This week, Dan Neumann is joined by Dr. Jeff Thompson. Jeff is the Executive Advisor and Chief Executive Officer Emeritus at Gundersen Health System as well as a pediatrician, author, and speaker on values-based leadership. His experience in leadership is extensive — with his role as CEO at Gundersen Health System for 14 years being especially remarkable. During his tenure at Gundersen Health System, they had been recognized across the country for their high-quality patient care.
In his book, Lead True: Live Your Values, Build Your People, Inspire Your Community, Jeff illustrates how a true leader puts their people, organization, and community first. In it, he has compiled stories from a diverse group of leaders who have employed values-based leadership and succeeded. These values greatly align with those of Dan’s in the agile space.
In today’s episode, Jeff and Dan discuss values-based leadership and how important it is to incorporate in an organization. Jeff gives several deep lessons on excellence and how everyone within the organization can live and benefit through an organization’s values.
Like what you heard? Check out our podcast page for more episodes full of interesting discussions, agile insights, and helpful resources.
Intro: [00:00] Welcome to Agile Coaches’ Corner by AgileThought. The podcast where practitioners and leaders seeking advice to refine the way they work and pave the path to better outcomes. Now here’s your host, coach and agile expert, Dan Neumann.
Dan Neumann: [00:16] Welcome to this episode of Agile Coaches Corner. I’m your host Dan Neumann and our goal here is to bring you agile topics in an approachable way and of course the opinions expressed here are those of the participants and don’t necessarily represent those of AgileThought, any other people or other organizations. And I’m really excited to be joined today by Dr. Jeff Thompson. Dr. Thompson is CEO Ameritus at Gundersen health systems. He’s a pediatrician and the author of the book Lead True, Live your Values, Build your People and Inspire your Community. And Jeff was the CEO of Gundersen health systems for 14 years. You were responsible for improving quality lowering costs and rapidly advancing technology. And you had a staff of, as I understand about 7,000 folks. He served hundreds of thousands of patients and you were the steward of spending about a billion dollars of the community’s money. Jeff’s long experience as an intensive care pediatrician, senior executive showed him how leading from one’s values can affect tremendous lasting change. And that alignment and leading with values really resonated strongly with me in the agile community. So thanks a ton for joining me Jeff. Really appreciate it.
Dr. Thompson: [01:25] Well thank you very much for having me. I really enjoy talking with folks about values based leadership. I think it’s applicable to to health care of course and business in general, communication industry, politics, building our communities a as a whole. So I like talking about it. I think it’s a great opportunity for both young and more experienced leaders to rise up and build a a better way forward.
Dan Neumann: [01:54] Agreed. So what I liked about the book and the values based leadership or living the values is that there’s a really strong encouragement to make the values explicit. Obviously every organization has values and sometimes you can tease them out by the behaviors they reward. But what I liked is how you made them explicit at Gundersen and with the role you played.
Dr. Thompson: [02:15] I think that was a key part of how we made it work for the whole organization. That you have to have the courage to say, this is what we’re about. And there’s who we are about and I think for, for staff that really want to exceed and you, and you can start sorting people pretty early if, if you give them a clarity on what the purposes, where we’re going, what we’re about, what we’re going to stand for, that, that gives them a wave, uh, where we’re going. And then the value set tells them how we’re going to get there, how we’re going to treat each other, how are we going to make decisions? If you take that and have, here’s where we’re going. It’s not going to be mediocre. It’s going to be excellent. Um, it’s a, it’s serving the greater good. It’s not just our own wellbeing and then, and then say, and here’s how we’re going to treat each other as we serve this bigger purpose. You now start inspiring people within your organization. But you also, you also start attracting people from outside who say, you know what? That’s an organization that I can lean in on and really make a big difference. So, so our, um, our, our hope was to be clear about that and then engage most of the 7,000 to pull on the oars with us in that direction.
Dan Neumann: [03:41] Yep. Making that purpose known. And you’d talked about not just the financial wellbeing of the organization, obviously that is super important as well, but the purpose beyond the money and in health care, I would hope that’s pretty obvious, but maybe it isn’t for a lot of organizations, especially as you get outside of healthcare. What’s the purpose?
