Mitch Wasden

Chief Executive Officer

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Solving for Why The Science of Transforming Culture through Identity

If culture is that powerful, why do

we have strategy retreats and

strategic plans, but NO culture

retreats and culture plans?

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“Culture eats strategy for breakfast” -Peter Drucker

RESULTS FROM LEADING WITH

CULTURE

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Results at Ochsner Medical Center-Baton Rouge

How identity drove results from 2007-2012

• Hospital: From 15th percentile patient satisfaction to 90th (3 years running)

• Clinic: From 50th to 95th (3 years running)

• Employee engagement from worst in the 8 hospital system to #1 in the 8 hospital system

• RAMI/RACI from worst in system and city to tied for 1st

• From unprofitable to profitable

Results at MU Health Care

How identity drove results from 2012-present

• Hospital: From 15th percentile patient satisfaction to 89th

• Exceeded budget 4 straight years, margins from 4% in 2012 to 8.75% in 2016

• Employee engagement increases for four consecutive years from 14th to 60th percentile

• UHC/Vizient Ranked MUHC #9 in the nation in 2014, tracking in top quartile.

• Market share growth from 19.6% to 26.7% in four years

• 1,200 PDSA/QI projects done per year by 5,500 employees

Benefits of Engagement

How identity drove results from 2012-present

• Create 22% higher productivity (Gallup survey of 1.4M employees)

• Doubles the rate of success of an organization

• Lower absenteeism

• 25% lower turnover

• Higher quality

– 41% fewer patient safety incidents

– 41% fewer quality incidents (defects)

Focusing on the correct order of Why, What, How…

Definition Typical Order Necessary Order

What: What we do What Why

How: What we know How What

Why: Who we are Why How

2) HOW (Visible and

Invisible evidence

of knowledge)

3) WHAT (Results/Outcomes)

What we often do:

Try to change #3 (results)

by going directly after How

and assume Why will fix

itself on it’s own.

What we must do instead:

Change results by changing

#1 (identity) 1) WHY (Identity)

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“Why” is invisible so we often miss it and focus on the visible like What and How…

“Why” as the Engine, not the Caboose When why powers organizations speed increases & friction decreases

how why what

WHY HOW WHAT

(What Ordinary Organizations Do)

(What Extraordinary Organizations Do)

What is your organizational identity or “why?”

MISSION?

VISION?

VALUES?

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Can you or your employees recite your:

Do you have BYOW Culture (Bring your own Why)?

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KNOWING THE

“WHY” BEHIND WHAT WE DO

IS KEY TO CREATE

MEANINGFUL WORK!

KNOWING + DOING = SKILL

USELESS USEFUL

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KNOWING

DOING

KNOWING

DOING

SKILL!

BKD Model: Work is MEANINGFUL when we see our identity in it.

MEANINGFUL

WORK

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USELESS

KNOWING

DOING

KNOWING

DOING

USEFUL

SKILL

KNOWING DOING

BEING

MEANINGFUL

WORK

10/5 Rule Say Do Ratio 1:1 Everything you need,

but nothing more No Public Venting

1) Warm Welcome

2) Anticipate Needs

3) Fond Farewell

Big Impact and

Small Wake

Innovation finds

a way

“Is there anything I

can do for you?

I have the time.

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The Culture of Yes Together we: Care, Deliver, Innovate and Serve

WE LIVE IN

COMPLEX TIMES

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Exponential Intellectual Property

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1900 1940 1970 1910 2000 1920 1930 1950 1950 1960 1980 1990

0

500

1000

1500

2000

2500

3000

3500

4000

Doubling every 2 years Applications

US Patent

Applications

EU Patent

Applications

Source: USPTO and EU PCT and EPC

Explosive Risk - Bankruptcy

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1900 1940 1970 1910 2000 1920 1930 1950 1950 1960 1980 1990

