The Rural Values

CollaborativeHelping Hospitals Build a Culture of Ownership on a Foundation of Values

Prepared for New Mexico Hospital Association

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Values Coach Inc.319-624-3889 Michelle@ValuesCoach.com

ContentsI. Guiding Insights

II. Overview, Purpose, and Assuring Ongoing Sustainability

III. Training for Certified Values Coach Trainers

IV. Expected outcomes and key success factors

V. Core Curriculum: The Twelve Core Action Values

VI. Additional Tools, Techniques, Resources, and Ongoing Support

VII. Results

VIII. Testimonials

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I. Guiding Insights

Guiding insight part 1

Culture does not change unless and until people change.

Guiding insight part 2

People will not change unless given tools and structure, and inspired to use them.

Same job. Different attitude.

You will never exceed the expectations that you set for yourself.

You will never exceed the limitations that you place on yourself.

We help people see the lion in their mirrors

“I got a whole new team and didn’t have to change the people because they changed themselves.”

Paul Utemark, CEOFillmore County Health SystemGeneva, Nebraska

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Participating organizations receive a “Proceed Until Apprehended” banner!

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II. Overview, Purpose, and

Assuring Ongoing Sustainability

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To date, more than 500 people have become Certified Values Coach Trainers

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Building a Culture of Ownership on a Foundation of Values This is the central theme of our work at Values Coach Inc. When a critical mass of people within an organization internalize and act upon The Twelve Core Action Values, they will inevitably have a positive influence on the culture of their organization. And a culture of ownership that is built on those foundational values is essential to being a great place to work, providing outstanding quality service, and creating a sustainable source of competitive advantage.

Purpose of the Values CollaborativeThe overall purpose of the Values Collaborative is to share the proprietary Values Coach course on The Twelve Core Action Values and related content with hospital employees to help them in their personal and professional lives – and do so in such a way that it helps the sponsoring hospital foster a stronger culture of ownership. Specific goals include: Make this program accessible and affordable to every hospital regardless of

size. Prepare Certified Values Coach Trainers (CVC-T) to teach and coach coworkers,

and eventually to reach out to a larger community. Help individual hospital employees learn values-based life and leadership

skills they need in order to achieve their own personal, professional, financial, and family goals.

Helping employees make the connection between personal and organizational values.

Support patient-centered care and operating effectiveness by teaching values-based life and leadership skills that create personal buy-in on the part of workers.

Help hospital leaders more effectively design their Invisible Architecture™ of core values, organizational culture, and workplace attitude.

Prepare individuals with mental toughness and hospitals with cultural toughness for the challenging times ahead.

Help hospitals build new bridges to their larger communities.

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Not another flavor of the month! It is essential that your participation in the Values Collaborative not be seen as just another program of the month (or worse yet, be just another program of the month). To be sure, training for The Twelve Core Action Values and related tools and techniques should reinforce what has gone before, but because this is an investment in people as well as in the organization, it should be entered with a commitment that values-based life skills will become part of the cultural fabric of the organization.

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III. Training for Certified Values Coach Trainers

Certified Values Coach Trainers (CVC-T)CVC-Ts will be trained and equipped to teach The Twelve Core Action Values and related topics to coworkers and (at the option of the hospital) reaching out to the larger community. They will also learn how to facilitate group discussion on such topics as building a culture of ownership, and to organize book clubs, community service events, and other activities.

CVC-T candidates do not need to be professional trainers (some of the best aren’t), they just need to be committed to living The Twelve Core Action Values to the best of their ability themselves and enthusiastically sharing what they’ve learned with others.

CVC-Ts will go through a 4-day course that will cover the content of The Twelve Core Action Values and other topics in depth, including hands-on practice with presenting, facilitating, and coaching skills.

They will be provided an extensive instructor toolkit.

CVC-Ts are authorized to teach classes within the context of their organizations and, if appropriate, community outreach (e.g. schools), but they are not allowed to charge for these services (the exception being for hospital-sponsored programs where proceeds are donated to a charitable cause).

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CVC-Ts: Catalysts for ChangeWe call Certified Values Coach Trainers Spark Plugs because that’s what we hope (and expect) they’ll do with what they learn: spark positive changes in their own lives and then share that spark with others. The following is excerpted from the Spark Plug “job description,” which participants are asked to sign upon entering the course.

Become more creative, productive, and enthusiastic at work and in their own personal and professional development.

Reflect a positive attitude and refrain from the negativity of complaining, finger-pointing, and rumor-mongering.

Assume informal leadership roles by setting an example of positive team-building and motivation for others.

Help co-workers, friends, and family members deal with frustration and adversity in a more positive and constructive manner.

Be a role model of positive leadership in representing our organization in a positive light for the community at large.