Dr. Thompson: [04:02] Right. It’s really not, I mean, the purpose is, and the values are clearly written on the walls and on the website, but that’s not how everybody lives. Whether you’re in a healthcare organization of business, uh, or in government for that matter. There’s some fabulous people in all those places. There’s also some people that are pretty short term thinkers and pretty narrowed in their focus and our argument was you want to compete for the longterm. You want to get the brightest and the best. There’s a lot of great people out there who want to serve a higher purpose. And it, it doesn’t mean you don’t have good finances. I mean finances. Uh, you know, we, I said many times finances were never the goal. They were the tool, an important tool, a critical tool. But they’re just a tool and you stand in front of the staff and say, do we have to have decent finances? Sure. All you want to get paid, you want to have benefits, you deserve to get paid, you deserve benefits. But we shouldn’t take any more out of the community than we absolutely have to, to, to be fair. And that means becoming more efficient, becoming more thoughtful, partnering with people across the spectrum of business and industry and education and government. And so you build a steady drumbeat of serving this other purpose, but in a disciplined way. We have to hit our quality marks. We have to hit our service marks, we have to be financially sound. And it turns out well, focusing in this way, we had the best finances in 120 years of the organization, but it was never the main goal. We grew the most, we had know 114 years, but it was never the goal. They were just tools. They were tools to serve the bigger mission.
Dan Neumann: [05:51] When you became CEO, was this kind of a new thread men and was getting alignment purpose and around those values, something that was difficult and if so, maybe what were some strategies that that folks might learn from for getting good alignment around purpose and values?
Dr. Thompson: [06:08] I think one of the, one of the most important things was there. We had a lot of good people before I became the CEO who were doing terrific work in the organization. The key I think was to be really clear about it and consistent on the message and write it down and put it up there. So you have the courage, you have the courage to say, here’s what our purposes, here’s what our mission is. Here’s what our value statements or the, the, the mission was, distinguish ourselves through excellent patient care, education, uh, and, and the wellbeing of the community. That means, that means if you came into me and said, well, we, you know, we’re at the 50th percentile for our outcomes, I would say, hmm, that’s not excellent. That’s in the middle. Do you tell half of your patients that they’re going to get less as good of care than most of the people in the country? I mean, you’re, you’re not going to say that. No, no, no. We give, deliver great care. Well the measures say you’re only in the middle. We need to do better. We can do better. Um, measuring yourself against your mediocre past isn’t, isn’t greatness. It just, you’re a little bit better than your mediocre past. But you’re probably still mediocre. So, so we said here and, and we applied it consistently across everyone. So one of the key pieces was a code of conduct, a code of conduct that that would apply to everyone in the organization. CEO, environmental services worker, doc, nurse, didn’t matter. Business leader didn’t matter. Everybody had the same code of conduct. Here’s what the organization would deliver to you and here’s what you deliver to the organization. It was printed on. Everything was put up on the wall it was put up right next to the strategic plan that said, here’s our purpose, here’s our mission and here’s our values. So it consistently, it consistently reinforced this principle. We are, we are outward facing, we’re serving the public. Um, we’re going to take care of each other and that’s the way we’re going to take care of our patients and our community. We are going to be disciplined in that approach. Um, but it’s going to be about excellence and outcomes, not short term. You know, did you hit this little mark? Little mark, little mark. Now behind it? Do we have a system of working on that? Yes, but the key, the answer to your question, the keys are to have the courage to put out there, here’s where the organization is going and here’s what we’re about. Completely public, put it out. It’s by every desk. It’s on, it starts every presentation that I made and then the code of conduct. Here’s how we’re all going to behave. Now we just, I just gave us some leadership training at a university not long ago and it was, we had great fun, it’s students and faculty and senior leaders from the university. Um, and, and fortunately for me, I’m quite excited about it. Maybe not for the leaders of the university, but the students, the students got done and said, ah, you know, Dr. Thompson said he had a code of conduct for all 7,000. We have a code of conduct here at the university for the students. How about the faculty. How about the deans? How about the chancellor, how about the rest? How about if we all have the same? That’s a good idea. So now it’s gone from 50 students making noise to 300 students making noise. So, I, I think I’ve caused quite a problem, but it’s quite good fun. And, and, and this is a consistency if you, if you, you know, I mean, the more, the more special and protected the senior leaders, the more the more unspecial and afraid the other members of the staff are so, so the more you separate, the more distance becomes, um, and, and they’re less likely to believe you are your emails or your talks in front of them. Um, so you have to, you have to have this code of conduct that applies for everyone, that that is a way that you can move forward and affect the whole culture of your organization even when you’re not in the room.
