SPEAKER 1: It's hard to do what he does. He makes it sound very easy because his energy is intoxicating. But what he's able to successfully continuously do is almost impossible.
SPEAKER 2: Yeah, it's hard to pull off what he does. But he's pretty amazing. And his [? LibQUAL ?] thing is actually in part-- is almost a social measure. He didn't really intend to make money doing this thing. He's kind of like-- he believed everybody should exercise. He's a world class trail runner, and has always been interested in fitness. And he looked around and he said, there's this big problem with obesity, and maybe I could do something. Make an impact on this, and hire the right people to kind of motivate people to actually do the stuff that they don't want to do.
And it's already taken off. He's got one guy who's approached him to open up 100 clinics in the US. They operate a large, large group of clinical practices. And they're hoping-- because it's a prescription-based system, the idea is that your doctor writes you a script that they assign you to go to this clinic. And his feeling is that that's sort of the beginning of a motivational thing. And then there's a lot of behavior change things that he does internally.
But yeah, he's going to do well on this thing, too, even though he didn't care initially about making money. But personally, his philosophy is going to make an impact.
So anyway, but an amazing guy, and I'm hoping to figure out ways of getting him-- since he's way over in DC, to get more virtual connections with him to inspire us on other things.
So any other comments or suggestions, both on John specifically and the entrepreneurial kind of spirit that he was exuding in culture change. It's really an interesting hiring process.
SPEAKER 1: You know, it's interesting, when I arrived to Sunrise from Marriott-- well, Marriott definitely had a culture which was very basic, actually. Take good care of your employees that will take good care of your customers, and the business will do well. So it started with the employees, very clear. How you did it wasn't as explicit. But what you did was very clear.
And then at Sunrise, we got value credos. There was like dignity, respect honor. It became a much longer list, to the point where people had to walk around a card in their pocket to remember. Like John was saying, I think three is the magic number. He's studied why that's the case. I don't know the answer to that. But I did see that once you just start taking out a card, which I think was modeled after the Ritz Carlton, if you have to look it up, you're not embodying it. If you can't remember it, that's the problem.
So Sunrise fell into financial hard times because of the real estate cycle. But when I came back to the company as an asset manager for a REIT, and oversaw like 40 of their communities, that whole culture went away when the business started to struggle. Nobody was carrying the card. I kind of saw the sign, not consistently but frequently. And financially it was re-engineered to be a successful company all over again. But it's interesting to not only have it but maintain it. And I think Marriott is a really good example, Disney is a great example of companies that really, despite the deviation in the economy, they never lose sight or a sense of where they're headed and what they stand for.
SPEAKER 3: I agree. I think, being an associate, and you look at especially the workforce that's coming in-- if you look at the workforce as it's transitioning, and everybody wants to work in the Facebook and Googles of the world, and it's like, well, why does everybody want to work there? Is it because they get to wear jeans every day, and there's M&M dispensers, and ping pong tables, and that's cool to go to work to? And to a certain part, yeah, sure, that's fun and that's good. But-- and this is what John was talking about-- it's the culture those places have.
There are no offices, they're communal, they're idea-generated, they're collaborative by nature. And because it's tech and because it's new, they're able to create where everyone has that same shared mental model. And that's what I think we're struggling with especially. You know and I'll be transparent. I mean, at North, well, we have 66,000 employees across 23 hospitals. Culture is really important to us. Being how hard it is, John got to be able to hit the button, stop, reset, and start again. We can't do that. Presby can't do that. Mount Sinai can't-- well, not with firing half the staff. He took them into a boardroom, and then just-- we wouldn't want to do that. But we can't do that.
SPEAKER 1: You really need the housekeepers to do that.
SPEAKER 3: Absolutely, right. And then we're crossing. But I think that just shows you how powerful the culture piece is, is that people have to want to love what they do, where they do it. And you have to have the right environment, I think, that's blending all of this together, which is really difficult to do. To change culture is-- and people ask, right. He talked about it's that airy stuff. And people say, well, what does that mean? And we describe it in very tangible ways. It's like, culture is, when you walk through the hall, does somebody hold the door open for you, or does someone let it shut on your face. That's culture right there, will someone hold that door open for you. And then get into-- it's interesting, the three he mentioned. We actually have five things that we ask to do. Maybe it's two too many.
But just what are those things that you have to do that changes it. And it's true. It's one of the most prized possessions, I believe, of what makes something so great, is just that feeling you get. So I thought it was great.
SPEAKER 4: Just to piggyback on what you're sharing, which I like very much, what we find when we're trying to help organizations shift the culture of care is, yeah, you can't just fire the whole staff. I think it's awesome that he took a hard line and he was able to do that. Obviously you're not in that position. A lot of organizations aren't.
SPEAKER 3: And I don't think that's the right answer to do necessarily. I don't think you have to do that.