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Doubling every 10 years

Personal

Bankruptcy/1000 persons

Source: Administrative Office of the US Courts and Census Bureau

Booming Population Growth

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Wo

rld

Po

pu

lati

on

(B

illi

on

s)

100 900 1500 300 2100 500 700 1100 1300 1700 1900

0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Source: World Population Growth: Historical Trends & Future

Prospects, Charles Hirschman

Our Mental Dilemma

What is noise and what is signal? 19

25 YEARS AGO:

5 15 YEARS AGO: TODAY:

20 100+

MEMOS/WEEK

VOICEMAILS/

DAY

EMAILS OR

TEXTS/DAY

“The healthcare industry is the most complex form of organization we have attempted to manage in human history.”

Peter Drucker

Question:

How can we expect leaders to have “System Thinking” without an education in System Theory.

Complexity in the Healthcare Industry

Complex Adaptive Systems

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Organizations that thrive in chaos are

called Complex Adaptive Systems.

They exhibit the traits of:

1. Self-similar but heterogeneous

(diversity of function)

2. Strong interdependence of its

members (you need each other)

3. Loose coupling between agents and

system (not too much bureaucratic

central control)

4. Self-organizing (solve issues w/out

much top down direction)

5. Adapt best when on the verge of

Chaos (called “Emergence”)

ANTS AS A COMPLEX ADAPTIVE SYSTEM

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Chaos Theory

Example of computer generated Chaos Theory with

“Strange Attractors” (or Order)

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Mandelbrot Set

Try to remember this image over the next several slides

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Mandelbrot Set

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Mandelbrot Set

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Mandelbrot Set

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Mandelbrot Set

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Mandelbrot Set

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Mandelbrot Set

Fractal = Identity

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Mandelbrot Set

Organizational Chart: Complex Adaptive System

Centralized

Functions

Front lines

Chaos

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Human Bias for Linear Thinking

CEO

CFO

Controller VP Rev Cycle

COO

VP Outpatient

Nurse Exec

VP Planning & Marketing

PR

CIO

Software Director

Organization as it is… Organization as the brain

can conceive of it…

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QUESTION:

How can I run a complex

non-linear organization using a

linear mind?

ANSWER:

CULTURE

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INSIGHT #1

YOU CAN ONLY MANAGE

COMPLEXITY WITH SIMPLICITY

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Group Behavior: Complex Flocking Behaviors

3 individual instructions creates group order:

1. ALIGNMENT: Steer toward the average

heading of the flock (see the vision)

2. COHESION: Steer toward the average

position of local flock mates (stay close to

your team)

3. SEPARATION: Avoid crowding other birds

(but not too close…need for autonomy)

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What complex flocking birds can teach us

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3 Rules make Order from Chaos

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INSIGHT #2

YOU MUST CREATE IDENTITY

WITH THE BRAIN IN MIND

IDENTITY - drives - ACTION - drives - RESULTS

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Identity is behind every action

Identity is the butterfly effect, that small thing that

creates large scale change

VS.

Mother Doctor Stressed Victim

Every situation recruits new

identities which want to be

validated or enhanced. Only

occasionally do we drop

identities that don’t serve us.

The Identities cloud reality

and keep us from seeing

things clearly.

The Situation

You are running behind

schedule and have three more

patients before you can leave.

One of your partners told the

receptionist to send any walk-

in patients to you so they can

leave early for a social

function. You then walk into

the room to see the patient…

Recruited Identities Activated by the Situation

Possible Identities Fear based identities keep us from

seeing clearly given they are more

clouded than power-based identities

(due to a limbic hangover)

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When we perceive a situation through identity filters, reality is obscured

1) EMOTION

• How we feel about the identity

• Emotion is encoded on each

mental map

• The stronger the emotion, the

more quickly it can recruit the

mental identity map (for good

and bad)

2) INSTRUCTIONS

• The brain creates a list of

instructions regarding behavior

associated with that identity

IDENTITY MAP: I am a Mizzou Fan

1) Emotion Pride/Joy

2) Instructions Shout: MIZ…ZOU!