Dan Neumann: [10:33] And I like that. Um, and for those companies that are going to hang them on the wall and then not live up to those, that breeds a culture of hypocrisy pretty quickly. And then people will, will sniff that out. Um, and I think you called that a get by culture and one of our chats.
Dr. Thompson: [10:52] Yeah, yeah. It’s, we, we added a, one of, one of the things we did is worked very hard on advanced care planning here for seniors. We thought it was a respectful way to treat seniors, give them the care they want, they want more care, giving more care. They want less care. We give them less care. We give them the care they want. They get to direct their care in the last years of their life. Um, the discipline part. So that’s, that’s clear and courageous. Yes, we’re gonna, we’re gonna make this stand. Is it a, in many parts of the country, would that cost us tens of millions of dollars? It did. Um, because of the revenue, because most of the time seniors, when they get to direct their own care at the end of life, choose less care. So there was a whole lot of revenue that we weren’t going to get. But remember, it’s not about the money. It’s about the wellbeing of the staff. Um, uh, and the wellbeing of the patients. And so we, we chose to do that. The follow through is very important. We had to make it available. These these directives available. We to have a system to follow through. We have to have quality improvement to make sure we’re really following. We had to have hospice and home care. The problem was some organizations just did the conversation and the advanced directive. I was speaking at a major university, very well respected, do a lot of great things and they said they were very impressed that we had 95% of our seniors had their advanced plans and available and were followed in the last two years of life. That was the highest anywhere in the country. They said, well, we got up to 90% of our seniors had advanced care plans. I said, that’s great, and we follow them 16% of the time. I said, that’s terrible. You’re making a promise and then breaking your promise. Um, she says, oh yeah, it was, it’s complete disaster. It’s terrible. I feel bad about it all the time. Um, same way inside an organization. If you say, this is what we’re all about. And then, and then the only people that have to live by what you’re all about are the frontline staff. It, it weakens your message. Do you think on nights and weekends, if you want to have a mediocre organization, you just, you do that. And then people give 70% of their effort and they keep employed and you just get along. And that’s what, that’s what average is all about. If you want to give 100%, then you have to engage them in a bigger because you have to show them that they can make a difference. And you want to get, get people 120% meaning, you know, after work, they’re thinking about what I’d like to recruit my sister to come here because she’s brilliant and great, and she can do all these things. Um, or you know, I wonder how to solve this problem that 120% takes a consistency of purpose. You know, goals bigger than themselves, aiming for excellence and a value set that they’re not wondering how they’re going to get treated. That everybody’s gonna get treated with the same set of values.
Dan Neumann: [13:57] Yeah. You want them to be able to bring their whole self to that work. And in agile there’s values like, or a principle of we believe in a sustainable pace. So that means people are not doing the software thing where they’re working 60, 80 hour weeks or you know, the death march of software. And we value technical excellence and in organizations say, well, we’re agile but you know, we, we aren’t technically excellent are we, we have these death marches well then, then that’s not very agile and it’s time to go back and really inspect your alignment with those. And you had alluded to in the book a, uh, a covenant that, that you used with your, your teams or your staff to help with that alignment. Is that correct?
