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(Intro) Culture isn't an add-on. It's everything about the organization.

So if people who come in to work with you don't understand the organization, their ability to be successful in the organization is really compromised.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a timea. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode. (Main)

Alright, it's keynote and today I am honored and excited to introduce a lot of you to Deborah Proctor. Deborah Proctor was the CEO at St. Joseph Health while I was CIO. And I'm really looking forward to this conversation.

Deborah, welcome to the show.

Thank you, bill.

It was so challenging. But today I want to talk about. being a CEO and setting the culture and all those things, was that the hardest job you ever had or was there a harder job you had?

No. Definitely the hardest job I had. And it became harder the more years I was in the job as the environment of healthcare became harder because it forced us into some situations of con contemplating, mergers, and that was very difficult, stressful work.

It probably what caused me to retire when I did

it does take its toll. But let's start with did you pursue the role of CEO? Did someone come alongside you at some point and say, Hey, you could be a CEO talk a little bit about your journey.

So I went towards the cultural side and became just very interested in how organizations work and what makes them tick and what, how do you accomplish things through the culture of an organization

They weren't even aware of each other's existence.

So seriously, they didn't do anything together. They were each operating in their local market. They had local boards so they were driven by local boards. But when they decided to become a system. They still played very much to a distributed system, to where there was still major focus on the local level.

Collaborate on certain efforts that made sense for collaboration. A lot of that effort was around the mission of the organization. And you can't talk about St. Joe's without talking about how strongly driven it was by the Sisters of St. Joseph and their clarity about what their mission was.

I tell this story often. The first presentation I did, it was to you the CFO chief Operating Officer, and I think the CIO, and we started into our presentation. I think we were like five slides in, and you said I need to stop you. I was like okay.

That's something I would do.

And I think we had an hour meeting, and I think you took about 20 minutes right in the middle there to say, does this change your presentation? And it did, which was really interesting to me.

Yeah, that's one of the things I reflect on when people say, Hey, how did you build a culture or mission-based culture?

I think they think about an add-on. What do you do, there's the work of their, the organization. And then there's this work of adding on getting people interested in values and mission and culture of the organization. Culture isn't an add-on. It's everything about the organization.

But let me back up to one of your first questions, which was, how did I get to be a CEO? Because I had never dreamed in my life of being a CEO, my career goal was to be a nurse. That was as far as it went. But I was working in another Catholic health organization in the late nineties, and I had one of the sisters in that organization approach me and say.

And they were the leaders. They were the providers. They were the whole And for them it was a ministry. And I mentioned that because that was essential to our culture at St. Joe's is returning it to the concept of being a ministry and not just a business. That's what caused me to decide to look for a job.

And after she said that to me, I just happened to hear that the CEO at St. Joseph Healthcare was leaving. And I thought, maybe I could do this,

I love your story of the interview process. So you're interviewing against heavy hitters. You're interviewing against CEOs who have been, established CEOs of health systems and that kinda stuff. Talk a little bit about the interview. 'cause I just love the story.

And one of the things that concerned me was I had such devotion to the sisters. I thought if I took over their ministry and messed it up, I would just feel horrible about that. It would just destroy me. And so I was very worried and I called 'em the recruiter and I said, I don't think I can do this.

And she said you must do this. This is really important for you and you have a really good chance. And I said, okay, I'll reflect on it. And I realized that I hadn't ever been to the website because I knew the organization so well, I didn't have to go to a website to get information about it.

And the other funny story during that time was that on that final interview day. I was flying in from Phoenix. I happened to live in Tucson at the time, but I was flying over from Phoenix the night before for an eight o'clock interview. And I got to the airport and it, my flight was delayed and it was delayed, and all of a sudden I heard him say at 10 o'clock at night that it was being canceled.

The, I was waiting in a waiting area and I was just trying to prepare myself and be calm. And I said a prayer that happened to be a prayer that I liked a lot. And as I was saying, the prayer that board chair came in and said it was time for the interview. And I went into the room and the board chair said, Deborah, as we start all of our meetings with a reflection, with a prayer.

It's one of those things it's really interesting to me.

I've interviewed a lot of people over the last eight years and one of the things I heard early on from a strong female CIO who was in New York City and she goes, bill, if there's a job description and there's 10 items and a woman looks at it and says, I only have seven of those items, she likely will not apply.

'cause she wants to be all 10 of those items. Whereas a man sees it and they say I have three of those items I'm gonna apply. And she says, that's a very common thing that happens over and over again. And she cited it as one of the reasons there aren't more women in leadership, and she encourages them to say, you know what?

Yet when you think about it had worked at the organization 14 years in my first go around with St.

Joe's. Then I had left for 15 years. And so I had a great deal of familiarity with the organization. I was a nurse by background which certainly brought something unique to the CEO role. I had. A real focus on culture, which the sisters knew that there was something important about what they were doing, but I don't know that they could have named it as culture.

