http://www.beckershospitalreview.com/hospital-management-administration/scripps-ceo-chris-van-gorder-leaders-can-t-write-a-memo-to-change-culture.html

When Chris Van Gorder joined San Diego-based Scripps Health as COO in 1999, the health system had 55 days cash on hand, and there was no trust between the administration and clinical staff.

His first day on the job, Mr. Van Gorder attended a meeting at Scripps Memorial Hospital La Jolla (Calif.) with another Scripps executive to resolve a miscommunication surrounding contract renegotiations. Rising tensions between physicians and administrators boiled over at the meeting, which cumulated with the Scripps executive quitting his job on the spot so he could sue the hospital’s chief of staff for slander.

“The physician sitting next to me tapped my shoulder and said, ‘Welcome to Scripps, you’re on,'” says Mr. Van Gorder. “That was the end of my first day.”

Flash forward 18 years and Mr. Van Gorder — promoted to CEO six months after joining Scripps — now runs a $3.1 billion health system that’s been named to Fortune’s top 100 employers in the country 10 years in a row.

Mr. Van Gorder discussed Scripps’ transformation — and the leadership strategies he used to drive these improvements — at the Becker’s Hospital Review 8th Annual Meeting in Chicago.

Earn employees’ trust

Shortly after he took over the CEO role, Mr. Van Gorder met with every board member one-on-one.

“Everyone wanted me to fix everything all at once,” he says. “But I knew I needed to prioritize and first find a way to work with our physicians.”

Mr. Van Gorder says it’s crucial for leaders to ensure proper communication with employees to establish trust and set the groundwork for a culture change. To mend relationships with Scripps’ physicians, he called a meeting with the health system’s elected physician leaders entire to acknowledge the lack of transparency between administrators and staff.

“They had all these demands and expectations they wanted us to meet,” he says. “But they didn’t know we were on the verge of bankruptcy.”

Mr. Van Gorder developed a physician advisory body called the “Physician Leadership Cabinet” to serve as a liaison between the clinical and administrative teams and weigh in on decision-making. Giving physicians more responsibility to manage the health system’s limited resources helped them understand the institution’s financial constraints, thus breaking down the communication wall between them and leadership.

“It’s really easy to say, ‘I want, I want, I want’ when you’re on the outside,” says Mr. Van Gorder. “But when you’re on the inside, you realize how difficult it is to manage scarce resources.”

The Physician Leadership Cabinet has proven successful. Health system leadership has accepted every recommendation from the board in the last 18 years, and every vote except one has been unanimous, according to Mr. Van Gorder.

Drive culture change from the middle up

Once leaders earn staff members’ trust, they should shift their attention to changing the organization’s culture, says Mr. Van Gorder. He believes managers have the most influence on culture, as they manage a majority of the organization’s employees.

“Leaders can’t write a memo to change culture,” he says. “But our frontline employees and middle management can influence culture.”

To develop an umbrella culture for the organization from the middle, Mr. Van Gorder launched the Scripps Leadership Academy — a year-long behind-the-scenes program for managers at the health system. Every program starts with a two-hour Q&A session where Scripps executives talk about how they got to where they are today.

“I was a cop. I worked at Arby’s,” says Mr. Van Gorder. “Most people look at executives and just see the suits. But as soon as you remove the veil of the title away from the individual, they become a human being.”

The leadership academy strives to show managers how the organization operates and how decisions are made. Each graduating class also works on a change project to improve a specific aspect of the organization. After the academy ends, Mr. Van Gorder challenges the managers — his “agents of culture change” — to take what they learned and demand more from the people they work with.

Maintain regular communication

Leaders must maintain a positive relationship with staff members to sustain the improvements in trust and culture, says Mr. Van Gorder.

He sends out a daily newsletter to Scripps managers and employees who request it, highlighting major news in the healthcare industry, along with organization updates and photos.

“Even if they just read the titles, they’ll start to understand the external factors impacting our organization,” Mr. Van Gorder says. “The more they understand this, the more they’ll accept the changes we’re trying to make in our organization. They’ll see it’s not something forced on them from management — it stems from the changes in healthcare.”

As email is the one way he can connect with Scripps’ 15,000 employees, Mr. Van Gorder freely invites employees and physicians to reach out to him directly if they are not getting the support they need to do their jobs, or even if they want to say hello. He responds the same day to every email he receives — a feat he sees as a basic level of respect.

“One of our values is respect,” he says. “If I’m not responsive to them, I’m not being very respectful.”