JOHN DEHART: So just for a refresh, well, I'm the entrepreneur in the room. That's why I don't have slides. That's how you know I'm the entrepreneur.
And so I've co-founded two health care companies. I've been in health care for 17 years now. My first one was Nurse Next Door. We do home care for seniors. We have almost 200 locations North American-wide, just entered into Australia-- so a fairly sizable organization.
My second brand is more my startup. We do-- LIVE WELL Exercise Clinics. So we focus on people with chronic disease. We use exercise as medicine with them. So I have 14 clinics in BC-- small, little company.
And it's funny because I've been sitting for two days now, listening, and I didn't know what I was going to talk about. Hence, I don't have slides. I kind of like to curate ideas and figure it out on the fly. And I've come back to culture, because we've started to talk about it.
And I think one thing that's popped out to me in my conversations is that we're all sort of in this institute on a mission to incorporate hospitality and the service standards of the hotel industry into health care. And it's a really hard thing to execute on. And the biggest lever to do it is culture.
And we often miss culture because it's a soft, fuzzy thing that we don't understand as well as the operations side of the business. And I think certainly, in my business, I've used it as our strategic weapon since we started-- well, not since we started the business. But if I could just say I have one strategic imperative in my business, it's always culture. And it's allowed me to get to where I'm at.
So I'm going to start with a little story to kind of elaborate. When we started Nurse Next Door, it was on the premise of a very simple thing. So 17 years ago, I wanted to deliver a health care service that never felt like a health care service.
So I wanted to take hospitality-- I'm a Cornell grad-- and embed it into the health care industry, because from my vantage point, health care just didn't get it. And so we did that at Nurse Next Door. I didn't have any experience in health care, and it worked. And it almost worked too well.
So in my first four years of building Nurse Next Door, we grew from one employee, one caregiver, to 1,000 caregivers in about a four-year period. So just for context, we grew 4,000% from year two to year four. We were the fastest growing company in Canada. We were growing faster at that time than almost every technology company in the United States. It was fast.
And that sounds pretty cool to you, probably. And remember, I'm in Canada. So this is a government-based health care system, and I'm building this private little company called Nurse Next Door in a government-based system.
The problem was I didn't get culture at that point, and we grew too fast. And so I remember four years into it walking into my office one day-- if I had more time, I'd tell you the deeper story-- but July 16 and realizing I'd built the antithesis to what I had started out to build. I'd built a health care company. It was just a pure health care company.
I had an office full of people saying no to our clients. My customer service philosophy had always been, the answer is yes. Oh, what's the question?
You just figure it out. I don't care if you call our competitors. You always say yes to a client. You figure out how to take care of them. And so I had this office full of people practicing health care and not hospitality.
And I realized at that moment in time, hundreds of interactions all over the province of British Columbia, where we were taking care of clients in the homes, that same thing was being acted out in hundreds of touch points every single day across the province. And I realized I had built a company where my clients weren't happy, my employees weren't happy, I wasn't happy as the owner of the company, and we had an unhappy company.
And so long story short, I went off for the day with my partner. I came back to the office that afternoon. We had 25 people at head office governing-- so kind of administering the 1,000 caregivers in the field taking care of our clients. Fired 10 out of the 25-- fired every single health care professional in the office that day.
And I laugh about it now. It wasn't really a funny thing, and I don't do that very lightly. But it was something that had to be done. I'm a big believer. I could have suffered a death by 1,000 paper cuts and made change really slowly, or do it all at once.
So get to the end of the day, 15 people left over in my office, and it's just me and my partner in my office at the end of the day. And this is probably one of the worst days of Nurse Next Door's history.
We'd built a house of cards. We were this big, fast-growing company that was kind of driving off a cliff. And I've never professed to be the smartest guy in the room, but I'm a very good learner. And so we had no idea what we were going to do.
But entrepreneurs do something really well. They set goals, and they often set wildly ambitious goals. So I looked at my partner, and we said, let's become the top 10 employer in British Columbia. It was the biggest prestigious award in our province at the time, because we had to solve this problem of, how do we build culture?
