The Front-Line Leader

Building a High-Performance Organization from the Ground Up

Chris Van Gorder

• Publisher: Jossey-Bass
• Year: 2014
• Print ISBN: 9781118933343
• eBook ISBN: 9781118933367
• Edition: 1
• Topic: Business
• Subtopic: Leadership
• Index: Business

Real leadership that leads to high engagement, higher performance, and a culture of accountability

As president and CEO of Scripps Health, one of America's most prestigious health systems, Chris Van Gorder presided over a dramatic turnaround, catapulting Scripps from near bankruptcy to a dominant market position. While hospitals and health systems nationwide have laid people off or are closing their doors, Scripps is financially healthy, has added thousands of employees (even with a no-layoff philosophy), and has developed a reputation as a top employer. What are the secrets to this remarkable story?

In The Front-Line Leader, Chris Van Gorder candidly shares his own incredible story, from police officer to CEO, and the leadership philosophy that drives all of his decisions and actions: people come first. Van Gorder began his unlikely career as a California police officer, which deeply instilled in him a sense of social responsibility, honesty, and public service. After being injured on the job and taking an early retirement, Van Gorder had to reinvent himself, taking a job as a hospital security director, a job that would change his life. Through hard work and determination, he rose to executive ranks, eventually becoming CEO of Scripps. But he never forgot his own roots and powerful work ethic, or the time when he was a security officer and a CEO would not make eye contact with him.

Van Gorder leads from the front lines, making it a priority to know his employees and customers at every level. His values learned on the force—protecting the community, educating citizens, developing caring relationships, and ultimately doing the right thing—shape his approach to business. As much as companies talk about accountability, managers seldom understand what practical steps to take to achieve an ethic of service that makes accountability meaningful. The Front-Line Leader outlines specific tactics and steps anyone can use starting today to take responsibility, inspire others, and achieve breakout results for their organizations. Van Gorder reveals how a no-layoff philosophy led to higher accountability, how his own attention to seemingly minor details spurred larger change, and how his own high standards for himself and his team improved morale and productivity.

From general strategy to the tiny, everyday steps leaders can take to create the kind of culture and accountability that translates into major competitive advantage, The Front-Line Leader charts a path to better leadership and a more engaged, higher-performing organization.

Chapter One
Know Your People

I have this old, embarrassing photograph of myself wearing a Native American headdress. It's shoved into my desk drawer. Even though the corners are bent and I've got this big, silly grin on, the picture means as much to me as any of the framed images featuring famous people that line my office walls. The photograph dates from 1987, when I was vice president for support services at Anaheim Memorial Hospital in Anaheim, California. It was my first vice president job, and it put me in charge of an array of departments including environmental services (or housekeeping, as it was called back then), food services, engineering, and construction.

I made a practice at the time of meeting regularly with all of my staff, including the environmental service (EVS) workers. I'd go down to the EVS break room and say hello when employees were coming on duty and getting assignments for the shift. I wanted to know what my employees did; otherwise, I felt, I couldn't be an effective manager. I had learned as a police officer that if you wanted to get information about your beat, you had to be on the street talking to people. You had to develop rapport and trust, and after a while people would naturally start talking to you and telling you what they knew.

Sometimes I just sat and talked with the EVS staff; other times I went out and accompanied them on the job. They taught me how to use those big, circular floor polishers, and every time I grasped the metal handles I was bucked around, much to their amusement. I didn't mind making myself a little vulnerable. Given how hesitant the employees acted around me and also how happy they seemed to see me, I surmised that I was probably among the few people from senior management to ever pay sincere attention to them.

As time passed, we built a relationship. The staff invited me to potlucks and other gatherings. “My boss's boss's boss knows more about what I do than my boss does,” they would joke. They also challenged me to see if I could find dirt after they cleaned. “You guys are so good,” I said, “I bet I can't find any.” But I would still put on white gloves and poke around. A couple of times, to be honest, I did find a little bit of dirt on the gloves, but I never let them know. The point of this exercise was not for me to evaluate their performance. It was about going out there, showing I cared, and thanking the team for its hard work.

One day, a couple of the workers knocked on my door and asked me to accompany them to the break room. When we arrived, I found that all the employees had gathered. With smiles on their faces, they presented me with a Native American–style headdress they had made out of fur. It had two pointy horns protruding out of the top, a blue and red beaded design running across the front, and fluffy white feathers streaming down each side.

