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How to Operate a Healthcare Facility That Keeps Workers Happy


One of Barclay Berdan’s prescriptions for a great workplace culture in the healthcare industry sounds a lot like “an apple a day.”

Berdan is CEO of Texas Health Resources, which has ranked as the no.1 best workplace in healthcare for four straight years. And when you ask him the secret to success at the 25,000-person health system, he points to a practice that seems too simple to be effective: a newsletter that has been going out monthly to all employees for 15 years.

Texas Health’s Promise Packet is a memo with two or three discussion items. These cover changes in the organization and include reminders of Texas Health’s purpose and values.

No big deal, right? Wrong. The real value of the Promise Packet is that every team throughout the organization is expected to spend 15-20 minutes discussing the Packet items. Division and team leaders are given additional materials to help them guide the conversation. And those leaders are held accountable for holding the discussions. “We actually ask, ‘Did you do this?’ ” Berdan says.

In effect, the Packet gets everyone on the same page and reflecting regularly on the Texas Health mission and values of respect, integrity, compassion, and excellence.

Just like “an apple a day” often comes with wiser choices about diet and lifestyle, the Promise Packet is more than just a monthly newsletter. It has sparked healthy organizational behaviors, including a deeper sense of the Texas Health “promise” of “Individuals Caring For Individuals, Together.”

“It’s not simply the newsletter itself that drives our strong culture. We use the Promise Packet as a catalyst for dialogue between employees, and that’s what makes all the difference,” Berdan says. “That ties everything together.”

Values are Vital

A strong purpose and a set of lived-out values are key features of the Best Workplaces in Healthcare & Biopharma. My organization, Great Place to Work, just published this year’s list of these top workplaces in partnership with Fortune. At Texas Health Resources and the rest of the list winners, 88% of employees say their work isn’t “just a job,” but has special meaning. And nearly 9 in 10 employees at these companies describe their leaders as honest and ethical in their business practices.

Saving lives and otherwise improving the wellbeing of people makes it relatively easy for organizations in the healthcare field to rally employees around a mission. And our research finds that doing so is important if these businesses want to be agile amid all the changes affecting the industry. Challenges in the field range from an uncertain regulatory climate to the rise of evidence-based, personalized medicine and higher expectations from consumers concerning holistic care and information transparency. In studying 95,000 healthcare employees, we discovered that pride—a close cousin of purpose—is the strongest driver of organizational agility. When healthcare staffers are proud of their workplace, they are nine times more likely to say their coworkers are adaptable to changes.

Clarity of purpose from executives also matters. Employees who say their leaders have a clear view of where the organization is going are five times more likely to say their peers are adaptable. Strong values put into practice by those at the top also figure in. When leaders are perceived as honest and ethical, employees are five times more likely to report an agile workforce around them.

Pride and leaders living out values also fuel high levels of service. Our research discovered that when employees are proud of their organization, they are five times more likely to describe their organization’s service quality as high. And when leaders are considered honest, staffers are three times more likely to characterize the organization’s service as high-quality.

Values and a Great Place to Work For All

Values are one of the six components of what we call a Great Place to Work For All. In our new book of the same name, my coauthors and I explain how values, a foundation of trust, and effective leadership allow organizations of all industries to maximize their human potential, which leads to greater innovation and revenue growth.

This formula has been at play at Horizon Pharma, another of the 2018 Best Workplaces in Healthcare and Biopharma. The Dublin, Ireland-based pharmaceutical firm with U.S. operations in the Chicago area opened its doors a decade ago. Already, it has seen revenues pass $1 billion, with medicines primarily for rare and rheumatic diseases.

Purpose at Horizon begins with company founder Tim Walbert, who suffers from several autoimmune diseases himself and speaks of the company’s mission being “personal.” The nearly 1,000-person company makes this principle practical by bringing actual patients of its therapies to speak to employees at least once a quarter.

Recently, a young girl who suffers from a rare disease called urea cycle disorder visited Horizon’s offices. The girl, who experienced a stroke and then subsequent brain damage from the disease and now takes a Horizon medicine to stabilize the condition, spoke about how happy she was that country singer Chris Jacobs wrote a song for her. Jacobs did so through a non-profit, Sing Me a Story, that Horizon supports. Hearing from this patient moved the entire staff, says Irina Konstantinovsky, chief human resources officer for the company. “Most of us had tears in our heart or in our eyes,” Konstantinovsky recalls.

The “It’s Personal” philosophy extends to how Horizon leaders treat employees at all levels. Konstantinovsky recalls a meeting last year at which Walbert seemed distracted on his phone. It turned out he was texting with Horizon sales representatives in the Houston area, which was wrestling with severe flooding. “He wanted to know if they were okay,” Konstantinovsky says. “He wanted to know if he could help.”

Tethered to a Great Culture

At Texas Health Resources, a strong sense of purpose has meant shaking up the leadership ranks. Berdan took the reins of the organization in 2014. At that time, clinical professionals made up just 5 percent or so of the leadership teams at Texas Health. The number has risen to about 50%, because Berdan recognized that people like himself with MBAs, but without medical training, shouldn’t dominate if the goal is improved care.

“You don’t want me deciding clinical practices,” Berdan says. “You want a physician, and a nurse, and a pharmacist.”

Indeed, Berdan links this shift in mindset and leadership makeup to better results in patient safety, clinical outcomes, and clinical efficiency. One sign: Texas Health has received the QUEST Award for High-Value Healthcare from industry research group Premier for three straight years. That award covers topics including affordability, effective care, and patient safety.

Texas Health’s executive changes and subsequent awards show how a focus on mission and values is better all around—better for the business and better for the people touched by the organization.

If the Promise Packet is akin to the proverbial apple-a-day, Texas Health’s set of values is like a rock climber’s safety rope. It protects people as the organization adapts and innovates, Berdan says. “It’s sort of like a tether,” he says. “’I’m willing to take the risk of change, but I’m tethered to the values of the organization.’”


Ed Frauenheim is director of research and content at Great Place to Work, Fortune’s longtime research partner for Best Workplace lists, including the Best Workplaces in Health Care & Biopharma. Ed also is co-author of A Great Place to Work For All.