We thought, well, let's set a goal to do it. And we didn't know how to do it, but I have this concept I call "R&D," "Rip off and Duplicate." Every single thing you want to do has already been done in the world to a world-class level. All you have to do is figure out who has done it to a world-class level, come to a room like this, listen, go to them, learn it, and then bring it back home and execute.
And it's sort of been my recipe book for success in almost everything I've done. And so we made a pact that summer with the 15 people left over. We wouldn't hire a single other person until we figured out how to build a great culture. And three more people quit that week, so it was sort of a tough time to be in our company.
And I just thought of, what are the greatest, most enduringly great brands that have stood the test of time in the world? And so I started studying Southwest Airlines. I studied Disney. I studied Starbucks, all of those great brands that I thought that weren't just flash in the pans. But they had literally endured for 25, 50 years, depressions, recessions, and what made them great.
And I started to meet with all of these companies. And it was really wild because it very quickly was shown what made these brands so great were these cultures. They had these cultures of raving fans. And when you started to dig below the surface of what made the culture so great, that obviously made those brands so great, they all shared the same thing.
And if anybody's ever read Jim Collins's Good to Great, this is all classic Jim Collins stuff. They were all very different companies. But alive in their cultures, alive in their people, they had three things. They had purpose, why you do what you do beyond just making money.
They had core values, how you do what you do. And they have what Jim Collins calls "vision"-- I call the "painted picture"-- a really crystal-clear, vivid description of the future. And these companies figured out how to operationalize it, how to really bring it alive in their employees.
So we all have core values on our walls. We all have these mission statements. But most of it is BS, because we haven't figured out how to inculcate our cultures, inculcate our systems, bring it alive in all of our processes. And so I sat there that summer and thought, that's what I have to do.
I have to figure out how to take this airy fairy stuff called "purpose" and "values" and "vision" and actually bring it alive in our company. And interestingly enough, if you think about how do you tap into the heart and soul of your organization, how do you tap into the heart and soul of your employees, how do you tap into the heart and soul of your clients or patients, it's all, the same-- purpose, values, and vision.
So we came home that summer. I walked into the office. Two months earlier, I had brought everyone in or 10 people in the boardroom and fired them. I called everybody into the boardroom at the end of the summer. And so everyone was freaking out at this time because they thought I was going to fire them.
And we literally said, we are going to bring our core values alive in this company. And we're going to do it by being the most disciplined company on the face of the earth. Everything that fits our core values is going to stay. Everything that doesn't fit our core values is going to go. We are going to become maniacal, go to the lunatic fringe, as I like to say, about living our core values.
And if you don't like it, I don't care if you're the best nurse in the world. Go be the best nurse somewhere else, because this is who we are. And it was an interesting time. We sort of drew a line in the sand in our company.
And we started to rebuild brick by brick around core values. And within probably three years, we became the number one place to work in British Columbia. By year five, we were the top place to work in Canada. And we became fairly famous in Canada for being a health care company that had built the best company to work for in the country.
We were named the smartest company in the country in 2015 or something crazy like that. And so we were winning all of these awards. But what it really did, by figuring out how to build a culture of raving fans-- our caregivers, our nurses, our office staff-- over-- at that time, when we started winning those awards, we probably had 50 to 60 locations.
What it really did was I talk about building a brand experience, how to deliver an experience in health care that never feels like health care. The big question is, how do you scale that? We have 6,000 employees across North America. We have 200 locations. How do I scale that across North America?
And it's culture, right? If you can figure out how to tap into your core values, this invisible hand that guides people to do the things in the way you want them to do, it's a magical, magical force. And that's what we started to figure out.
So that was my big learning in those years. And I think the key when it comes to core values, you talked about credo-- so very similar. We tend to think of core values as these airy fairy statements that adorn the walls of our hospitals or our long-term care facilities. And core values are your moral compass, your guiding tenant. We all know that.
But here's what your core values really are. And for you to bring them into action, they are your very, very few non-negotiable rules of how you do things. Three's actually the magic number. Anytime you get above three, you actually start to get too many. I can go into the science of that at some later time.