Yell at the other team

Wear Black and Gold

In a new context, identity maps

generally recruit .05 to 8 seconds

before we are consciously aware

of them affecting our behavior

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Ingredients for a Mental Identity Map

PROPOSITION:

The root cause of failure in most

organizations is not a lack of KNOWLEDGE.

It is a lack of BEING.

BKD Model: Being, Knowing, & Doing

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INSIGHT #3

WE ALL THINK IN IDENTITY

NARRATIVES 95% OF THE TIME

When you see a group photo that you were in, who is the first person you look for?

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The Narcissist Test

Why can you listen to an hour

lecture and only recite back 7%

of it’s content but remember

almost 100% of the stories that

were told?

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CHANNEL 1: NARRATIVE

• Plays our favorite program called “Me and My Story”

• We are always the main character

• We broadcast on this channel 95% of our waking hours

• High ego needs

CHANNEL 2: DIRECT EXPERIENCE

• We broadcast on this channel 5% of the time

• We are not the main character but rather feel at one with the story line and those in it.

• No ego needs

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Science has proven the brain broadcasts on 2 channels

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INSIGHT #4

MAKING THE SCIENCE OF

IDENTITY PRACTICAL

CREATING A USEFUL IDENTITY AT WORK:

1) Aspirational

2) Something every employee can see themselves in

3) Something that mimics the way the brain creates

mental identity maps

4) Only 3-5 concepts so that the brain can remember

it. It’s ok to “chunk-down” concepts.

5) Use focus as a valuable resource

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Creating a culture/identity in a way the brain can remember

10/5 Rule Say Do Ratio 1:1 Everything you need,

but nothing more No Public Venting

1) Warm Welcome

2) Anticipate Needs

3) Fond Farewell

Big Impact and

Small Wake

Innovation finds

a way

“Is there anything I

can do for you?

I have the time.

VA

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be

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“Pro

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The Culture of Yes Together we: Care, Deliver, Innovate and Serve

PROGRAMS THAT ENFORCE IDENTITY

• Rounding on every employee every month

• Culture of Yes Awards

• Linking Culture of Yes to behaviors in evaluations

• Reciting the identity at the start of staff meetings

• Culture of Yes at the end of e-mails signatures, memos, etc…

• 99% of employees can recite COY based on rounding data,

and this year 90% can recite the 10 behaviors.

• Short phrases provide convenient short-hand for the culture

• Leadership using the language (ie. “it’s a wake issue,”)

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The Practice: Culture Building through “Attention Density”

RULES OF THE GAME: • 3 of a kind = $10 gift card

• 2 pair = $15 gift card

• A full house = $20 gift card

Given to employees by their

manager, senior leadership, or by

nomination from a co-worker

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Rewards & Recognition: Award cards

Attention Density of Key Messages Every Day….

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Culture of Yes Campaign for MU Health

https://www.youtube.com/watch?v=Ua

uS68WcS5o

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INSIGHT #5

OTHER ORGANIZATION WHO HAVE

DELIBERATELY FOCUSED ON

CULTURE AND BEHAVIORS

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• Launched in 1995 in Kevin Plank’s garage

• $4 Billion in sales in 2015

• Leapfrogged Adidas to become #2 behind

Nike ($30 Billion)

• By 2017 estimates are for Under Armour

to reach $7.5 Billion

• Now has the largest digital health-and-fitness

community with 150 Million users at a time when Nike

shut down their “Fuel band” product.

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Under Armour Results

WHAT IS

UNDER AMOUR'S SECRET?

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MISSION: Make all athlete’s better

• Plank-ism Behaviors

– Think like an entrepreneur

– Create like an innovator

– Perform like a teammate

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“Culture is formed on habits” Kevin Plank - CEO Under Armour

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CEO: Kevin Plank

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Culture as a trade secret

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INSIGHT #6

EMPLOYEES FOCUS ON WHAT

THE LEADER FOCUSES ON.

