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Lessons from Top Leadership Teams: Develop from the middle

Jim Molpus, for HealthLeaders Media, September 5, 2008

A leadership culture is not something you can buy off the shelf. It takes nurturing and development. At the beginning of the decade, San Diego-based Scripps Health—the 2008 Top Leadership Team in Healthcare honoree for large hospitals—had as many different leadership cultures as they had hospitals.

"The five Scripps hospitals were operating as silos. In fact, they were competing against each other," says Scripps Health CEO Chris Van Gorder, who took over the helm of the system in 2001. "Management and staff at each hospital thought their 'cultures' and 'missions' were the best as well as their policies, procedures and systems. There was very little interaction between management teams and very little sharing of best practices and system expertise. In addition, there was really no "Scripps Culture"—just a group of different cultures all appropriate for their local markets."

Van Gorder started to see another sign: promotions at the senior level were almost always being given to external candidates. The path to fix both issues was to create the Scripps Leadership Academy, a group of mostly middle-managers who started to meet monthly to talk about common challenges.

"I needed to find a way to bring the organization together. I did not believe that was possible by focusing just on senior leadership. My hypothesis was that I could bring our middle management together starting with 20 participants in the first year, another 20 the second year and so on. My hope was that it would create a powerful group of 'change agents' dedicated to building a system culture by demanding more from their supervisors and delivering more to their subordinates."

The meetings themselves started with an open Q&A, with the CEO answering whatever questions were asked (except for personnel issues which could not legally be discussed in an open group). Transparency was the first ingredient to build trust. "I wanted the Academy to understand how the organization really worked-why decisions were made the way they were—and what was going on behind the scenes. Over a few months, each class became more trusting and comfortable asking very direct and pointed questions. And each month their understanding of the organization grew as did their leadership skills."

Each year the leadership academy takes in more applications than they can fill for the number of slots. An "alumni association" of past members has formed that now contributes by organizing a system wide social event and a series of leadership lectures. The Scripps system has benefited from the sense of cooperation among rising leaders, and at the same time created a pipeline for executives to grow.

"I fully anticipate one or more of our future hospital chief executives and corporate senior executives will come from the graduates of the program," Van Gorder says. "Most accept the concept of continual leadership and management education both internally and externally. Several have decided to go back to college for their graduate degrees."


The Scripps Leadership Academy is just one of the solutions for healthcare leadership that will be shared at the annual Top Leadership Teams in Healthcare Conference, Oct. 16-17 at The Drake Hotel in Chicago. Some 40 senior-level healthcare leaders will share hard-earned, practical solutions to many of healthcare's current leadership challenges. For more information or registration, go to: www.topleadershipteams.net.

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