1. $3.0 Billion in Clinical Revenues
2. 1,200 Employed Physicians
3. 14,000 Employees
4. Nationally Ranked in 13 Specialties by US News & WR
5. #30 in NIH Funding - $300M+ in research spend annually
6. Received $1 Billion from Nike Founder Phil Knight for
Cancer Research
2
OHSU:Oregon Health & Science University
If culture is that powerful, why do
we have strategy retreats and
strategic plans, but NO culture
retreats and culture plans?
6
“Culture eats strategy for breakfast” -Peter Drucker
Benefits of Engagement in Culture
• 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)
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 5 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
BKD Model: Work is MEANINGFUL when we see our identity in it.
MEANINGFUL
WORK
12
USELESS
KNOWING
DOING
KNOWING
DOING
USEFUL
SKILL
KNOWINGDOING
BEING
MEANINGFUL
WORK
Exponential Intellectual Property
14
1900 1940 19701910 20001920 1930 19501950 1960 1980 1990
0
500
1000
1500
2000
2500
3000
3500
4000
Doubling every 2 yearsApplications
US Patent
Applications
EU Patent
Applications
Source: USPTO and EU PCT and EPC
Explosive Risk - Bankruptcy
15
1900 1940 19701910 20001920 1930 19501950 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
16
Wo
rld
Po
pu
lati
on
(B
illi
on
s)
100 900 1500300 2100500 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?17
25 YEARS AGO:
515 YEARS AGO: TODAY:
20 100+
MEMOS/WEEK
VOICEMAILS/
DAYEMAILS OR
TEXTS/DAY
“The healthcare industry is the most complex form of organization we have attempted to manage in human history.”
Peter Drucker-
Complexity in the Healthcare Industry
• Cultural Identity is the “Butterfly Effect”
• Butterfly effects explain how tiny actions can cause huge results
• The problem is these actions are non-linear and so are difficult to flow chart out. As a result we often discount them.
IDENTITY AS A BUTTERFLY EFFECT
21
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)22
What complex flocking birds can teach us
23
3 Rules make Order from Chaos
IDENTITY - drives - ACTION - drives - RESULTS
25
Identity is behind every action
Identity is the butterfly effect, that small thing that
creates large scale change
VS.
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: Go Blue!
Yell at the other team
Wear Maize & Blue
In a new context, identity maps
generally recruit .05 to 8 seconds
before we are consciously aware
of them affecting our behavior
26
Ingredients for a Mental Identity Map
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 IdentitiesFear based identities keep us from
seeing clearly given they are more
clouded than power-based identities
(due to a limbic hangover)
27
When we perceive a situation through identity filters, reality is obscured
When you see a group photo that you were in, who is the first person you look for?
29
The Narcissist Test
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
30
Science has proven the brain broadcasts on 2 channels
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?
31
PROGRAMS THAT ENFORCE IDENTITY
• “Power of One” Awards
• Linking behaviors in evaluations
• Reciting the identity at the start of staff
meetings
• Making the phrases part of the public
language
• Power of One stated at the end of e-
mails signatures, memos, etc…33
The Practice: Culture Building through “Attention Density”
Imagine Inspire Engage Excel
• Invent the future
• Simplify complexity
• Connect to the mission
• Lift others
• 10/5 Rule
• Assume positive intent
• Say Do Ratio 1:1
• Reach higher
The Power of One: Together we Imagine, Inspire, Engage, & Excel
36
Culture as a trade secret
37
INSIGHT #6EMPLOYEES FOCUS ON WHAT
THE LEADER FOCUSES ON.
SO FOCUS ON THE DESIRED
ORGANIZATIONAL IDENTITY.
42
Museum Curators
make choices
about what they
want people to
focus on...
Leaders make
choices about
what they
want people
to focus on...
Imagine Inspire Engage Excel
• Invent the future
• Simplify complexity
• Connect to the mission
• Lift others
• 10/5 Rule
• Assume positive intent
• Say Do Ratio 1:1
• Reach higher
The Power of One: Together we Imagine, Inspire, Engage, & Excel
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.
47
What employees focus on
• It will take 18 months to get 12,000
people to memorize 1 sentence
• It will feel cool in the first six months,
stale from 7-12 months, and then
become who we are at 12-18 months
• Employees will never model it if the
leader doesn’t model it and recite it at
huddles, reward for it, and hire for it.48
What to Expect…