So I had a variety of experiences, which is unusual for women. Also. Women tend to get a job and stay with a job as versus see what job would advance their career. And most men are thinking about what's the next step in their career? How do they advance it?

Yeah. I, so I want to delve into culture.

Let's start with this. 'cause there's so many elements of culture at St. Joe's. There's values in action, there's sponsorship, there's I went on the pilgrimage. I forget what it was called, but there was an onboarding lunch.

A lunch, yeah. There was, but then there was also a three year thing. It was very intentional. Everything about it. I could still tell you to extend the healing ministry of Jesus Christ and the tradition of the Sisters of Saint Joseph. It's it's, there was so much of it that just was intentional.

Why is culture important?

And understanding culture's not the only thing. I believe strongly that you have to have a clear mission. You have to have an energizing vision statement. You have to have underlying values. Then you have the culture that allows you to achieve all that. It's the way we get things done.

So you remember the mission really clearly 'cause we focused on the mission a lot and we went over it and things that we did. When Tom Peters wrote a book and talked about values in an organization and placing your values statement on the wall and so a lot of people got in line and named their values.

I have a view that a lot of organizations have a mission statement and they have a vision statement that is really wordy because they tried to put every thing they could into the vision statement when they talked about it, and somebody would add another piece and another piece.

And so you have these really long vision statements. And then they have values. What's missing is they then go to strategy . There's an important step that I think goes before that which is you have to ask yourself, how will we measure that we have achieved this mission and this vision?

, and we tried to get clarity on what were these measurements? How are we going to know when these things were successful?

We did it. Three day intensive retreat where we worked for about 12 hours a day trying to do this work. And we came out with three things that were very easy to remember. And this is what we said we were about. And we were about perfect care, which was making sure that a hundred percent of our patients got perfect care a hundred percent of the time.

Community health, which meant that we would be in the top percentile of healthy communities in the country .

And then we built all sorts of things within the organization to have people understand those things. As you said, one of the very successful programs was Values and Action. Values and action took the four values and every organization nominated people in the organization who represented one or more of those values.

It was awesome. The one year I got to review those stories they were amazing stories of people who are really, giving their full self to the organization.

The first year we did it I couldn't believe it.

Letting people know what it looks like when it's done right is important. We can talk all the words we want to, but how do I know what this means? Values in action was one way. Event Pilgrimage was an entirely different approach to things. That was a program we put together where we took the management again, the doctors, the board on a trip through the history of the sisters the important points where they had started their ministry when they were called into ministry.

That was their work so we took leadership to the places where the sisters had started this work and walked them through an understanding. And it wasn't just a tour. You actually did work and reflected on things while you were on the pilgrimage. It was actually very deep inner work to reflect on things.

But again, what I wanted was people to understand who the sisters were so that we could lead in their same way.

So it wasn't just putting value statements on the wall, it was giving all these ways for people to experience what this meant.

Let me tell you how I experienced it. First of all, I was one of those crazy leaders that you hired who needed this whole thing. I remember the work of Father Madai sending the sisters into the community still impacts me today.

People will say to me, it's like, what's distinct about your organization? I'm like, we're just filling gaps. We just go out and talk to the CIOs and the CISOs and the CTOs, and we ask them, how could we help you? And then they tell us, and then we do those things. And it's how's that different from your competitors?

And I remember, we went to the organization and they gave us these 10 things. These are the 10 things that should be in the portal. And we had prioritized these. We started building it and everything else. And then somewhere along the lines, somebody said, have you talked to patients? And this is so obvious.

It's and a lot of organizations have, and we had patient councils and that kinda stuff. So we did, we went out and talked to patients and it turned out that the number 10 item was the most important to the patient. And the number nine item was the most important to the patient. Number one item was like the 10th most important.

And it, it was like completely flipped. And we had spent so much time developing the top three based on what we perceived instead of what they really needed or wanted from us as a system. It's interesting that just one aspect of culture go. Talk to them, what are their needs, and then respond to their needs.

That was the need. Yeah.

It's really interesting. I want to go a little bit more into sponsorship. One of the most impactful meetings I think I ever had was with you and Theo. And it wasn't an easy meeting 'cause you were very honest with me of some of my deficiencies as a leader within St.

Joe's, some of the things I could develop. But I think one of the things that made that meeting so valuable was we didn't only talk about some of the challenges that I was having. One of the things you did in that sponsorship meeting was you took ownership for my success. And you alluded to that.

In the meeting. And when I walked out of there, I never felt more valued as a leader in an organization as I did coming outta that meeting, even though I was told some very challenging things of things I would need to develop in order to be a more effective leader.

I'm glad to hear your thought that way.