SPEAKER 4: Have to do what?
SPEAKER 3: I don't think you have to fire everyone.
SPEAKER 4: No, you don't.
That's exactly where I'm going, actually.
SPEAKER 3: Yeah, you don't have to do that.
SPEAKER 4: Exactly. You don't have to do that. Worked for him, probably doesn't work for a lot of people. But what's worked for us when we're teaching people about what we do is we focus on this motto, "show, don't tell." Model, model, model, model the new culture. Show people how it impacts them so that they can feel it in themselves and be excited about it. It's a slower train, but the truth of the matter is, if people aren't game to get on the train with you, they just won't. And your attrition will happen naturally. And slowly but surely, the people who aren't willing to help build that new culture just won't stay.
SPEAKER 1: It's hard. Because a lot of the workers in our industry-- at least we see this in senior housing, particularly like the night shifts-- it is a second job. It's not their first job of the day. It's the second job. And now they're taking care of elderly people that are very frail and very dependent on their assistance while their own families they haven't seen in maybe 24 hours.
And that's a lot. I completely subscribe to what John was saying. But it's often not surprising to me when you see the person that's totally exhausted, barely making ends meet, just be there to get the work done, and just say that I showed up, hopefully on time. And it's a tough business. And I think Marriott realized that early on that the risk associated with caring for people was so much harder than the hotel guest experience. There's just such a great margin for error. And the hospitals are even more so. Because you're actually opening people up. We're opening our doors once they're already closed. So we have to be very sensitive to that, and be cautious and careful of what we expect, but at the same time, set the highest expectations on culture, but be mindful of this is difficult work and people are in difficult circumstances. And I'm always very sensitive to that.
SPEAKER 3: I think it's a great point about night. I always say, when is the go time for hospitals-- when is peak time for hospitals? The answer is, it's all the time. But it's like anything else. There's definitely a time where there's a little bit more visibility in what happens. It's like a bar or restaurant. A restaurant, starting at 5:00 PM or 6:00 PM, is fully complemented with staff. And it's happy hour, so people are going to be there. And there's not one bartender, there's not one server, there's multiple.
What happens in most hospitals at 5:00 PM? Right, to your point exactly-- and 5:00 PM literally and figuratively, but you've got the more junior staff coming in, or people who are taking second shift, less leadership in the building, and now all the visitors are coming in to see mom or dad for that first time. So it's like imagine go time, and if like no one's really there. And think of the environment you're kind of setting up of like, everything is staffed 9:00 to 5:00, Monday through Friday. But what about all the other times?
And it's that we have to think of. we are 24/7, 365 operation, which is really tough-- really, really tough to do. So you're right. The timing and staffing is tremendous.
The other thing I'll say about the hiring piece is we're big on group interviews now as well. And our talent group is huge. And then there's hundreds recruiters that work at Northwell that just recruit. And so it's hard to get on the same page.
But we do group interviews. And I always tell people-- and anyone on my team-- if we really like you, there's this whole section of why we tell you not to take this job. So we try to talk you out of taking this job. So that when you walk in, this is why you shouldn't come work here. Because we want to sell you on what real life is going to be. [? And ?] [? not ?] all the ideals of what it could be, and how great-- and it's easy to sell the good stuff, but it's hard to sometimes sell reality and what you're going to walk into. And I think that's what's so important.
To me, the group dynamic is so important. If it's hard for you to connect with a group of people and you don't like doing that, that's very indicative of what it's going to be like for you working inside a hospital. It's not just one on one. It's everyone. So I think it's really important.
SPEAKER 5: I was going to say, it's sort of like what you said. But the hospital is sort of like taking a look at the--
SPEAKER 6: Can you use the mic? Sorry.
SPEAKER 5: That's OK.
SPEAKER 6: [INAUDIBLE]
SPEAKER 5: OK. It's sort of like looking at the airlines and looking at the airports. So the plane goes off at 5:00 in the morning, and the plane goes off at 5:00 at night. And do we have junior staff there at United Airlines, and Delta, and the others, or do we have real staff? And do we have junior pilots going out late at night? No.
So I think it might be interesting for the health care industry, especially with hospitals to look at the operational aspects of the airlines and the facilities-- the actual airport-- and what goes on there with theirs. So it might be an interesting combination because it is part of hospitality, the airline industry. And I don't know if they mention that in school. But it's the same thing. It's talking to people, communicating, having spirit, having heart, knowing what people need. And it's a 24/7. So it just might be something interesting for hospitals to investigate and look at as part of how to solve their issues.
SPEAKER 7: Well, I wouldn't look to the airline industries. I think that the airline industries are moving in the wrong direction. I think we look to the airline industries for safety, and we take a lot of lessons from the airlines and in safety initiatives, but certainly not customer service.