I held it in my hands and admired it. “This . . . is very nice. What is it?”

“This is for you,” they said proudly. “Our chief.”

Everyone applauded, and I didn't know what to say. What an incredible honor. Today, in addition to keeping that photograph in my drawer, I display the headdress in my office as a reminder of what I learned: that you can't be a distant boss and hope to be effective as a leader. You have to connect with people. You have to put time and energy into getting to know them and their work. Not just once. Or twice. Or three times. But regularly, month after month.

Fly-Bys Don't Count

Advice like this may sound familiar, but most CEOs and senior leaders don't do the kind of deep outreach I'm describing. More commonly they do what I call “fly-bys”; they flit in and out in a cursory manner—looking the part of the political candidate, shaking hands and kissing babies—not really bothering to truly engage with workers. Maybe they feel uncomfortable around line staff. Maybe they feel they have more important things to do. Maybe they're overwhelmed by the sheer size of their organization. Whatever the case, I doubt their attempts at outreach are doing as much good as they might think.

Here's an example. I once hired a chief nurse whom I'll call Marsha for one of our hospitals. Marsha's job was to oversee all nursing operations at her facility. Unfortunately, she became occupied with outside obligations, paying insufficient attention to her core duties. This led in short order to low morale among her workforce. Things got so bad that she had to leave the organization. Shortly after her departure, I happened to be in her hospital visiting my sick father-in-law. One of the nurses caring for him asked me to accompany her into the hallway for a private chat. “Chris,” she said to me, “I wanted to thank you. I'm glad Marsha is no longer working with us.”

“Why? You didn't like her?”

“No, because she was never here. Every so often she would throw on some scrubs so it would look like she was one of us. She would come up here and sweep through the units and smile and kind of talk to everyone a little bit. Then she'd disappear for months and you'd never see her. It was never real. We're glad she's gone.”

Employees aren't stupid. They know a fly-by when they see it. By satisfying herself with fly-bys, Marsha was highlighting for her staff how little she cared about them. She wasn't bothering to listen, talk, and build relationships. She wasn't engendering trust. She was pretending to be one of the team—and, I would add, pretending to be a leader too.

Roll Up Your Sleeves and Get Dirty

In reaching out to employees, don't content yourself with just making conversation. Observe them on the job, actually serving customers. As an exercise, we regularly have groups of middle managers sit in our lobbies for an hour or more. Their mission is to watch the interactions between our volunteers, our staff, and our patients. Every time we do this, our managers return with valuable new perspectives. One HR manager sat in a hospital lobby that she normally walks through nine or ten times a day. Afterward, she bubbled over with ideas for improvement. “I don't want to badmouth my hospital, but I never realized how dark the lobby was! I also watched a volunteer at the registration desk who was trying to multitask, answering phone calls at the same time she was trying to give directions to patients. It was very disorganized. And employees were spending more time paying attention to their BlackBerries than to patients.”

An even deeper way to get immersed is to pull up your sleeves and work with line employees yourself. When Hubert Joly took over as CEO of Best Buy in 2012, it was reported that one of the first things he planned to do was clock in at one of the company's retail locations to work the floor for the better part of a week. Noting that he hadn't clerked in a store for almost forty years, Joly related that he didn't want to learn about Best Buy “from the headquarters” but “from the front line.”¹ This gesture must have helped Joly build relationships with his front-line personnel. It likely humanized him in their eyes, reinforcing the idea that he was just another Best Buy employee like them. Similarly, by letting myself get spun around by that floor polisher, I was acknowledging that I was no better or higher up than my workforce.

I don't know if Joly made these visits a regular feature of his tenure; I hope so, because working with the front line really makes an impact when it's done repeatedly. Our leadership team joins line workers at Scripps in a number of capacities, and it has become essential to our success. Once a year, for instance, as part of my ongoing training as an emergency medical technician, I trade in my suit for some scrubs and work in one of our emergency rooms as a technical partner. In a hospital, a technical partner works for and assists the nursing team; he's the person making and cleaning the beds, getting supplies, doing EKGs, taking blood pressures, and the like. During my shift, I'll tell the nurses not to treat me as the CEO, but as their trainee and subordinate. “I'm working for you,” I'll say, “because you know more than I do about the work I'm doing today. So please guide me and help me to help you!”