It is a personal commitment. An investment in the success of the person you are sponsoring. And that sounds like part of what you felt bill, is that there was a commitment to helping you be successful in the organization. So much of what we do is we hire people, we tell them what we want in terms of performance objectives and things, but we don't tell them how to be successful at achieving those in the organization.

You come into another type of culture where things have to be thought over. They have to be deliberated upon. So St. Joe's is a great example of that kind of culture. When we did things in St. Joe's, we had a discernment process a process we're going through and saying, is this the right thing for us to do?

Then you probably shouldn't have hired 'em if you're not willing to sponsor them. I is what

I you probably need to move them outta the organization or into another place, where they'll be more of a fit because in sponsorship I'm saying to you, I'm going to ensure you're successful.

But it doesn't mean you're not gonna fire me if I don't get the job done, is that,

no, it doesn't mean that at all. If not only if you don't get the job done, but if you don't do it in a way that's consistent with. The culture of our organization.

that's interesting. You could get the job done in an inconsistent way with the values in the culture of the organization and that creates havoc within the organization and

Absolutely.

And you have to deal with that as well.

I had a team member at one time who was brilliant and brought so much to the organization in terms of brilliance and I, I could recognize that brilliance and wanted to keep it in the organization as a driver for us because the leader was someone who challenged a lot.

But there was not the commitment to the values in the same way and the way the person interacted with all parts of the organization, their own team the individual hospitals was always having to put out fires for this individual. And I thought to myself one day I can't sponsor.

Yeah. I want to hit on a few things that I think we're just thinking, man, we could talk for the next three hours.

I have a feeling. But there's a couple stories. I relate to people and they look at me incredulously that really wasn't the case. And the first one I remember a budget meeting, and one of the things that you were notorious for, and I think notorious is the right word is you wouldn't give us a budget number to start.

You would say, go. In the culture and the values and the mission and what we're trying to accomplish, the healthiest community's perfect care, sacred encounters what should we do? And we don't always get frustrated with, you'd be like, Deborah, how much money do we have to spend?

And you're accurate.

When I got there there was always a budget number developed by the finance department that said, this is what we're aiming for for this particular year. And then plans were built around that amount of investment. To me, again, it's backwards. And I go back to the you got this mission and you have a vision in your mind, and now you've got these outcomes that you've identified.

And to get to those outcomes, you have to make investments. So my belief was, what are the things we need to do next year? What are the things we need to invest in next year for us to achieve those goals? And then I did say that we would go out and find the money but there also was a recognition that we couldn't do everything.

I involved the CEOs in judging everything that was being asked for. I. That the CEO couldn't just argue for their things. We had a process by which we put everything on the table that everything that had been asked for, and then prioritize those according to what we had to achieve in our outcomes.

The next thing I wanted to talk about prioritization of projects is still, I think this took years off my life.

It probably took years off your leadership life. It was so difficult, man. The conversations painting this culture. It didn't mean that we all got along and we hugged each other after every prioritization meeting. They were very difficult meetings.

They were extremely difficult.

Yeah. And it was like, are you saying we shouldn't get this new MRI? Are you saying we shouldn't, do cancer care in this way, in this community? And you're sitting there balancing these things and I'm sitting there going, Hey, I need a new data center. And people are like, data center that process was so difficult. What would you say to people who are struggling with that today?

And without having those in place, You're making random decisions. You are making decisions of investment by, fiat because it, on what basis are you deciding that there needs to be a cancer center versus a data center? Because both of those are critical to the organization at some time.

And we couldn't give the best cancer care without having access to data. That supported what the needs were in our community. So a data center, was important even though it didn't sound as important as cancer care. I think there just has to be real clarity about what drives what to lead to a set of outcomes.

It was interesting. For anyone who thinks Deborah was not a strong leader, first of all, the fact that you brought all those voices to the table is sometimes distinct in organizations that you wanted all that feedback.

But one of the things that to this day I think it was pretty amazing, is you had a very strong executive president's council, whichever one was the smaller group of leaders. They were very strong, very opinionated, very, and they've all gone on to really successful careers.

They were brilliant group people. That's the group of people that you sat in there and were making those decisions. But one of the things that was distinct is you essentially said to them there's 11 votes, but you, at the end of the day, you could trump the whole thing and say, I.

I think that's something that leaders have to be willing to do to stand up and say, this part is my decision. And I will take the accolades or the punishment at the end of the day. I heard this term and I don't remember where I heard it from, but it had a big influence on my management, which was the term decision ripoff.

And decision ripoff is when you invite people to the table and ask them to. Give input and they think they are making the decision, and then you make the decision anyway. You have to be clear when you're involving people who is the ultimate decision maker or people will experience decision ripoff.

There had to be clarity about that. Who's got the ultimate decision making? Because it really changes your organization. Culture again if people experience decision, rip off on a frequent basis.

