This document outlines steps for transitioning an organization from a culture of accountability to one of ownership. It begins by discussing the importance of changing individual behaviors and providing tools to inspire change. A survey of managers at Doctors Hospital revealed issues like toxic negativity and lack of commitment. The document then discusses establishing core values and invisible architecture to build the foundation for a positive culture. It introduces the concept of the Pickle Pledge to reduce complaining. Examples are given of how Midland Memorial Hospital implemented these strategies, resulting in improved outcomes like lower turnover and higher patient satisfaction. The key message is that cultural change requires changing individual behaviors.

2. From Accountability to
a Culture of Ownership
Doctors Hospital at Renaissance
Joe Tye, CEO and Head Coach
Values Coach Inc.
Copyright © 2017, Values Coach Inc.

3. Why we do what
we do >>>>>

6. Guiding insight #1
Culture does not change
unless and until people
change.

7. Guiding insight #2
People will not change
unless given tools and
structure, and inspired to
use them.

8. “I got a whole new team and
didn’t have to change the
people because they changed
themselves.”
Paul Utemark, CEO
Fillmore County Health System
Geneva, Nebraska

12. There is an invisible barrier on the
potential of your organization

13. The Leadership
Challenge

15. Companies that study employee
engagement* consistently find:
~ 25% fully engaged
~ 60% not engaged
~ 15% aggressively disengaged
* e.g. Gallup, Avatar, Press Ganey, Modern Survey

16. Spark
Plugs
16

17. Zombies
17

18. Vampires
18

20. Disengaged people, especially
disengaged managers, are a
quality defect

22. The Satisfaction 
Engagement 
Ownership Continuum...
And the retention
problem child

23. I sure am
satisfied

25. Checklist
complete and
all systems
go?

26. Check!

27. I’ve got my
application in
at Southwest

28. Me too!

29. 10 minute
turnaround
: Check!

30. Problem child
Engaged but not loyal

31. The journey from mere
Accountability
to a culture of
Ownership

32. Ac
count
able

35. What a culture of
accountability feels like
to the person being
held accountable?

36. Accountability
Doing what you are supposed to
do because someone else expects
it of you. It springs from the
extrinsic motivation of reward
and punishment.

37. Son, you’ll be proud
of your old Dad...
Today the boss held
me accountable.

38. “In the long run…
accountability encourages a
culture of evasion, denial, and
finger pointing.”
Richard Farson and Ralph Keyes: The
Innovation Paradox

41. No one ever won
a DAISY Award
by being held
accountable!

43. 34,876,693 views
138,944 – avg 5 stars

45. Just when you thought United’s PR
catastrophe couldn’t get any worse

51. Ownership
Doing what needs to be done
because you expect it of
yourself. Ownership springs
from the intrinsic motivation of
personal pride.

53. What 16* managers told me
about your perceptions of the
culture at Doctors Hospital at
Renaissance
* 90% response rate

54. Powered by
Q4: Our people are committed to their own personal development.
Answered: 15 Skipped: 1
82%
19%

55. Powered by
Q3: Our people are committed to their own professional development.
Answered: 16 Skipped: 0
56%
13%

56. Powered by
Q1: Our people know the values of our organization.
Answered: 16 Skipped: 0
69%
6%

57. Powered by
Q2: Our people are committed to assuring that those values are
reflected in how they do their work.
Answered: 16 Skipped: 0
38%
0%

58. Powered by
Q5: Our people are committed to the mission of our organization.
Answered: 15 Skipped: 1
56%
0%

59. Powered by
Q10: Our people are advocates for progress.
Answered: 16 Skipped: 0
69%
25%

60. Powered by
Q9: Our people effectively manage change.
Answered: 16 Skipped: 0
25%
0%

61. Powered by
Q7: Our people don't just complain about problems, they work to find
solutions.
Answered: 16 Skipped: 0
31%
0%

62. Powered by
Q8: Our people are role models representing our organization in a
positive light for the community at large.
Answered: 16 Skipped: 0
69%
19%

63. Powered by
Q11: Our people feel a genuine sense of pride in being a member of
our team.
Answered: 16 Skipped: 0
62%
6%

64. Powered by
Q13: I feel encouraged by my leadership team.
Answered: 16 Skipped: 0
44%
0%

65. Powered by
Q6: Our culture does not tolerate bullying, toxic negativity, or
disrespectful behavior.
Answered: 16 Skipped: 0
13%
0%

66. San Antonio multi-hospital system
leadership survey started yesterday
66%
32%

67. Powered by
Q12: Our managers effectively deal with toxic negative
attitudes/behaviors in the workplace.
Answered: 16 Skipped: 0
6%
0%

68. What 16* managers told me
about your perceptions of
yourselves
* 90% response rate

69. Powered by
Q14: I am personally committed to practicing the values of this
organization.
Answered: 15 Skipped: 1
100%
69%

70. Powered by
Q15: I am personally determined to give my best effort at work every
day.
Answered: 16 Skipped: 0
100%
75%

73. Powered by
Q17: What percent of total paid hours in your organization are wasted
on toxic emotional negativity (e.g. disrespect, bullying, spreading
rumors)?
Answered: 16 Skipped: 0
~25%

74. San Antonio multi-hospital system
leadership survey started yesterday
~5%

75. $233,000,000 annual SWB
X
25%
=
>>>>>>>>>>>>>>>>>

76. $58,250,000 per year!