Dr. Thompson: [14:42] Yeah, we used a, we call it a compact it’s same kind of thing. It wasn’t, it wasn’t a signed document. It was in fact a, um, it was, um, a, a document that was given to you if you went to apply for a job, we’d send you this and say, this is how we live. Is that okay? If it’s not, don’t, don’t fill out your application it’s a waste of time. And so, and then when you’d come for your interview, we’d show it to you again to say, look, here’s what we expect from you. Here’s what the organization will deliver to you. You good with that? And then if they got the job, then they would get a note from me saying, here’s, here’s what we’re all about. Here’s where we’re heading, here’s where we’re going and here’s how we’re going to treat everyone. Everyone, everyone. Um, that doesn’t mean this is how the senior people can treat senior people. And then different. It’s how we’re going to treat everybody? And, and so it became, and then at your first evaluation here, oddly enough here, it’d be the same principle showing up, uh, on, on the same thing. So when you had this repetition, here’s how we’re going to live and you made it public, here’s how all of us are gonna live. Um, now is there always some people say, well, I don’t like Dan Neumann, so I’m gonna, I’m gonna, I’m going to nail him on this piece of it. There’s always some hunting of your, I mean, you got 7,000 people. Everybody’s not perfect. I’m not implying this. This made everybody perfect, but, but what it did do is set a standard and then you had to require discipline. Sometimes discipline was very hard. I mean the discipline was super hard. You’d have someone that was amazingly good in some area. You know, in the book there’s a story of a young neurosurgeon came and quality was great. He was great and he was on time and he was fast and he was, could see a lot of patients and all that was great. And he calls me up one morning and said, you know, Jeff, I think I’m a, like, I’m in trouble. I said, why would you be in trouble? He said well, I hollered at a security guard for putting a ticket on my, on my car. Where was your car and he said well it was parked in a fire lane, right by a building. I said, it’s a fire lane. He said, well I was going to come out if the fire alarm rang, and I said that’s not how it works. You gotta not park in a fire lane for Pete’s sake, man. And he said, yeah I know but the guy… I said, why were you hollering at him? Well he ticked me off. He said, well, the guy… I mean the ticket doesn’t cost you any money. Not that he couldn’t afford it, of course, but that it doesn’t cost you any money. It just reminds you parked someplace different. What did you say to this man, he said, well, I told him he should get a job that’s useful and, and I make more money in a week than he does in months. And then I didn’t say anything. I just let that sit for a minute. He says, are you going to fire me? So now you, now you have a, now you have a, uh, a fork in the road, right? So you have this person that’s very valuable to the organization, hard to recruit, does some amazing things, and yet he’s behaving outside the lines. Um, he’s behaving in a way that is not consistent. And so what do you, do? You fire him or you or you just let it pass or what do you do? So I said, um, it depends on what you do. If you apologize to this man, if you write a note to his supervisor apologizing for this behavior, which of course it’s 20 minutes, so it’s all over the organization. Um, and uh, and then, and then you enter a program to behave better, treat people better, then then we can make a run at this. We’d love to have you stay, you’re doing great work in many other areas, but I can’t have you destroying a nurse, for example, at 7:30 in the morning and then have her make mistakes on patients for 11 and a half hours because we know that’s what happens. And so we won’t let that happen. And his reply was, I put $5 million on the books last year. Well, that’s the reality. He’s absolutely right. He did. He’s a hard worker did a lot of, a lot of work, important member of the whole team. And I said, I’m going to miss that $5 million, but you cannot, you cannot continue to behave this way because if I allow you to behave this way, then I’ll lose another doc, another surgeon, another nurse, another patient. It’s just not okay. So it’s, if it’s not okay for anybody, it’s got to be not okay for everybody. And so it’s just not okay. And he was unwilling to, um, develop a plan to manage his behavior. And so he had to sell his house, left the community and move to another seat. I felt badly for him and his family. Um, but, but the truth is, um, I could not allow that. So it’s a matter of discipline. So it’s, it’s courage to say what you’re about. It’s discipline to follow through. And then durability to take the beating afterwards cause they’ll, man was the department happy to have to fire him? The department wasn’t happy and I felt badly for his family and then it wasn’t, that was not good. And then we had to recruit and it costs us some short term money. So short term, short term thinking, short term thinking, it would’ve have been easier just to let this pass and wag my finger at him and say, don’t do that. Knowing full well he would again, um, long-term thinking says for the good of the organization broadly, if you don’t manage these, these problems, then you’ll lose other good people who are unwilling to put up with it. And they might not complain. They might have the power to change it, but you’re going to lose those people or you’ll have people making mistakes or you have people who have brilliant ideas that are unwilling to put them forward because they’re afraid of ridicule by, by a bully. So managing, managing influential people’s bad behavior is a great opportunity in most organizations. Few organizations have really nailed that. It’s a great opportunity to improve the overall creativity. Um, engagement, uh, uh, decreased turnover. It’s a great place for organizations to say, here’s, here’s, here’s how we can get better.