And at least to one of my favorite things that you introduced me to, which was the concept of the silent veto.

And as an IT leader, I experienced this all the time where like we went through the governance process, we decided to do a project, and away we went. And I'd go to the first hospital and things would go well, and I'd go to the second one and things would go well and I'd go to the third and I couldn't get resources assigned.

I think you did perfectly. It's when somebody just refuses to work around the decision that's been agreed to. They're essentially not saying anything, but they're silently vetoing the project.

You hated that.

I very much hated that. People are always asking me, what characteristics do I look for in a leader? One of the most important characteristics for me is trust and the ability to build and maintain trust. And the silent vitro, takes all of that away.

The second thing is there has to be a willingness to be a part of a leadership community. That's a whole nother idea. The idea of community it's different than being part of a team. The community applies something deeper where there's a shared commitment to each other and, the third thing you have to do is be able to make courageous decisions.

And if I could say, there's one thing I see lacking in Washington and I see lacking in businesses and I see lacking, different places where I interact in the world, is this idea of courageous leadership. Having the courage to say, we're going to do this in spite of what you all might think.

The Catholic Church has a position that supports unions. It does not say you have to be unionized in a Catholic organization, but it says employees have the right to unionize. So again, within my setting of a Catholic ministry. I looked at what we were doing in the union battle, and I did not agree with many of the things that we were doing which were the typical of things people do to keep a union out of the organization.

Put out negative information about the union present

the

Joseph's who were focused on unity and reconciliation. We could not engage in anti-union behaviors. A lot of the CEOs felt that I was rolling over to the unions and just saying, come in and unionize us. Nothing could be further from the truth. I didn't particularly want to see unions in our organizations, but I had to accept this concept that employees have the right to unionize.

What rights there are beyond that are fairly limited except what's set by the National Labor Relations Board. But trying to get our organizations to understand that we would not hire Union Busters that wasn't okay in our organization

I have now new appreciation when people, when I read a story in the press, I'm just like, yeah, but that leader has much more information than I just received.

I remember one time they were trying to form, and I remember somebody saying they're asking for benefits that are less than what they already have. And that's really how you combat a union, is you give people a great work environment and you pay them fairly in the top percentile.

And you essentially listen to them and continue to iterate the environment to help them to deliver on their aspirations and goals.

Against just turning over and letting the unions take over without us having any ability to talk to our employees.

Let me close with it. This has been a marathon. I appreciate you doing this. I want to touch on your healthcare situation, you're now experiencing healthcare from the other side, right? So I'd love for you to talk a little bit about that, but I'd also like for you to maybe close with, if you could wave your magic wand and fix.

One thing about healthcare at this point, what would you like to see fixed if you could just make it happen?

Ever being able to restructure our system successfully. And I don't know how that's gonna be done. I don't know if it's possible to wave a magic wand. I've been thinking about this for the last 40 years and we've still not significantly changed our payment system in any way. That allows us to as I said, deliver care the way we want to.

So that's the one thing I would do if I could do anything.

Yeah. Getting alignment. I know that when I grow the grocery store, there's more things against me in that grocery store than there are for me in that grocery store. It's and there's very powerful marketing people and brand people and whatever.

Making sure that I do things that aren't necessarily in the best interest of my health. And that's only the tip of the iceberg. 'cause you mentioned alignment provider payer pharma. We love the advancements that are going on in pharma, miracle drugs and great things are happening in pharma.

There were times that while I was in the industry that I really felt we might get something accomplished. Whether you liked her or didn't like her, Hillary Clinton led a huge effort to make the changes we needed to make on our health system. Whether you agreed with her solutions she was really pointed at all the things that we would like to see change.

And I think Obamacare was again, an effort to really try and do things differently. But there's been when you consider the massive amount of energy and dollars that went into those efforts. We've had very little change as the results. Our outcome measures are worse in many areas.

A will to do it, a courage to do it. And second, the ability to build a partnership and a collaboration that will allow for that kind of change. And I don't have much hope for that in our current environment. I think everything speaks differently. that we're getting the opposite. We're getting deeper divides rather than closer collaboration.

Well, Deborah, I want to thank you for coming on the show. And I also want to just thank you for your role in my career, in my development as well and giving me the opportunity. 'cause you are one of the people that was part of my hiring process. And I'm not sure if you would've done it again, but I appreciate you doing it that one time and hiring me and that would No,

that's not true, bill.

also tell this story, I, and it's a story of your humility. I remember going into your office and you essentially saying to me, it's we haven't been able to do this.

I don't know this area. I want you to educate me, like we're gonna meet. I think we decided to meet on a monthly basis. And those conversations were as much me talking to you about technology and where it's going and how to think about it. And you. Teaching me how to survive in a healthcare environment.

Teach me.

Thank you Bill, and I look forward to talking to you again soon.

Absolutely.

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