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Certified Values Coach Trainers

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CVC-T Group in Kearney, Nebraska CVC-T Group in Lincoln, Nebraska

CVC-T Group in Kaufman, Texas CVC-T Group in Sidney, Nebraska

CVC-T Group in Ord, NebraskaPassing out The Florence Prescription in McCook, Nebraska

CVC-T Group in Omaha, NebraskaMaster CVC-T Group in VISN 20 of the Veterans Health Administration

Teaching The Twelve Core Action ValuesThe course on The Twelve Core Action Values is structured so that it can be taught in several different formats.

First, it can be taught in a single 2-day class. This is ideal for a management retreat and for launching a Values Initiative in a way that maximizes initial momentum. The CVC-T tools most appropriate for this approach will be the PowerPoint presentation (the template can be tailored for the instructor and the organization) and the note-taking workbook. This approach is by far the most effective for achieving a sustained impact on culture.

Second, it can be taught in twelve 60-minute sessions. This works best for people who are not able to get away from the work unit for an uninterrupted two-day period, and has the added advantage of allowing time for assimilation between classes. The CVC-T tools most appropriate for this approach will be the twelve 10-minute icebreaker videos and the note-taking workbook.

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IV. Expected outcomes and key

success factors

Expected outcomes for participating hospitalsThe most important outcomes of participating in the Values Collaborative will be difficult to measure except indirectly: how does one measure pride, enthusiasm, self-confidence, or other such intangibles that result from people connecting with and acting upon values? However, when a critical mass of workers make that transition, the hospital should see: Enhanced employee engagement (Core Action Value #7 is Purpose and

Core Action Value #10 is Enthusiasm). Enhanced patient satisfaction (Core Action Value #3 is Awareness and Core

Action Value #11 is Service). Increased productivity (Core Action Value #9 is Focus). Higher levels of creativity (Core Action Value #8 is Vision). Greater resilience and “cultural toughness” for dealing with the inevitable

challenges of the years to come (Core Action Value #4 is Courage and Core Action Value #5 is Perseverance).

A more positive workplace environment, including a significant reduction in the incidence of gossip, rumor-mongering, and finger-pointing (Core Action Value #2 is Integrity).

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Key success factorsOver the past 20+ years, Values Coach has been privileged to work with many organizations across North America, including many in industries other than healthcare. We have seen several consistent themes in the most successful undertakings, including: The CEO is willing to make this investment in people as “a gift” to help them be

more effective in their own personal and professional lives – as parents, as time and money managers, as goal-setters and achievers – without explicitly tying the initiative to specific financial or service outcomes.

The middle management team is supportive of their Spark Plugs and the work that they are trying to do (having a department head ridicule “Sparky” can deflate enthusiasm throughout that department and beyond).

Structure and process are used to reinforce the commitment to values, including such things as making The Twelve Core Action Values part of new employee orientation, visibly posting The Self-Empowerment Pledge and “Pickle-Free Zone” signs in manager’s offices, announcing each day’s Pledge promise on the overhead, etc.

Spark Plugs making a commitment to community service.

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EvaluationWe begin by acknowledging that the most important outcomes cannot be measured (how do you measure the impact of one person making a profoundly positive life-transformation because they began to act upon their values?).

The Culture Assessment Survey does give us a solid baseline assessment of how employees rate values, culture and attitude within their organization that allows us to compare with our data base and to monitor changes within the organization.

Given that, we can look at operating factors such as employee satisfaction and engagement, patient satisfaction, productivity, and turnover (keeping in mind that Values Training will be but one of a number of factors influencing these variables).

Hospitals seeking the Values Coach INSPIRED Award for Values and Culture Excellence must have an institution-specific plan for evaluating the ongoing impact of their commitment to Values Training.

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We also have an instant assessment tool that can be accessed by laptop or smart phone at:

www.Culture-IQ.com

V. Core Curriculum:The Twelve Core

Action Values

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“People who are clearest about their personal vision and values are significantly more committed to their organizations.”

James Kouzes and Barry Posner: A Leader's Legacy

Most people intuitively have good solid values, but it is very rare that they have specifically defined those values, much less that they conscientiously apply those intuitive values to how they spend their time and money, how they manage relationships, or even to what they put into (or let come out of) their mouths. The Values Coach course on The Twelve Core Action Values is a 60-module curriculum for values-based life and leadership skills.

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The interaction of personal and organizational values

There is an intimate and powerful interaction between the values of an organization and the values of the people who work there, though this is rarely expressed in explicit terms. One of the exercises CVC-Ts will do with Spark Plugs is create a matrix showing this relationship.

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Organizational values define strategies while personal values define culture.

Core Curriculum: The Twelve Core Action ValuesIn recent years, dozens of books and articles have been written emphasizing the importance of values clarity for organizational success. The Values Coach course on The Twelve Core Action Values is a comprehensive and systematic guide for values-based life and leadership.