But they're the very few non-negotiable rules of how you do things. So if you think-- I know we have 6,000 caregivers. A hospital might have 20,000 employees. You have these 100-page employee policy manuals that every single employee gets. You don't know what's in those books, do you? Nobody does.
Of course, your people don't know. But if they know the three or maybe four things that are your golden rule, that are your credo, that are the hardcore, non-negotiable rules that you hire by, that you fire by, that you reward and recognize by-- if those become the most powerful parts of your organization and you figure out how to bring them alive and operationalize them, it is the beauty and the power in the health care industry.
And so when you get it right, if you think about your core values, they make you who you are. Your core values should never be like anybody else's. They make you unique. They are the soul of who you are. They're the soul of your brand, and that's where the power lies.
But often, I think we become cynical about this stuff. And I was certainly cynical. I was a finance major here. So my first four years-- in the Hotel School. My first four years of building Nurse Next Door where I screwed up, I didn't really understand HR. I didn't understand culture.
I was a terrible leader at the time. I just didn't get it. I was a finance geek. You realize that's where the power lies, and it's the force.
So I'm going to give you a little example of how we bring core values alive because I know I only have 10 minutes. When we hire-- so we hire lots of staff, just like most of you in this room. I have kind of a multi-step process. But here's an example of how we hire.
When we put out an ad, it will say something like, "company obsessed with core values looking for like-minded people." So right away, we kind of say, hey, this is very important to us. And what we do, we do a group interview, first off.
So we probably have-- one of the luxuries of being one of the top employers in a country, you're a talent magnet. So we don't really have recruiting issues, like a lot of other health care companies, because people flock to us because, as I always say, there are lots of great employees out there. There are very few great companies to work for.
So we get 100 applicants. We do a group interview. We saw this at Southwest Airlines. We saw this at Toyota when we sent our leadership team to Japan for a couple weeks. They do group interviews.
So one of us will interview eight of you at the same time. And so you come into the office. Some people won't do group interviews, and we do this at all levels of our organization. And if you don't do a group interview, then you don't get hired by us.
So in our hiring process, the entire way through, I'm looking at all the ways I can repel you or attract you. That's what core values do. If you have your core values and you're true to them, you really know who you are as a brand or as a person, as a leader. You want to attract those who are like you and like-minded and repel those who aren't.
So eight people will file into a room. And guess how we start the interview? We talk for 10 minutes about our core values. We are fanatical about our core values.
And it's always really cool because you're sitting there. You're thinking one of three things. This is kind of neat, or, two, these guys are crazy. And I don't want to be here. Or three, I've been searching for a company my entire 25 years of being in health care that does this, and this is my place.
And it's amazing how many people say that. We've had one person in 10 years that's actually walked out at that point, and that's awesome. It doesn't mean they're a bad person. It just means they're not the fit for us, because when you know who you are, you can repel the people who won't fit in your culture. And you will attract those who do like bees to honey.
So we go through the group interview. We kind of make it fun. We're only looking for culture fit here. We're only looking for a core value match in this group interview.
And so we get to the end of the interview. I always ask my favorite question at the very end of it. I'll say, "So if we couldn't hire you, who should we hire?" And you have to actually say who you would hire.
And so in both of my companies, we have different core values in both of my companies. But at the heart of those brands is kindness. I've always thought, how do I build the kindest company in the country? And so we're looking for a person who will stand up and say, you know, I would hire Meredith because she's fun, she's really bright, she's kind of quirky, and I really just like her energy. That's who we're looking for.
It's amazing when you ask a question like that how people answer, how cynical people will be, how people will throw others under the bus in sort of a funny way. I can always cut 50% of a room just with that answer. Again, I'm starting to look for culture fit.
So we go from 100 to-- we interview about 40 people in a group interview. These are just kind of our average metrics. And then from that group interview process, we'll invite six people to a second interview. It's part of a three-step hiring process.