Dan Neumann: [21:15] And what I really like about that story and the way it’s relayed in the book as well is there’s, there’s the concept of a fool’s choice. You either fire him or you don’t fire him. But what I like is that you are able to come up with, here’s a framework by which you keep the values. You know, you apologize to the person directly, you write a letter, you, you know, go forth and then say no more effectively and now there is a way for that person to stay in the organization and align with the values or they can choose not to be. So you’ve created at least a third option besides the fire him or don’t fire him. And I really liked that part of the, um, the anecdote that you relayed.
Dr. Thompson: [21:56] I think our job is to try and help people be successful. I mean my, my first hire was a vice president of HR because she was a people builder, not a rules police. Now it’s not like we don’t have rules. Of course we have to have rules and there’s laws and we follow the laws and that’s important work. But the emphasis is just like the finances. The laws are just a tool. It isn’t the end all and be all. The end all and be all for the human resources department was be people, builders. That’s their job. Build. People figure out ways that people can succeed. That was their responsibility. Do we have to follow the laws? Yes. Just like the finances. Do we have to hit our financial marks? Do we have to stay solvent. Do we have to pay our people? I want to pay our people. They deserve to be paid. It’s, I’m, I’m fine with that. But, but it isn’t, the goal of the organization to pay people. The goal of your organization is improve the wellbeing of the community. And I think once, another piece that, that senior leaders sometimes don’t get, is once you get this going, it can go on its own. I mean, it’s, people innovate in the middle of the night on weekends when you’re not standing there looking at him. One Friday, um, that was kind of downer story but here’s a better one. One Friday I was gone. I was off speaking someplace. And, and the two senior vice presidents, they were, one was on vacation, one was someplace else. They weren’t around. And, and right after lunch, uh, a radiation oncologist, Dr. Pat Conway walked into administrative area and we, we had an open suite area, so no offices except for HR. And the, and the goal was everybody who had an issue, it was everybody’s issue. So no lines and boxes. If somebody had a problem, our, all of our jobs was to solve it, whether you’re an executive assistant or the CEO, you solve problems. We solve people’s problems. Um, so, so he walked in and he was looking for the vice president that was responsible for his team. And another one stood up. Brian Erdmann wasn’t a doc, was administrative guy responsible for all different areas. And he said, can I help you doctor Conway? And Pat says, no, no. I was looking for, um, um, my medical vice president. And he says, well, maybe I can help. He says no you won’t be able to help. Brian says, I might be able to help. I like to try. And Conway says, no, this is crazy. I’ll just come back another day. Then Brian says, tell me. Pats says well, I’m, I’m treating this guy today for this cancer in his neck and I’m trying to come up with all these complicated things. It’s very complex cancer and it has spread all over his body and I’m giving radiation to try and make him comfortable and he doesn’t pay any attention. He’s not paying attention. He’s there with his girlfriend, neither are paying attention. Finally I say, you know, this is your life. I’m trying to pay attention. I mean, I need to figure out what you want. And the guy says, uh, I want to get married. What? I want to get married. That’s what I want. You asked me what I want. I want to get married. We’re talking about your treatment thing here and he says yeah, but you asked me what I want. What I want is I want to get married. Well, when do you want to get married? Well, today would be good. What do you mean today? I’m an oncologist. What do you mean today? So that’s what I really want. I want to get married today. So he had to go get some treatment. The doctors were going to see him a little later and um, so we came up to the thing and Erdmann having no idea what he was going to do. Said we can do that. Why did he say that? Because we were going to make more money on it because we are going to get some award? He said it because this is our principle or the principles take care of people. Our principle’s to find out what they want or principals. Excellence, not mediocrity. Mediocrity says, well that’s nice. I hope someday they get married. You, you give them a pat on the head. Excellence, excellence is saying we’re going to get this done. So he calls the chaplaincy and say, how do you get these people married? Well we have to get a wedding and said where do they live? Well that’s in different states. Somebody has to drive to Minnesota and get a marriage license. Where’s her dress? Where are we going to get a cake, video, blah blah, blah. In two and a half hours, we had the whole kitchen organized, three cakes and had cakes there for everybody at the thing, all the flowers left the uh, the, the gift shop with no clarity on who’s going to pay for them, but they all went to the wedding. Um, the, some