These values are universal – they transcend particular religious or political beliefs, job titles, ethnic background, or other factors. From Authenticity to Leadership, this is who we want to be.

These personal values reinforce the organizational values of the hospital.

There are four cornerstones that put action into each of the twelve values.

This course recognizes the often misunderstood truth that values are skills that must be learned – not high-minded philosophical pronouncements; the course is packed with practical skills to help people achieve their goals by living their values.

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Core Action Value #1

AuthenticityThe Cornerstones1. Self-awareness2. Self-mastery3. Self-belief4. Self-truth

Core Action Value #2

IntegrityThe Cornerstones1. Honesty2. Reliability3. Humility4. Stewardship

Core Action Value #3

AwarenessThe Cornerstones1. Mindfulness2. Objectivity3. Empathy4. Reflection

Core Action Value #4

CourageThe Cornerstones1. Confrontation2. Transformation3. Action4. Connection

Core Action Value #5

Perseverance The Cornerstones

1. Preparation2. Perspective3. Toughness4. Learning

Core Action Value #6

Faith The Cornerstones1. Gratitude2. Forgiveness3. Love4. Spirituality

Core Action Value #7

PurposeThe Cornerstones1. Aspiration2. Intentionality3. Selflessness4. Balance

Core Action Value #8

VisionThe Cornerstones1. Attention2. Imagination3. Articulation4. Belief

Core Action Value #9

FocusThe Cornerstones1. Target 2. Concentration3. Speed4. Momentum

Core Action Value #10

EnthusiasmThe Cornerstones1. Attitude2. Energy3. Curiosity4. Humor

Core Action Value #11

ServiceThe Cornerstones1. Helpfulness2. Charity3. Compassion4. Renewal

Core Action Value #12

Leadership

The Cornerstones1. Expectations2. Example3. Encouragement4. Celebration

Every employee evaluation at

Grinnell Regional Medical Center

includes a rating on The Twelve

Core Action Values

VI. Additional Tools, Techniques,

Resources, and Ongoing Support

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The CVC-T ToolkitMost resources will be available online at the Values Trainer website at no charge for participating organizations, and can be purchased in hard copy for a substantial discount. Available resources include:

The workbook on The Twelve Core Action Values.

The Self-Empowerment Pledge including a set of promise wristbands and the Pickle Pledge including a Pickle-Free Zone door hanger.

Leader’s guide with study questions, suggested exercises, and other resources.

A mini-library of Joe’s books The Florence Prescription, Pickle Pledge, Winning the War with Yourself, and The Healing Tree.

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Values Trainer Resource WebsiteEvery employee of a participating organization will have access to the Values Coach members-only resource website, which contains a wealth of eBook, workbook, audio, and video resources. These include

Twelve one-hour audio recordings on The Twelve Core Action Values that can be burned to a CD or downloaded to an iPod.

Twelve 10-minute icebreaker videos recorded by Joe Tye before a live audience.

Icebreaker videos and customizable PowerPoint presentations, handout masters, and other resources to facilitate training.

A growing archive of webinars, teleconferences, video seminars, and other resources for personal and professional achievement and fulfillment.

Audio recordings of The Janitor in Your Attic – Morning Motivation and Evening Meditation programs.

Personal Daily Journal for setting goals and monitoring progress.50

We begin with a Culture Assessment Survey of all participating hospitals; each organization can compare its results with the group average and with our overall data base.

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From the data base

We can produce a custom edition of The Florence Prescription with a special foreword by the New Mexico Hospital Association and print copies for every employee of participating organizations

The Pickle Challenge for Charity is a fun yet powerful starting point for any culture change initiative – and it creates possibilities for a friendly competition between hospitals.

The Pickle Challenge has taken on a life of its own!

Turning Complaints into Contributions!More than $60,000 has been raised for charities by the first 30 participating organizations – more than 200,000 complaints turned into donations!!!

Values Coach has made over $20,000 in matching donations!

The Self Empowermen

t Pledge

The Advanced Course21 video lessons – 3 for each day’s promise

Midland Memorial Hospital PledgePower web page

Participating hospitals can share the entire PledgePower course with all employees on their website or intranet (see example from Midland Memorial Hospital below)

VII. Results

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Mary Lanning Memorial HealthCareHastings, Nebraska

Gallup Engagement Score improved from 23rd to 72nd percentile.

Productivity improved by 55 FTEs.

HCAHPS scores topped the 95th percentile in six categories.

Fillmore County HospitalGeneva, Nebraska

Patient satisfaction increased in 27 of 30 categories.

CEO Paul Utemark said he got a whole new team and didn’t have to change any of the people.

Community Hospital (employees)McCook, Nebraska

Rating hospital as excellent place to work increased by 26% to the 74th percentile.

