Kendall L. Stewart, MD, MBA, DFAPA October 10, 2011

1. Creating a Culture of ExcellenceSome Practical Strategies for Determined Leaders1,2A Presentation for the Ohio Association of Free Clinics Kendall L. Stewart, MD, MBA, DFAPA October 10, 2011 1I want to offer a few practical strategies you can use to build and sustain your own culture of leadership excellence. 2Please let me know whether I have succeeded on your evaluation forms.

2. What’s in this for you? • Every leader says she wants to create a culture of excellence in her organization. • But only a minority of organizational leaders are willing to pay the price. • Complacency, impatience and a natural resistance to change are hard to overcome. • Success is a huge barrier. • For those who are serious and willing to pay the price, here are some practical strategies that will work.1 • After listening to this presentation, you will be able to • List three common barriers to organizational excellence. • Identify three practical strategies for creating a culture of excellence. • Explain why these strategies make sense. • Explain how to deploy these strategies effectively in your organization. 1Given the international publicity we’ve received, Portsmouth might not be the first place you would look for excellence. 2But we have achieved some remarkable success in Safety, Quality, Service, Relationships, and Performance. 3Moreover, we are now pursuing perfection!

3. What are some of the barriers to an organizational culture of excellence? • Leaders who don’t “get it.”1,2 • Leaderswho are unwilling to “walk the talk.” • Leaderswho are unwilling to pay the price. • Leaderswho are too impatient. • Leaders who refuse to face reality. • Leaderswho are unwilling to forego “ladder climbing” for 5-10 years. • Leaders who indulge in temper tantrums and blaming. • Leaders. Period. 1Helping physician leaders “get it” can be as frustrating as teaching men to be romantic. 2I worked with a man about how to impress his wife with a card on their anniversary.

4. What are the foundations of organizational excellence? Processes Performance People Planning 1The management literature says you have to align the entire organization around common goals to achieve success. 2Actually, all organizations excel because of the STPs—the Same Ten People.

5. What practical strategies will promote a culture of excellence? • Performance • Focus on results.* • Identify meaningful performance indicators. • Insist on comparative data. • Pursue perfection. • Publish your results. • Processes • Deploy a practical process-improvement process.* • Involve people in meaningful process improvement. • Empower leadership teams to decide and execute. • Use task lists to hold people accountable. • Document key processes as a part of succession planning. • People • Manage yourself first.* • Field the best possible leadership teams. • Recognize the stars. • Recognize the average people more. • Extrude the net-negative people. • Planning • Embrace discomfort.* • View problems as opportunities. • Align the organization around a few strategic values. • Adopt a decision-making process that is inclusive, transparent and evidence-based. • Clarify who opines and who decides.1 1Let me tell you about our Clinical Resource Leadership Team (CRLT) process at SOMC.

6. Focus on results. • Why? • It’s why leaders exist. • We all tend to forget this. • This makes people uncomfortable. • (Energizing) discomfort is a very good thing. • A relentless focus on results will set you apart as a leader. • It’s a also a huge competitive advantage. • How? • Begin every meeting by inquiring about results. • Focus on the results that matter. • Insist on comparative data. • Expect perfection. • Always ask about the plan. • Always ask about the task list. • Hold everyone accountable.1,2,3 1Always know your current performance metrics, what’ve you’ve done, what you’re doing and what you’re going to do. 2Expect your colleagues to know these things too. 3If you don’t volunteer, someone will likely ask.

7. Deploy a practical process-improvement process. • Why? • Processes are the ways things get done in life. • If you keep doing the same things, you will keep getting the same results. • In spite of this obvious truth, most people will keep on doing the same things. • Leaders have the power to improve processes.1,2 • Don’t let that power go to waste. • How? • Identify and critically examine the process that is producing the current, imperfect result. • Consult the process owners. • Suggest improvements in the process. • Find a process improvement champion; you may be it. • Push back hard on the resistance you will get when you do. • Insist that people give the changed process a reasonable chance. • Keep on improving your processes. 1You will hear and learn about many process improvement models. 2The SOMC Improvement Model is Seize an Opportunity and Make a Change. 3At a deeper level, we primarily follow the PDCA (Plan, Do, Check, Act) or PDSA (Plan, Do, Study, Act) Model.

8. Manage yourself first. • Why? • You can’t manage others until you do. • Everyone is watching whether you are practicing what you preach. • You will not be a credible persuader unless you do. • You cannot hide your moods—and people take them personally. • How? • Recognize that as a leader you are always on stage. • Acknowledge that everyone is watching. • Accept that what the people around you want most is predictability and an even temper. • Recognize your arousal. • Exit the stage and contain it immediately.1,2 1This became crystal clear soon after I moved to Portsmouth. 2I was mowing and garage sale hobbyists were parking on my grass.

9. Embrace discomfort. • Why? • Above all else, we long for comfort and seek to avoid discomfort. • But people only change when they feel uncomfortable. • Successful leaders feel uncomfortable every day. • And they make the people around them uncomfortable too. • It is not easy to get this exactly right. • How? • Focus on results. • Face reality. • If you do, you will find plenty to feel uncomfortable about. • Talk about your discomfort. • Confront your colleagues when they grow complacent. • Ask hard questions.1,2 • Hold yourself and others accountable. 1 “Why are more than 80% of SOMC employees overweight or obese?” 2 “What exactly are SOMC leaders going to do about that?”

10. What have we learned? • The top ten percent is only ten percent. • Building and sustaining an organizational culture of excellence is hard. • And in spite of what we say, most (90%) leaders are not willing to pay the price. • Knowing what to do is not that hard. • Doing it is.1,2 1And setting realistic expectations for average people is one of the things leaders need to do. 2Let me tell you about playing flag football in college.

11. Where can you learn more? • Join the discussion about practical approaches to more effective leadership on the SOMC Leadership Blog. • Learn more about Southern Ohio Medical Center here. • Review and download this presentation and related presentations and white papers here. • Read Results That Last: Hardwiring Behaviors That Will Take Your Company to the Top to review some leadership strategies that successful health care executives have embraced. • Learn more about how to confront others effectively by reading A Portable Mentor for Organizational Leaders. • Review practical techniques for conducting crucial conversations in Crucial Conversations: Tools for Talking When Stakes are High. • Consider adding the practical and comprehensive Successful Manager’s Handbook to your personal library.

12. How can you contact me?1 Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center Chairman & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Waller Building Suite B01 Portsmouth, Ohio 45662 740.356.8153 StewartK@somc.org KendallLStewartMD@yahoo.com www.somc.org www.KendallLStewartMD.com 1Speaking and consultation fees benefit the SOMC Endowment Fund.

13. Are there other questions? SafetyQualityServiceRelationshipsPerformance 