I don't know that I would say "junior individuals," but certainly what happens in the evening hours of having individuals who it is a second job for them, and how to have that engagement-- the challenge, and why you can't just hit reset, is that in many cases incentives are just not properly aligned. And when I spoke earlier about the fact that, on 60% of your patient population, you lose money. So it's very hard to be able to become that Google, where you could offer pet insurance and everything else, and attract the labor, and attract the individuals that you want to into your organization.
And I think that we're seeing fewer and fewer people-- and some of it is generational, some of it is whatever other various reasons-- who have that real humanistic drive, and calling that this is their passion, and seeing more people that view it as a job. And that's why we spend so much time, and that's why you've heard lots of organizations talk about that culture. And if you don't come to the organization with it-- of course you have to have some hardwired elements-- to really try and ingrain it so that it becomes contagious. Wow, I really work at a special place. This is an amazing organization that does great things. And getting people on the bus with your mission. But it is not a easy thing to do in today's work environment.
SPEAKER 8: So if I could just take another extension from what Jeff said. The reason Ritz Carlton has been so successful and has won two Malcolm Baldrige Awards is because of their focus on hiring the right talent and building that culture. So hiring the right talent means that, when I worked with the Ritz Carlton for my 13-plus years there, it didn't matter where I went-- I could go to anywhere in Asia, it could be Singapore, I could go to St. Thomas, I could have gone anywhere, to Canada-- but I knew within walking into a hotel, within five minutes I could find 10 people that I knew would be really good friends.
Why? Because we all had the same shared value system. So it's not necessarily that we all-- we didn't think alike. We were all completely different in the sense that-- we still had the same departments. You had finance, you had culinary. Who's ever met a chef that's not temperamental. You know, seriously. A finance person is always going to be a finance person. But when we use Talent Plus to help us select the right talent, we hired the right person for finance, we hired the right person to be at the front desk, we hired the right person to be in the spa. Because there are certain things that are innate in that line of work that you must have to be successful.
But also, we all came back to sharing that value and that core set of beliefs that was our culture. And that's what was a success. Because everyone, no matter what the job was, was driven for exceptional service. Excellence was the only thing that was possible. And they gave $2,000 to each employee. It didn't matter what work you did. You had up to $2,000 to take care of a guest. Probably-- I never used that $2,000 in the entire time I was there. I've gotten close once, but in 13 years. And that's then empowerment that everybody felt.
So that was a part of the culture that was started from the beginning of the company. And that's what the company was based on.
It is very hard to transition that into health care. Because health care was never founded on that culture and that belief. And what a lot of the larger organizations are now finding is that it's like a freight train or it's like a cargo ship to just try to turn that to focus on culture. So a lot is-- what you're seeing now is a blended culture. So we know that culture is important, you're bringing it in, but you still have employees that are just in the wrong position because they were never supposed to be in health care because their empathy does not even exist. It's not on the spectrum. It's nowhere. And it doesn't mean that they're bad people. They're not. But that's not their line. They shouldn't have been in front of the patients. They probably should have been in billing. You understand?
Because when someone's sick and in front of you, you don't want that person who is just focused on give me your card, give me this, do you have this? You want someone who's going to say, oh, feel that empathy, while getting all the information that's necessary.
So those are the things that health care, especially the larger organizations-- when you're over 10,000 employees, it's really hard to make that change and to infuse that. So it's going to take a longer time for health care organizations to get there. But the shift has already begun. Because if you noticed, one thing, it didn't matter which organization we represented, everybody talked about culture. They talked about really building that brand and really making sure that, before anything else, we understood what was most important. And it was really connecting to the purpose of why we were doing the work.
So the shift has begun. It's going to take longer. But health care was never built on that premise. You wanted only good care. You wanted good health care in terms of clinical outcomes. You wanted to make sure you went to the best doctor, whether he smiled, whether he had good bedside manners. You would have overlooked that 10 years ago. Because just like the chef that's temperamental, he cooks the best food, so I will suffer even though he throws the pan against the wall. It's the same with the surgeon who-- he's temperamental, too. But let me tell you, I will come out looking like a beauty, so I will take that abuse. So those things, over time, we're shifting, and we're going to see more changes happening. Go ahead.
SPEAKER 9: So Annette is my partner in crime, and she mentioned something that I really have to piggyback on. I have been a Malcolm Baldrige appraiser for a few years now. And you did mention the value of culture, and that has been resonated. But I think one of the things that is absent from the conversation is that, in hospitality, there are clear structures and processes that are missing in translation from health care, which is why it is so difficult to really duplicate what happens in hospitality versus what happens and what that looks like in health care. You know, here are your core values, and here are the structures and processes that we have in place to achieve these outcomes. And you're constantly evaluating that in hospitality. In health care you get, here are your core values, here are some inconsistent structures and processes that aren't even aligned with the core values that are identified, and they're also still not aligned with the outcomes that we're measuring and looking at on our financial statements.
