of a large EMS company — helicopters, ambulances — and he said, his paramedics, his EMTs, some of them are more beaten up by the challenges outside of work, and they're ... Being three hours in a helicopter in full body PPE is a challenge, but then having to take it all off and shower before you go into the house — if you can go into the house at all.

Lisa Miller (18:07):

Right, if you can go in. Agree. So is there some ... The work you do is so complex. Right? You have assessments. When I say complex, I don't mean it's difficult. I think it's so important to bring you and engage and work with you — but when I say it's complex, I want to narrow...let you give our audience maybe some advice, one or two, distill some wisdom. Maybe that's a better way to say it, if you can distill a couple of pieces of wisdom that they can use today, this week, for this hospital, I'd love for you to do that if you could do that. I know your work is, it's broader and deeper — but if you could distill some wisdom, that would be great. We'd love that.

Joe Tye (19:00):

Sure. If I had an easy answer to all this, I wouldn't be on this call right now. I'd be heading to Stockholm for my Nobel Prize ceremony. I think it's simple, but not easy. Keep in mind that you have to invest in culture, but the culture of any organization is shaped by the collective attitudes and behaviors of the people who work there. I'm very concerned, for example, that I've heard from a number of people who really study bullying in the workplace, people like Renee Thompson, that it's getting worse during the pandemic. How do you keep your standards high?

Joe Tye (19:43):

I'm very concerned that I'm hearing from a lot of people where in the spring, we're getting community support. Now caregivers are being harassed and abused — and even threatened by people in the community. So I think getting out there. Kit Bredimus, the CNO at Midland Memorial Hospital in West Texas, actually went on television to plead with the community — stop harassing our caregivers and do something nice for them. And, at least temporarily, it had an effect. But I think anything you can do to show your people we're with you, we have your back, we are all in this together. It is all hands on deck. And whether you're a housekeeper or a neurosurgeon, we're all part of this together. That I think is job number one for any healthcare leader today.

Lisa Miller (20:41):

Yes. I love it. I think it's perfect and simple, but it's going to require some work. And I just want to make one final point. I had also read somewhere else that you really speak about visibility is even more important now than ever. Right? Rounding is important now more than ever. It's important for leadership to round, but now you feel it's so much more important that the leadership has to round and be visible.

Joe Tye (21:15):

And not just during the day. Show up on Friday night in the emergency room. Show up at noon back in the kitchen in the cafeteria when people are really working. Show up in the morning when environmental services gets together for their morning huddle. And if you have to be in ... Go to the ICU every day. And if you have to put on full-body personal protective equipment, do it. If it's not in your comfort zone, get out of your comfort zone. I think it's really critical that leaders show people that they care and that they're there with them now. You mentioned the books I've done. The most popular is called The Florence Prescription.

Lisa Miller (21:59):

Yes.

Joe Tye (21:59):

And it's a fictional story with Florence Nightingale as a character. Florence made rounds. There were four miles of corridors in the Scutari Barrack Hospital and the General Hospital. And she made rounds every night. Her day job was running the place, and she really invented the modern hospital in a two year period. But she was also visible. She was there. She showed people she cared. And I think that's what's going to get us through this is leadership — showing that you care, and supporting your people.

Lisa Miller (22:37):

Yeah. I absolutely agree. Can you tell our listeners where they can learn more about you, Joe? They can definitely buy your books on Amazon. But I believe that you also have a way that they can get a hold of you to talk with you. I know there's a number of training programs that you provide. And can you just tell listeners how they can get a hold of you, please?

Joe Tye (23:00):

Sure. Our website is ValuesCoach — all one word, no hyphen, valuescoach.com. Usually, the focus is on... our course on the 12 core action values and our consulting work on invisible architecture. Because of what's going on now, we have a program called Everyday Courage for Extraordinary Times. And that's really the focus of our website because that's what's important right now. And then we have another called theflorencechallenge.com, which is more specific to The Florence Prescription.

Lisa Miller (23:32):

That's great.

Joe Tye (23:33):

And then my email is simply joe@valuescoach.com.

Lisa Miller (23:37):

Great.

Joe Tye (23:39):

Thank you.

Lisa Miller (23:40):

Joe, thank you so much. I really enjoyed our discussion. And we've had a couple discussions, so I look forward to continuing to see your work. And I'm going to finish this book. Again, it's Building a Culture of Ownership in Healthcare. Thank you very much, Joe. Appreciate you being on our show.

Joe Tye (23:56):

Thank you for having me.