Building organizational and personal resilience.

THE IMPORTANCE OF leaders being able to demonstrate resilience and build it within their organizations is well articulated in the compelling articles by Wicks and Buck and by Spake and Thompson. Their advice is especially timely, as healthcare leaders find themselves facing challenges they may not have faced or even anticipated during their careers, including how to build a culture capable of achieving operational excellence, overcoming hardships, embracing change, and remaining resilient. As Wicks and Buck state, healthcare leaders are never immune to the pressures of their complex jobs. Indeed, if we are to be the leaders our organizations require in this time of flux, we must first understand what makes us and our organizations tick and be able to adjust our personal and professional practices to meet the challenge.Fourteen years ago Scripps Health did not find itself to be resilient. In fact, the organization was rife with distrust and dysfunction, resulting in financial loss, significant staff turnover, and morale issues. This problematic environment ultimately led the medical staffs of the five system hospitals to take votes of no confidence in the leadership of the organization. In response, the board of trustees acted by changing leadership and, under their guidance, asked me to chart a new road map for Scripps.To create a successful and resilient organization, my team and I needed to unify the various cultures within the organization. Although some of the areas demonstrated wonderful cultures-the diverse makeup of staff in our hospitals and ambulatory sites, for example, closely matches that of the communities they serve, leading to the delivery of culturally sensitive care, high quality, and high service- there did not appear to be an "umbrella culture" under which all of the subcultures could be brought together. In fact, the subcultures and business units competed with each other, such that the perception was that "my hospital" or "my culture" was better than "yours."Culture is not created by memo or edict from the board or executive leadership. Real culture comes from the middle of the organization-from the medical staffs and from the frontline staff and managers. It develops over time and is based on the same principles that create a resilient organization:* Transparency* Honesty* Consistency* Continuous reflection on what is working well and not working well* Faith in leadership* Pride in the organization* Continuous and effective real-time communication* Accountability* Compassionate leadership* Stability* EngagementTo develop an umbrella culture founded on these principles, Scripps created a number of councils and structures intended to produce a sense of ownership, transparency, and accountability among the various constituencies.Building Organizational ResiliencePhysician Leadership CabinetThe Physician Leadership Cabinet (PLC) is an advisory body to the Scripps CEO, who also cochairs it with the system's chief medical officer. The PLC consists of the system's chief nursing executive and the member hospitals' chiefs of staff, vice chiefs of staff, and chief executives.The PLC structure is designed to fill the inevitable gaps of information between the clinical and administrative leaders of the organization. The hypothesis for its formation was simple: If intelligent and committed individuals are given the same information-clinicians sharing their clinical knowledge and administrators sharing their business knowledge-a mutually acceptable goal will be reached. Critical to the mores of the group from the very beginning were the aforementioned principles of a resilient organization.The results exceeded our expectations. Over the 14 years of its existence, Scripps has accepted 100 percent of the recommendations from the PLC and the hypothesis has been proven true. But not only did the organization benefit from the individual projects and dialogue, a real sense of joint ownership was also developed, as was mutual trust between the individual physicians, medical staffs, and administrators. …