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Greg Paris had been chief executive officer of Monroe County Hospital for six years when he decided to wash his hands of mediocrity.

The Albia, IA, hospital, located about 60 miles south of Des Moines, was what Paris calls “ordinary”—low patient satisfaction, poor staff morale, barely breaking even.

Today, ordinary no more, the 25-staffed-bed critical-access hospital boasts employee satisfaction scores in the 98th percentile, up from the 48th percentile when Paris got fed up. More than 40 percent of the hospital’s employees drive past another hospital to get to their jobs—despite the fact that Monroe County’s salary scale is less than the area’s urban and regional hospitals.

“The only way I can compete is to make it a place that is fun to come to work,” Paris says. “When you get out of bed in the morning, you say, ‘Cool! I get to go to work, I’m going to laugh, and I’m going to make a difference in somebody’s life today. I’m part of a team that’s going all one direction.’”

He compares changing a hospital’s culture to losing weight—consistently doing many small things differently than before. The specific acts—thank-you notes to employees, celebrating the fact that an employee held a patient’s hand when he died, having fun with your coworkers—are not difficult in and of themselves.

“They’re not earth-shattering, but if you do them, you’ll get to operational excellence,” he says. “But it’s hard to have the self-discipline to do the things that it takes.”

What ideas worked for Paris? Here are three:

Get to know your people. Start a file for each staff member with family information, and refer to it before rounding. At least once each month, every manager notifies Paris of an employee who deserves recognition; he sends a hand-written note of appreciation to their home.

Stop hiring warm bodies. Select “attitude” as a value. Let employees hire their coworkers. Set expectations and hold workers accountable for meeting them.

Celebrate. Once a month, MCH employees are asked to write down one thing that is going well. “We just plaster our cafeteria with it,” Paris says. “We have a free food day, and we have some kind of a fun event, and we take some time to think about the things that go right in our world and stop focusing on the things that go wrong.”

—Lola Butcher