And in that second interview with six people, it's a 60-minute interview, 30 minutes on talent. And I'll ask one or two questions. And my one question that I'll ask is, "In your current role, how have you knocked it out of the park?" And if you don't blow me out of the water with that answer-- and I'll pull it from you. I'll ask other questions to pull the examples and the metrics out of you.
If you don't knock it out of the park, if I'm not sitting at the other end of the table, saying, I have to hire this person now, you probably don't get through to the next round. But then I leave the room. And then somebody else comes in for a 30-minute culture interview.
And I leave the room because if you have blown me away with your answer, I want to hire you. And guess what? I will overlook the culture maybe non-fit because you're going to make my life so much easier. So we always get somebody from another team to interview on the culture side.
And I'll give you an example. And one of my favorite examples is in my LIVE WELL company, where I always say to companies, if you're going to live your core values, you have to do something radically unique to live them. You have to kind of put your stamp of here's our uniqueness as a brand, as an organization, and here's how we live our core values.
So one of the things we do in our second interview at LIVE WELL-- remember, at LIVE WELL, we're a gym for people who don't like to go to the gym. People who hate exercise, who hate eating well, that's our place. So we better make it really fun and social for you to show up.
So our clinicians at LIVE WELL, our kinesiologists, we don't call them "kinesiologists." We call them "joy masters" because they bring the joy. That's their main part of their role is to bring the joy. Sure, they do the clinical stuff. But their job really is to bring the joy to those 12 people working out at one time who all struggle with chronic disease.
So here's what we do to figure that person out. Michelle Obama did a video online-- it's on YouTube-- a dance to "Uptown Funk." It's a 10-step dance to "Uptown Funk." You can watch it, and she shows you how to do it.
So we say to the six people or the six people in that second interview process, we say, go home. Watch this video, get five people, and video yourself leading a group of five-plus people to "Uptown Funk." And what's so cool about that exercise is out of six people, only three will do it.
Three will go away and say, that's just dumb. So no, we're not going to hire you. And the three people who do it, we're not looking for an awesome dance routine. I'm looking at someone who's just going to have fun doing it.
And it's such a cool exercise to do. I believe in interviews. I believe in reference checks. But honestly, if I just did that, I know exactly who we should hire because it screams culture to us.
So we have this whole library of these videos of joy masters doing these dance routines with their grandmas and their family members and their friends. And it's just-- that's how we know if you're the right hire at LIVE WELL. That's how to hire for culture fit.
So I think I'm going to stop. I could give you 100 examples of all the ways that what we do-- five minutes-- so perfect. I'm going to end with this. I think culture has to become a lever in everything we do. Whether you want to implement the stuff that we were talking about today, the daily huddles, you've got to get the culture piece right.
We talk about a talent shortage in the next 10 years. There's a reason why culture is our number one mandate in our company and it always will be, because it's a very simple formula. I know if I get that piece right, I know if I have the best culture, our competition, well, they won't be able to attract people like us.
The people around this table, if we compete with you in the city for caregivers and nurses, you won't be able to compete with us. It's actually really simple. And most of health care isn't very good at this. So it actually is a very simple strategy. I don't have to be that smart to build a very powerful home care company, because that's all I have to figure out.
But I think more importantly, the rate of change in this world is just crazy right now. And it hasn't been talked about too much today. But when you think about how our world, how the health care industry will change in the next 10 years, we have no idea around this table of what it looks like.
I go back to-- I don't know if anybody's heard of Singularity University, but it's a think tank in Silicon Valley with NASA. It's a joint venture. And I was at a course-- I have to think-- two years ago. The CEO was talking about exponential change in the world and how this change is happening because we're at the confluence of all of these technologies at one time happening-- artificial intelligence, robotics, machine learning, crowdsourcing.
You can go down the list. Never in history has this all happened at one time. And so it's not linear change. It's exponential change. And that's why we don't understand how fast things are moving.
And I remember they gave an example of how they had just done a study. The experts had figured out the internet of things. And they were talking about how by 2020, there would be 50 billion sensors, 50 billion connected devices. And then just within two years, they changed the number to 1 trillion.