So I think if we step back-- if health care steps back and looks at some of the structures and processes and look at that alignment, we'll be better able to transition and achieve some of the results that we're trying to get from hospitality. So I think that's a little missing piece-- just a teeny bit.
SPEAKER 2: Thanks. Any other final quick comment?
So a couple of things. One, thank you for mentioning the Baldrige thing, both of you. One of our current executives-in-residence, Nancy Schlicting, was the CEO until just recently of Henry Ford Health System. And they won a Baldrige Award. And she was very proud of that.
And one of the things that she did that some of you know about is founded this new hospital called Henry Ford West Bloomfield. And it was, as Jeff alluded to, everybody struggles with not getting paid enough by a lot of their patients-- or the insurance companies for them. Their downtown flagship hospital was in central Detroit, not exactly the most economically vibrant part of the state or the country. And so they needed to do something to get into the suburbs. So she hired a guy from Ritz Carlton to work with her and her team to start from the ground up and build a new hospital that was based on principles of hospitality.
And not everybody like John has this incredible opportunity to build a brand new team and start from scratch. But it's a pretty amazing place. If you ever have a chance to go visit, just to see. You can tell right away. Because they use Talent Plus, and they tried to hire the right person to the right seat on the right bus. And it really is a pretty amazing place.
And they also did a lot of interesting things, picking up, really, on a lot of the ideas from the Institute, from evidence-based design research, to kind of figure out what works well, and you have this kind of fusion that happens with all private rooms who have families stayover facilities, where it becomes kind of a hotel as well as a hospital experience. It's an interesting place.
Another place, I would say, with what Eden does and others, if you ever have a chance to visit Griffin Hospital in Connecticut, which is a Plaintree Hospital. It's now the flagship hospital for Plaintree. And that was started by a bad patient experience with a woman in California, I believe, who really wanted to move towards more patient/family-centric care. And I think it's an interesting example because it's sort of right in between Yale New Haven and all the amazing hospitals in New York, including New York Presbyterian. And during the height of the staffing crisis, they did such a great job of integrating some really innovative design ideas from the evidence-based design research, and also culture change, that they ended up having huge waiting lists for clinical staff to work at this place, even though there are all these other places they could go.
So I think there's a lot of ideas that people have come up with. Are you guys a Plaintree Hospital, too? Yes, that's what I thought. And so there's a lot of ideas that people are working with. And it's a challenge. There's no easy fix for all this stuff. But I think it's been really wonderful to hear a lot of the ideas that people are working on to try and figure out better ways to develop and use some hospitality ideas for the support staff and dining services and others to really kind of integrate some of these hospitality ideas in making things better.
And it's obviously a journey we're exploring here. It's just starting. We're not too far into it. But we look forward to additional ideas. And if anything pops up with any of you after, on the way home or otherwise, please get back to us. And our writer is going to help to kind of memorialize a lot of this stuff in an article-like proceedings. And we're also going to share the slides and things like that as well. But I just want to thank all of the speakers, particularly for the most recent session, and for all of you who have spoken over time. So could we have a round of applause for all the speakers.
And I'll leave you with one kind of funny hospitality-related career tip that one of our alumni gave me at one point. I asked him in a bar once, when we were flying back from Ithaca, what the common denominator was of the most successful people he hired. And it wasn't a complicated thing like [? John ?] [? Hertz' ?] whole process. He said, I look for bartenders.
And you know, it's funny. It sounds sort of stupid. But when we talked about it, he said, look, a person who's been a bartender-- just like a person who's been a waiter and who handles tons of tables-- they have to learn how to deal with difficult personalities, people who have drunk too much, people who are really depressed because they just got divorced or whatever happened in their life. They've got to help them through that crisis at the same time they're trying to remember that they were supposed to get a Long Island Iced Tea for one person and a complicated drink for somebody else. And then they've got problems. And they have an instant feedback loop. Because if they get bad tips, they're not doing a very good job. So they kind of recycle in it.
It's just kind of a funny story. It's not that that's the perfect career tip. But I think those of you who work in the hospitality industry or have had jobs in that, I think you can pick up on some of those things. Because that customer service ethos and the ability to kind of deal with multiple competing things is something that we can hopefully all learn from.
But anyway, I think we have a unique opportunity here. And we've got wonderful people. [INAUDIBLE] [? Mardell's ?] folks from DEA are such an amazing group of people to learn from on the design side. All of our colleagues in the hotel school and in the Sloan program, and throughout Cornell. So I think we're really blessed to have this opportunity here, and to have all of you people sharing your insights and wisdom. And I hope you'll be back again soon. And thank you so much for coming.
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Closing discussion on dining and service innovations across the health care continuum. Part of the Healthy Futures Roundtable held on October 10th, 2018.