78. Based upon these survey
results, the San Antonio
system has a $45,000,000
cultural productivity
advantage over DHR :-o

79. Powered by
Q16: I am happy with our patient satisfaction scores.
Answered: 16 Skipped: 0
0%
0%

80. “You will never improve
student test scores by
trying to improve
student test scores.”
– Educate Texas
We will return to this

81. Let’s do some more math…
Out of 224 possibilities
(16 people x 14 questions*)
there were 14 (6%) “strongly
agree” responses.
Not counting the two “more
about me” questions 

82. Are we all
okay with this?

83. Were you surprised
by any of these
results?

84. Are these results
likely to generate
outstanding patient
satisfaction?

85. Are these results
likely to establish
DHR as a Best Place
to Work?

86. If this survey had been taken
by all employees (and not just
managers) would the results
have been better or worse?

87. Would we use
that 6% number
on a billboard ad?

88. But just think how
successful DHR would
be if that number was
100%!

89. Invisible Architecture™
is more important than
bricks & mortar

90. The Blueprint
Behind the
Blueprint™

91. Invisible architecture
is to the soul of your
organization what
physical architecture
is to its body.

92. 3 stages

93. TheFoundation

94. Core values define who
you are, what you stand
for, and what you won’t
stand for

97. “Our values are the foundation of who we are,
what we believe, and what we strive to be.”

98. “Treat each other with respect, compassion,
honesty, and trust. No jerks allowed.”

99. Organizational values define
strategies while personal
values define culture.

100. 100
“People who are clearest
about their personal vision
and values are significantly
more committed to their
organizations.”
James Kouzes and Barry Posner:
A Leader's Legacy

101. Culture of Ownership Classroom
Midland Memorial Hospital

102. New employee orientation

103. Every employee
evaluation at
Grinnell Regional
Medical Center
includes a rating
on The Twelve
Core Action
Values

105. Core Action Value #1
Authenticity
The Cornerstones
1. Self-awareness
2. Self-mastery
3. Self-belief
4. Self-truth

106. A potentially life-changing question
What would you do if every
job paid the same and had
the same social status?

107. Do you want to be
one of a million or
one in a million?

108. Core Action Value #2
Integrity
The Cornerstones
1. Honesty
2. Reliability
3. Humility
4. Stewardship

109. “If you know who you
are then you will
know what to do.”
Hendrik Kraemer

110. Core Action Value #3
Awareness
The Cornerstones
1. Mindfulness
2. Objectivity
3. Empathy
4. Reflection

111. If you’re not enjoying the
journey, the destination will be a
disappointment.

112. Core Action Value #4
Courage
The Cornerstones
1. Confrontation
2. Transformation
3. Action
4. Connection

114. Core Action Value #5
Perseverance
The Cornerstones
1. Preparation
2. Perspective
3. Toughness
4. Learning

115. “Brick walls are not
there to stop you, they
are there to make you
prove how much you
want something.”
Randy Pausch: The Last Lecture

116. The walls are
not optional

117. Letting them
stop you is

118. Core Action Value #6
Faith
The Cornerstones
1. Gratitude
2. Forgiveness
3. Love
4. Spirituality

119. Faith is a power that is only
just beginning at the point
where certainty ends

120. Faith is hardest
to find when
you need it the
most

122. Core Action Value #7
Purpose
The Cornerstones
1. Aspiration
2. Intentionality
3. Selflessness
4. Balance

124. The work that you
choose to do, and the
attitude with which
you choose to do that
work, are the hammer
and chisel that carve
the statue that is you.
Self Made Man by Bobbie Carlyle

125. Core Action Value #8
Vision
The Cornerstones
1. Attention
2. Imagination
3. Articulation
4. Belief

126. Then put foundations
under them.
Build your
castles in the
air…

128. Core Action Value #9
Focus
The Cornerstones
1. Target
2. Concentration
3. Speed
4. Momentum

131. Core Action Value #10
Enthusiasm
The Cornerstones
1. Attitude
2. Energy
3. Curiosity
4. Humor

135. Core Action Value #11
Service
The Cornerstones
1. Helpfulness
2. Charity
3. Compassion
4. Renewal

137. Core Action Value #12
Leadership
The Cornerstones
1. Expectations
2. Example
3. Encouragement
4. Celebration

138. A leader is someone who
takes you to a place to
which you didn’t know you
wanted to go.
– Joel Barker

139. A leader is someone who
helps you become the
person you didn’t realize
you could be.
– Joe Tye

140. TheSuperstructure

141. Culture is to the
organization what
personality and
character are to the
individual.

142. Same
business
Different
cultures

143. People pay to
shop at Costco…

144. People shop at Wal-Mart
because they don’t have
to dress up like they do
for the Dollar Store.

145. Same
business
Different
cultures

146. Nap
Rap

147. “Advertising is a tax
you pay on having an
unremarkable culture.”
Robert Stephens, Founder of Geek Squad