The experts were 950 billion sensors off. If the experts were that far off, that means every single person in this room, we have no idea how things will change. So this is more for the CEOs in the room of hospitals or the bigger systems. How do you set yourself up to be able to maneuver through that change in the next 10 years, when we have no idea what it's going to look like?
The 100th employee at Nurse Next Door was a software developer. My second full-time employee at LIVE WELL was a software engineer. That's how times have changed. And so you have to have your organization ready, because we don't know how things are going to happen.
And if you don't have that culture of openness-- which I can tell you, the big hospitals don't. We did a joint venture in California with one of the biggest hospitals in the US. They did a joint venture with us because of our entrepreneurial spirit. They wanted to tap into our rate of change and her speed that we worked and all of the innovative things we did.
And then we got into this health care system, and they're a $20 billion health care system. And I call it the "corporate immune system." The health care system has this corporate immune system built around it, and it's set up to attack change. You have these antibodies that just attack entrepreneurial change.
And we just got sucked into this vortex, where all the entrepreneurial spirit that they started with all got kicked out. And so I know firsthand, this will be the biggest single driver of change that we have to go through.
I wish Bob was here, because we talked about Amazon for an hour yesterday. His biggest fear is Amazon taking over the hospital system. That's what he's losing sleep overnight with, and that's the right thing to do.
So how do you set your company up for it? So I wish I could talk for another half an hour and open it up to questions, but I believe I have to go.
MEREDITH: One minute.
JOHN DEHART: OK.
Sorry it was so-- oh, good. Oh, I've got five minutes.
I'm sorry that had to be so fast. But anyways, I have--
AUDIENCE: It's a pleasure for you to continue.
JOHN DEHART: Yeah. I have four minutes, if you have questions.
MEREDITH: That's your alarm.
JOHN DEHART: There's my-- thanks. I chose Meredith. She was my TA when I was at school here, and I know how fastidious and detailed she is. So you were the only--
MEREDITH: John won-- you were a part in the school, and I was his TA. And he won the business plan competition. So for all the students in the room, it could happen. It really does happen here, and it continues to blossom forever.
AUDIENCE: So when I get back to New York, I'm changing my title to "joy master." What an incredible title. I think you're spot-on with certainly the challenges of large organizations in fighting innovation for various different reasons.
The one question I have and one thing that struck me is you mention building a culture with like-minded people. And I think that what I'm seeing now is a real shift to a much more diverse culture and diversity as a future direction to sort of challenge each other and help prepare for that change that you talked about, versus bringing in like-minded people. So I'm interested to get more of your perspective on that.
JOHN DEHART: Maybe "like-minded" was the wrong word. I think it's more-- when I say "people who fit our culture," I'm going to describe what that means. Let's say at LIVE WELL or Nurse Next Door.
So you're going to be fun. You're going to be kind. You're going to be an optimist by nature. That would-- oh, and you're going to be highly innovative. Whether you're a caregiver or a nurse or in my executive team or a head nurse-- we have about 140 people at head office-- that is the descriptor of you.
So we may look different. We may come from different parts of the world. We may have different religions. But those things, we're all aligned.
So when I want to add technology to my caregiving force across America, guess what? I'll probably do it faster than my competitors because I know we've hired with that filter, where people will adopt it no matter who they are. So thanks for bringing that up.
So it's not like-minded. It's more, who are you? What's your-- what do you stand for? And attract those people.
Not everybody fits what I just described. Not everybody in this room would like to work in my company. You wouldn't fit, and that's OK. But if you do, it's awesome.
AUDIENCE: Good job.
JOHN DEHART: That's awesome. I just-- oh, yeah, I heard it. I just-- so I can answer another question if I want.
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John DeHart, SHA ‘96, Co-Founder, Nurse Next Door and Co-Founder, LIVE WELL Exercise Clinics, speaks about healthcare entrepreneurship and the importance of leveraging culture to incorporate service standards into healthcare services. The talk was part of the Healthy Futures Roundtable held on October 10th, 2018.