Rating training & development as “excellent” increased by 51% to 91st percentile.

Likelihood of recommending hospital as excellent place to work increased by 45% to 84th percentile.

Community Hospital (patients)McCook, Nebraska

HCAHPS scores went from meeting just 12.5% of benchmarks to currently meeting 87.5%.

Overall quality of care rated “excellent” in patient surveys increased from 60.9% to 87% in current quarter.

Midland Memorial Hospital Values and Culture Initiative

MMH Values Trainers

Daily Leadership HuddleMidland Memorial Hospital

Culture of Ownership Classroom

Midland Memorial Hospital

Personal development and team building!

63%

87%

Reduced cost of turnoverNursing turnover has decreased 32% overall…

And 43% for nurses in their first two years on the job

Enhanced awareness safer patients… - 66% reduction in c-dif- 64% reduction in CAUTI- 38% reduction in ventilator related events. - 166 days since last event

HCAHPS Overall

FY13Oct'13

Nov'13Dec'13 Jan'14

Feb'14Mar'14

Apr-14May-14

Jun-14 Jul-14Aug-14

Sep-1440

50

60

70

80

90

100

65.4 64.6 63.9 55.5 67.9 67.8 81.4 67.5 66.9

82.9

71.175.0

83.3

26.4 32.6 33.3 33.3 21.9 17.7

15.8

29.7 30.3

11.4

26.722.8 7.2

4.35.6

7.3

8.7

2.2 2.3

7.22.8 2.9

2.4

64.361.5 63.2 64

66.9 67 67 68.7

69.970.85

77.1

10-9 8-6 5-3 2-0National Top Box VBP Achievement VBP Benchmark Accumulative Score (TB%)

Arrow marks beginning of Values and Culture Initiative

Emergency Department

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Annual Cultural Productivity Benefit

$7,200,000

Midland Memorial Hospital proudly displays their INSPIRED Award for

Values and Culture Excellence

VIII. Testimonials

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“Working with Values Coach to foster a stronger culture of ownership at Grinnell Regional Medical Center has been a great investment in our people, our organization, and our community. The Twelve Core Action Values has become part of GRMC’s cultural DNA and our Values Trainers have helped employees at every level be more productive in their work and more positive in their personal lives. This has been reflected in higher patient satisfaction, quality metrics, safety initiatives and other important measures.”

Todd Linden, President and CEOGrinnell Regional Medical CenterGrinnell, Iowa

“When we shared The Twelve Core Action Values with our employees and medical staff, the response was unanimous: ‘We need more of this!’ That’s why we [trained] a core group of Spark Plugs to promote values-based leadership in our hospital and in our community. From Authenticity to Leadership, this is who we want to be.”

Sandy Haryasz, (then) CEOPage HospitalPage, Arizona

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“There are amazing testimonials from participants as to how The Twelve Core Action Values has affected their personal lives. Graduates of the program have related stories of lifestyle changes that include weight loss, smoking cessation, career goal setting (including additional formal education), and personal-life priority setting.”

Bill Powanda, Vice President, Griffin Hospital (from Griffin’s 2006 application for the Fortune 100 Best Places to Work For (Griffin was 4th overall)

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“Our initiative on The Twelve Core Action Values has definitely been worth the investment... Graduates of the values course are genuinely interested and engaged, and are now working together as a group helping us develop a roadmap for the cultural enhancements we wish to bring about in the years to come. This training in values-based life and leadership skills is an excellent complement to the more traditional technical subject matter that’s often the focus of hospital training.”

Jeff Hill, (then) President and CEOMidwest Medical CenterGalena, Illinois

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“I have seen very few alternatives that can have a greater impact on the culture of an organization. Our Certified Values Coach Trainer group is incredibly fired up, and we are already hearing about amazing life changes people are making as a result of participating in the class. It’s one of the best investments we’ve made in our people and in our organization.”

Bradley D. Neet, (then) President/CEO

Mary Lanning Memorial HealthCare Hastings, Nebraska

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“This training – which 100% of our staff have now completed – helps all of us connect with our core values and answer the questions of ‘Who am I and why was I placed on this earth?’ When we know the answers to these questions, we are better able to connect with the values of the organization and better meet the needs of our patients.”

Marty Fattig, President and CEONemaha County HospitalAuburn, Nebraska

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“Over the past 3 months our patient satisfaction has improved steadily from the 19th to the 96th percentile in outpatient services based on Press Ganey surveys, and we’re seeing significant improvement in other areas. Our commitment to Spark Plug training on The Twelve Core Action Values and to The Florence Challenge has been the single-most important factor causing this improvement. This work is having a far-reaching and positive impact on the culture of our hospital.”

Patsy Youngs, PresidentTexas Health Presbyterian Hospital KaufmanKaufman, Texas