And make no mistake, my gesture is not a put-on. It's real. Once, on my shift, a trauma came in, and the nurses had me throw on a lead protective apron (required during X-rays) and go up to the heliport with a nurse to accept a critical patient from the flight crew. Back in the trauma room, the surgeon had me stand right next to him. “Okay,” he said, “you're going to help me deliver care. The patient has bilateral fractures from a motorcycle accident.” And there I was, assisting the surgeon and nurses until the patient went to surgery. Although any assistance I provided was very limited and took place only under their complete guidance, I still soaked in the complexity of what the other caregivers were doing as well as the compassion with which they were delivering care. These professionals probably didn't have the knowledge or experience to run the whole health care system, but I couldn't do their jobs either. We had a lot to learn from each other. This meant that I needed to consult with them on decisions, not just assume I knew best because I had the “top job.”

Obviously it's not possible to try everybody's job in your organization. But no matter what industry you're in or the size of your business, there are many ways to get a regular array of front-line experiences. One of my favorites is volunteering. I like to get out of the boardroom to teach first-aid classes to our front-line, nonclinical staff. This not only gives me another perspective on health care delivery but also allows me to engage with staff in an entirely different way. When I'm teaching, I'm no longer the CEO; I'm just another first-aid instructor.

For over a decade now, I have volunteered several times a month with the San Diego County Sheriff's Department Search and Rescue team; I hold the rank of Reserve Assistant Sheriff and am responsible for search and rescue and law enforcement reserves. The assignment gets me outdoors—hiking, rappelling, and driving around in the backcountry on 4x4s. The work is sobering, though; we search isolated, rural areas for people lost or stranded and in need of help, and we also perform searches for dead bodies and crime-related evidence. On one occasion, my team was out in the wilderness doing an event to raise awareness about search and rescue. Toward the end of the day, a young woman riding her horse past the event lost control. After hanging on for a quarter of a mile, she fell off, sustaining moderate injuries. I chased her down in one of our rescue vehicles and, along with some colleagues, provided first responder care. Afterward we placed her on a backboard and readied her for transport to the hospital.

I followed the ambulance to Scripps La Jolla and went inside, still wearing my sheriff's department uniform. The nurses on duty looked at me funny—they knew me, because this was the hospital where I did my EMT training, and they were not used to seeing me in this uniform. I asked how the injured woman was doing, and they told me she was fine and in a nearby room with her mother. I went to visit her and introduced myself. Her mother was surprised to learn that the CEO had been directly caring for her daughter. That meant a lot to her. And, as our chief medical officer has told me, my work in the field means a lot to our staff too.

I'm lucky to have a wife who gives me leeway during my off hours to volunteer like this. Rosemary herself volunteers on the front line, which further helps me build a strong relationship with our workforce. Rosemary loves dogs, and she enjoys bringing our Labrador retriever into Scripps facilities for pet therapy visits. Certified therapy dogs like our Amber help alleviate stress and even pain for patients and staff. In her presence, patients feel connected to their homes and their own pets, and they're distracted for a moment from being in a hospital.

Rosemary visits with Amber as often as she can, sometimes a couple of times a week, so she's a familiar sight around Scripps. She doesn't announce that she's my wife, but when someone recognizes her, she'll confirm that she's married to me. Thanks to these little moments, people seem to understand that I'm not just “the CEO” but a regular guy with a wife and a dog. From that, they feel that much better about their own jobs and the organization for which they work.

To be clear, I don't volunteer on search and rescue or as a first-aid instructor specifically seeking to make an impression on front-line personnel and patients. If that were the case, my efforts would probably appear contrived. I volunteer because as a former police officer, I feel fulfilled protecting people and rendering assistance in their time of need. If you're a manager...

Table of contents

• Cover
• Praise for The Front-Line Leader
• Title Page
• Copyright
• Dedication
• Acknowledgments
• Introduction
• Chapter One: Know Your People
• Chapter Two: Get Outside Yourself
• Chapter Three: The Credibility Factor
• Chapter Four: Tell Stories
• Chapter Five: Create a Culture of Advocacy
• Chapter Six: Take Care of the “Me”
• Chapter Seven: Hold People Accountable
• Chapter Eight: Build Loyalty and Engagement from the Middle
• Chapter Nine: Bring People Together
• Chapter Ten: Ask “What If?”
• Conclusion
• About the Author
• More from Wiley
• Index
• End User License Agreement