At Sanford Health, they take the saying “culture eats strategy for breakfast” seriously. Leaders at the integrated rural health system knew that bringing a strategic plan to life would be an uphill battle if they didn’t invest in a people-focused culture to drive it.
That’s why culture comes first at Sanford Health, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
To build its culture, the health system launched its Sanford Accountability for Excellence (SAFE) program in 2019. Leaders modeled the program on high-reliability organization principles to establish a positive, supportive culture of continuous improvement that is driven by empowered front-line teams of physicians and other health professionals.
The program focuses on implementing solutions to challenges in four key areas: clinical quality, patient safety, employee engagement and physician well-being.
The aim is “to make sure that we are foundationally solid on a just culture and continuous-improvement principles so that we can effectively deploy the strategy,” said Daniel Hoody, MD, MSc, an internist and chief medical officer at Sanford Health in Bemidji, Minnesota. “It’s about creating a bedrock from which everything else grows. It’s like the base of Maslow’s pyramid for how we create a culture for every one of our 45,000 employees.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
Follow a recipe for culture
The Sanford Health program is modeled on relevant principles from different continuous improvement modalities, including Six Sigma, Lean methodology and Just Culture.
“There was a very intentional effort to take health impact tools, techniques and resources out of those methodologies and then crosswalk them with the Sanford culture and our people,” said Dr. Hoody.
Accountability is a key component of the effort. This focuses on integrating relationship and reliability skills as well as standards into every aspect of the organization.
The relationship skills include:
- Greeting people and listening with empathy.
- Listening to learn and understand, rather than listening to respond.
- Communicating with positive intent.
- Creating intentional space for frontline experts to ask questions and inform the path forward.
Meanwhile, the reliability skills include paying attention to detail, communicating clearly, leading with true curiosity, seeking to understand and speaking up for safety.
To fully understand how this program works in action—and everyone’s role in the culture—all Sanford Health employees participate in the training. Leaders within the system also go through additional leadership training in the program.
Keep trust at the center
A hallmark of the Sanford Health program is providing employees with a space to voice their concerns and challenges. The program then takes it a step further by giving employees a seat at the table to solve these problems.
That starts with building trust and respect, so physicians and other health professionals feel confident expressing their concerns.
The message for these doctors and others is: “We value your opinion and, more importantly, we value your perspective—and we want to hear about it,” said Dr. Hoody. “We’ve also built trust through action. We truly care about what their front-line experience is, and they are more likely to bring problems forward.”
This approach allows physicians and other health professionals to feel comfortable constructively confronting challenges and conflicts in a positive way.
For example, Sanford Health’s inpatient clinicians “had a lot of changing dynamics around patient flow with uncontrollable external factors,” said Dr. Hoody. “We utilized SAFE skills to create a space for the team to bring forward distressing scenarios, express questioning attitudes and speak up for safety.”
In turn, the leadership listened to the team’s concerns with empathy and curiosity. Then they empowered the front-line physicians and other health professionals to think differently about how to better manage unpredictable variables in their everyday work. Together, the leadership and the front-line team redesigned their care model and revamped their staffing model to address their challenges.
These collaborative solutions helped physicians and other health professionals in the department feel happier, engaged and more resilient. That ultimately translated into improved patient care with increases in quality and efficiency outcomes, including a reduction in hospital-acquired line infections and medical and surgical length of stay.
“If our people are happy, the patient care is going to follow,” said Dr. Hoody.
In fact, Sanford Health’s patient care metrics have improved exponentially since implementing SAFE. For example, the rate of serious safety events has dropped by 46% for the entire Sanford Health system since the program launched in 2019.
Meanwhile, some of Sanford Health’s major medical centers have exceeded these metrics. For example, Sanford Bemidji Medical Center’s serious safety event rates have decreased by 70%.
Help physicians feel valued
These efforts have paid off when it comes to physicians and other health professionals feeling valued and empowered. Sanford Health ranks in the top 25% among other organizations in the health care industry for meaningful work and inclusiveness as a strength, based on its employee-experience survey results.
“From my experience, clinicians don’t usually leave organizations because of the money. They leave because they don’t feel valued. And they stay because they do feel valued,” said Dr. Hoody. “The SAFE program really gives us the opportunity to make our front-line teams feel valued.”
Additionally, as Sanford Health commits to solving operational challenges head-on, physicians are better poised to focus on patient care.
“When we have the solid foundation built into an operating system with good huddles, tiered huddles, escalating problems and getting them solved, the majority of my day as a clinician is spent with patients and families. That’s a great day, and my cup is filled,” said Dr. Hoody.
Feeling valued is a striking mitigator of burnout and is a key performance indicator measured through the AMA Organizational Biopsy®.
Learning from each other
As the largest rural health system in the U.S., Sanford Health has 45 hospitals, 211 clinic locations and 160 Good Samaritan Society senior living centers. Yet they all share the common thread of the SAFE program as their cultural foundation.
While the needs and challenges vary across Sanford Health’s sites, they all use the same approach, work from the same playbook and share what they have learned with each other.
This is important because “the single greatest amplifier in health care is taking learnings and spreading them,” Dr. Hoody said.
Sanford Health has formalized processes for sharing what they have learned through monthly visits with leadership, clinical leader site visits and quarterly meetings that focus on quality.
In addition to sharing knowledge, Sanford Health is constantly evaluating what’s working and what is not—and then taking steps to ensure their efforts are successful.
“We wouldn’t be walking the walk if that piece of it was not part of our journey,” said Dr. Hoody.
Learn more about why organizational well-being key performance indicators matter to your health system’s bottom line.