SO FOCUS ON THE DESIRED

ORGANIZATIONAL IDENTITY.

Cheerleading

Amusement

Boredom: “this

isn’t as fun as

it used to be”

Tough

Sledding

So you mean

this isn’t going

away? Ever?

Hard Wired

Culture

Str

ength

Time

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Anatomy of Culture Improvement Efforts

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Leader as a museum curator

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Museum Curators

make choices

about what they

want people to

focus on...

Leaders make

choices about

what they

want people

to focus on...

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OUR ORG WHY (BEING/VALUES/MISSION)

EMPLOYEES

10/5 Rule Say Do Ratio 1:1 Everything you need,

but nothing more No Public Venting

1) Warm Welcome

2) Anticipate Needs

3) Fond Farewell

Big Impact and

Small Wake

Innovation finds

a way

“Is there anything I

can do for you?

I have the time.

VA

LU

ES

B

EH

AV

IOR

S

Th

e d

iffe

ren

ce

be

twe

en

“Pro

s”

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What are your Masterpieces? The Culture of Yes: Together we: Care, Deliver, Innovate and Serve

Employees focus on what the leader

(curator) is focused on...

If you don’t want employees to focus on

something (drama, victim mentality, etc…)

get it out of the gallery.

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What employees focus on

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INSIGHT #7

THE SAME EMPLOYEES CAN

INCREASE THEIR RESULTS BANDWIDTH

WITH A STRONGER COLLECTIVE AND

INDIVIDUAL IDENTITY

• Amateurs can make some baskets, but pros can do it over, and

over, and over again.

• People don’t pay to watch amateurs

• Professionals take pride in their performance every day.

AMATEURS PROFESSIONALS

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Pros vs. Amateurs: Individual Identity

• Diversities main value is accentuating differences

that make the whole better.

• Too often the focus is doctor vs. nurse, finance vs.

marketing, or differences in sex, gender, or race.

This kind of focus puts people in competing tribes

rather than putting them on one team

• There is far more value to be gained by focusing on

differences in proven strengths of each employee

and using that to coach each employee throughout

the year.

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Individual Strengths as an Identity

TEAM FIRST POSITION SECOND

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Hierarchy of Identity

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Reinforcing and Evaluating for the right Individual Identity – Performance Evaluations

70 Percent of Performance Evaluations either make performance worse or show no improvement* *A. Kluger and A. Denisi meta-analysis of 607 studies

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

5

3-4

2

Impact on Engagement

©2015 Eli Lilly and Company | September 8, 2015

Illustrative

Deliver Rating, Pay Adjustment,

Bonus

85%

15%

BWHAT WOULD HAPPEN IF…

A focus on weaknesses prevents failure.

A focus on strengths leads to excellence.

1

First Second Time Time

90 150

First Second Time Time

350

Average reader

Above-average reader 2,900

Copyright © 2012 Gallup, Inc. All rights reserved.

Wo

rd

s P

er

Min

ute

WHAT TO MEASURE

©2015 NeuroLeadership Institute | 52

Replace

rating

Worst

20%

20% 20%

20%

Best

20%

With progress toward mastery learning and progress

New to

X

skill

Very

high

level of

X

mastery

progress to

date

This is who you

are

ENGAGEMENT INCREASES WHEN MANAGERS FOCUS ON EMPLOYEES’

STRENGTHS

FOCUSING ON STRENGTHS IMPACT

63 Copyright © 2016 Gallup, Inc. All rights reserved.

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Quarterly GROW Conversations

G: Goals R: Results O: On-track/Off-track W: Way forward

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MOUNTAIN TRIBE VALLEY TRIBE

Strong Identities Drive Higher Performance

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“You were not

his mother…”

People will work hard for money, they will

work harder for other people, but they will work hardest for a cause.

Our identity is the greatest cause we know,

we spend 95% of our waking hours thinking

in that language.

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Questions?

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