lady from the foundation knows how to play piano. She came and played piano. A lady out of CT sings at wedding. She sang. The, the media people, our own internal media. People showed up. We had two videographers and two camera people taking pictures. Um, somebody drove 50 miles north to get her wedding dress and bring her wedding dress back in two and a half hours. We had a full staged wedding in the garden area of our hospital and these people got married and did everybody know the guy was going to die in a few months? Of course they did. Did anybody care? They didn’t care. They didn’t care. This was the right thing to do for these people. The important piece of all this, many important pieces but did anybody call me? Did they call the senior vice president. Did they call anybody. Did they call the chief financial officer? They didn’t call anybody. They just said no, this is the right thing to do. We just do the right thing. What we do is the right thing. So they married these people, they had nurses, everybody was crying. It was great. Um, and and um, did he eventually die in four or five months? Of course he did. We knew all that, but that wasn’t important. What was important is people were able to act because they knew the values of the organization and they weren’t going to get criticized because they spent some money from the floor shop or the cake or took some people’s time to do this. This is the right thing to do. This is what excellence was. This is what respect is. This is what compassion is. It was all the values. So once you, once you set these values up and you show that senior people, mid level people, everybody can live by these, then people act on their own, then they can innovate on their own, they can solve problems on their own. It doesn’t have to all boil up to the CEO or the senior vice presidents. Now you have, now you’ve unleashed the talents of the 7,000, not just three or five or 10. Well, I’ll take the 7,000 against any three or five or 10 any day.
Dan Neumann: [28:43] For me, a lot of organizations, it’s, you know, you ask for forgiveness. It’s better to ask for forgiveness than ask for permission. And I think what you’ve done is create another option for setting up a framework where people can do the right thing.
Dr. Thompson: [29:03] I think, uh, one of the things that organizations worry about is when they put structure in, that they may limit innovation or creativity. And my contention is, is the ways you encourage innovation is that you have a certain amount of structure that allows people the freedom to act on their own. So if the structure is, here’s our purpose, here’s our goals, we’re going to be excellent. We are going to exceed. We’re going to go after, uh, the, the, the highest calling. And then you have a set of principles on which you go towards that with: here’s our values, here’s the principles and how we’re going to behave and treat each other. That is how you get excellence and that’s how you get momentum. And that’s how you get creativity in your people. I mean, you have to have a culture that, uh, you know, uh, has some disregard for conventional wisdom of course. Um, but, but the structure can really add, can really add to the creativity by allowing people to know, here’s how I’m going to be treated, here’s where the fences are, and now I can run freely within those fences. And, and given that, you know, our breast center became the first breast center of excellence in the country much quicker than Hopkins or Stanford, other great, great places, but we had better outcomes, our staff was acting on their own or our environmental people pushed our greenhouse gases down 95% in, in eight years. We were invited to the Paris climate talks because of what we had accomplished, accomplished because of this clarity on where we’re going and then unleashing the creativity of staff across many, many departments in our organization. So, so if you take the purpose and your values as your cornerstones, you build a code of conduct around how you’re going to behave, you evaluate and manage your leaders around that consistent across the organization, then you can get momentum in many different departments and then you have a progression towards excellence rather than kind of hovering in mediocre.
Dan Neumann: [31:27] And that framework is, is one of the things you, you took that framework that you were using to manage people and align them and allow them that autonomy to act within that boundary. And so I liked that part of the book too where within each chapter then there’s some specific takeaways and allowing people to take action based on your experiences and the learnings you’ve had over the time. So I really want to appreciate you, Dr. Jeff Thompson again, uh, and the book is Lead True and would really encourage folks to, to pick that up and again, really appreciated running into you and having the chance to have you join on the podcast. Thank you very much.
Dr. Thompson: [32:07] Well, thank you very much. It’s delightful talking to you and uh, and good luck with your company. If I can help again, I’d be happy to do that with a podcast or with, with the group. So thanks. Thanks for chatting with me. Dan I’ll talk to you again soon.
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