148. Culture is to recruiting and
retention what marketing
is to gaining and earning
customer loyalty
>>>>>>>>>>>>>>

149. Modern Healthcare cover story 1/19/2016
“Nurse shortage looms”

150. Describe your culture
in just 6 words.

151. Southwest Airlines Motto
Servant’s Heart, Warrior
Spirit, Fun-Loving Attitude

152. Cypress Semiconductor Motto
The Marine Corps of
Silicon Valley

153. The Real Marine Corps
The Few, the Proud,
the Brave*
* And you’re not one of them

154. 154
From managers sitting
in the same room at
one large medical
center’s leadership
retreat

155. 155
We love patients and
each other

156. 156
We are ALWAYS
here for you

157. 157
Multiple priorities,
limited resources,
great expectations

158. 158
We’re entitled,
hating it,
and staying

159. 159
Disjointed
departments
working against
each other

160. 160
Negativity reigns
while circling the
drain

161. 161
I’ve been here
longer – you
leave

162. 162
Beatings will
continue until
morale improves

163. The Florence Challenge
Emotionally Positive
Self Empowered
Fully Engaged

171. Therapy pets
can even sign!

172. A Key Point!
You cannot allow
people to opt-out of
positive culture
change!

173. And...
Cultural work can’t be just a
“flavor of the month”

174. Culture doesn’t change
unless and until people
change

175. TheInterior

179. 179
Workplace attitude is
determined by what you
expect and what you
tolerate…

180. 180
And over time, what
you tolerate will
dominate over what you
say you expect!

181. “We complain to get
sympathy, attention,
and to avoid
stepping up to
something we’re
afraid of doing.”
Will Bowen: A Complaint
Free World

182. Toxic Emotional Negativity
The healthcare
crisis within

183. You cannot be a negative, bitter,
sarcastic pickle sucker in the
break room…
This
place
sucks

184. Then somehow flip an inner switch
and become a compassionate
caregiver in a patient’s room…

185. May I help you? I
have the time.
NOT
!

186. You cannot be a
negative, bitter,
sarcastic pickle
sucker at work…
My job
sucks

187. Then somehow flip an inner
switch and become a nurturing
and empowering parent at
home…

188. I wish she
would stay
at work!

189. 189
The simple promise that
will change your life...

190. 190
And transform your
organization…

192. Work sucks
then you die

194. 194
Important!
The Pickle Pledge is about
whining – it does not mean
you don’t identify real
problems!

195. 195
Important!
The Pickle Pledge is not a
disciplinary program – it is
voluntary and lighthearted

196. The Pickle Challenge
has taken on a life of
its own!

197. 197

206. The first 30 organizations to take
The Pickle Challenge for Charity
raised over $60,000 (including
Values Coach matching donations)

208. Caveat: You will get resistance
to The Pickle Challenge.
It will be most vociferous from
people who could most benefit
from taking it to heart.

209. Midland Memorial Hospital
Values and Culture Initiative

210. The Pickle Challenge

218. MMH Values Trainers #1

219. Outcomes

220. 63%

221. 87%

223. HCAHPS Overall
65.4 64.6 63.9 55.5 67.9 67.8 81.4 67.5 66.9
82.9
71.1
75.0
83.3
26.4 32.6 33.3 33.3 21.9 17.7
15.8
29.7 30.3
11.4
26.7
22.8 7.2
4.3
5.6
7.3
8.7
2.2 2.3
7.2
2.8 2.9
2.4
64.3
61.5 63.2 64.0
66.9 67.0 67.0 68.7
69.9
70.9
77.1
40
50
60
70
80
90
100
10-9 8-6 5-3
2-0 National Top Box VBP Achievement
VBP Benchmark Accumulative Score (TB%)
Arrow marks beginning of
Values and Culture Initiative

224. 224

225. RN Turnover:
 32% reduction overall
 43% reduction for new nurses
(in first 2 years of employment)

226.  22% reduction in CLABSI
 38% reduction in ventilator
related events
 64% reduction in CAUTI

227. Annual Cultural
Productivity Benefit
$7,200,000

228. More than one million
dollars in annual energy
cost savings

229.  Patient satisfaction from
record low to record high
 Emergency Department from
bottom 10% to top 10%

230. First hospital to
earn the
INSPIRED Award

237. “If we each do our
part, we will change
our lives for the
better.”
237

238. “If we all do our parts,
we will change our
organizations for
the better.”
238

239. “And in changing our
organizations, we can
change our world for the
better.”
239

240. Joe Tye
Values Coach Inc.
Jordan Creek Plaza
PO Box 490
Solon, IA 52333
Telephone: 319-624-3889
Email: Joe@ValuesCoach.com
Twitter: @joetye
How to contact me