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Change Culture for 30,000 Employees? Become a Learning Company

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Alan Cooper is a principal with The Tudor Group, which provides organization development (OD) consulting to hospitals and other healthcare facilities. Previously, he was vice president for learning and innovation at North Shore-LIJ Health System, New York (NSLIJ). During his tenure, his organization launched a multiyear project to create a culture based on learning and education, and as a way to create greater employment engagement and a customer-service, patient-centered hospital environment.

JATHAN JANOVE: What prompted this change?

ALAN COOPER: Our new CEO. In 2001, Michael Dowling announced his intent to create a culture based on learning for our 30,000 employees in multiple hospital facilities, and that he expected results to include better patient service and outcomes.

JANOVE: What stood out about this change?

COOPER: One was that instead of learning and OD reporting to HR, the CEO made it the other way — the HR director reported to the Chief Learning Officer. The message was “culture first.”

JANOVE: What did you do to ensure that the learning program you offered would meet the needs of employees and NSLIJ?

COOPER: Early on, we made an important distinction—Learning was not training. We focused on what would be internally driven. Through surveying, we sought to find out what employees felt they needed to learn to do their jobs better, what they needed to advance to the next level, and what they’d actually like to learn.

JANOVE: Did this approach result in offering programs unrelated to healthcare?

COOPER: To some extent, yes. However, we continued to connect the program to our overall strategic plan which centered on patient experience and operating efficiency. We called it “strategic organizational learning.”

JANOVE: What else stood out about your program?

COOPER: As much as possible, we had classes taught by fellow employees. We taught classes on adult learning theory, presentation skills, and use of simulations and case studies to empower employees and develop their ability to create interactive, project-based, “learning by doing” education vs. “death by PowerPoint.”

JANOVE: What were the results?

COOPER: There were many. Our employee satisfaction and engagement scores soared. We enjoyed substantial seven-figure savings through Lean and Six Sigma initiatives led by our employees. We significantly reduced patient length of stay times and employee turnover, especially with mid-level managers. Last but not least, patient satisfaction scores skyrocketed in some of our facilities, from 23% to 99%.

JANOVE: For organizations intrigued by the NSLIJ experience, what suggestions do you have?

COOPER: These come to mind:

  1. The initiative needs to be led at the top. Our CEO was the primary change agent; he very much walked the talk. In OD and HR, we always saw ourselves as agents making the CEO’s vision happen.
  2. Create the proverbial “Burning Platform”—the urgent “Why” behind what you’re intending to do.
  3. Be patient; don’t give up. Culture change takes a while. New initiatives are fragile and need tending. Don’t underestimate resistance. Early in the process, a senior executive pulled me aside to give me a “friendly” warning. She said I’d better distance myself from the program “if you want to save your career.” Although frightened, I stayed the course, and she ended up leaving. Indeed, over a period of about 5 years, two-thirds of our senior leaders were replaced. One-third quit while the other third was fired.
  4. Don’t ignore metrics. We worked closely with our finance department to identify and track metrics that could be related to the learning initiatives.
  5. Go for some quick, measurable wins such as obvious inefficiencies or problems that can be easily corrected. For example, our patient satisfaction scores were so low that we knew we could make progress relatively soon.
  6. Consider making your programs optional, at least at first. At NSLIJ, we didn’t want the program to be perceived as something being imposed on employees; rather, we wanted them to see it as being for their benefit and long-term development. Subsequently, aspects of the program were made mandatory. During the initial optional period, our CEO noted which hospital executives and managers supported the program. This helped him assess which leaders belonged and which ones needed to be replaced.

JANOVE: Any other suggestions or advice you’d offer an organization desiring to create a culture based on learning, education and development?

COOPER: Just remember that it’s a journey that takes time and constant focus. Patience and timing become extremely important. It’s about changing the culture, not checking the boxes—culture eats strategy every day. Although a consultant can help guide the effort, organizational change is an inside job and needs to be led by the employees.

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