Leading to a New Future: A Leadership Case Study

Facing Reality – Where Leadership Starts

The situation at San Antonio Community Hospital (SACH) in Upland, California had become critical. San Antonio Community Hospital (SACH) faced a loss of profitability in 2004 and endured a climate brutalized by conflict between the administrative and medical staff, pomposity on the part of key administrative personnel, a loss of trust throughout the system and a sterility in leadership from the administration as evidenced in their command and control perspective, opaque processes and squashed board and management interaction. With another year of operating in the red the board of SACH determined that change was needed immediately. So, in 2004 they fired their Chief Executive Officer, their Chief Financial Officer and their Chief of Nursing Operations. Simultaneous to these changes the board hired a new Vice President of Human Resources. They promoted the Nursing Director to Chief of Nursing Operations (CNO) and the Director of Planning to the Chief Financial Officer (CFO) position. Then they began the search for a new CEO. Clearly the environment was favorably disposed to significant change.

Addressing Reality – Where Leadership Executes

In stark contrast to the situation San Antonio Community Hospital (SACH) in Upland, California faced in 2004 the hospital was named one of the nation’s 100 Top Hospitals® by Thomson Reuters in 2009. The award recognizes excellence in clinical outcomes, patient safety, patient satisfaction, financial performance, and operational efficiency.

Steven C. Moreau, President and Chief Executive Officer (CEO) of SACH said, “This is a culmination of many years of hard work by our great physicians and staff who are dedicated to providing the highest quality of care.” What the statement does not reveal is the impact Mr. Moreau’s own presence and philosophy of leadership had on transitioning SACH from loss to profitability. “It is part luck,” he stated, “I was in the right place at the right time.” But luck had little to do with the transition SACH.

Attributes – How Leadership Actualizes Excellence

Three things became apparent in an interview with Mr. Moreau and those who work with him. First, successful organizations exhibit clear and simple values. How did Mr. Moreau’s leadership  philosophy contribute to San Antonio Community Hospital’s fast rate of improvement over a five‐year period? Mr. Moreau’s leadership of the 279 bed San Antonio Community Hospital created the synergy needed between the board, executive team, physicians and staff to develop long‐term strategies and execute them with the extraordinary skill needed to produce extraordinary results. He exhibits three critical leadership attributes:

  • SelfAwareness – Mr. Moreau leveraged a growing self‐awareness and situational awareness to establish an environment and organizational culture needed to build momentum around three core values: excellence, engagement and execution.
  • Trust – Mr. Moreau modeled and established transparent processes that built trust and “ownership” for change by exposing employees at all levels of the organization to the information that makes the hospital work. This respect saw the board and the physicians as partners in the vision rather than antagonists and recruited them to create a new vision for the hospital.
  • Belief – the conviction and courage needed to commit to a preferred future with the tenacity and grace to insist on that future regardless of the apparent challenges and barriers to getting there. Mr. Moreau demonstrates that power of belief in others, himself and the opportunity presented in the challenges was a highly potent fuel to cultural change.

Second, successful organizations possess a deep commitment to excellence. The SACH board drove the commitment for change as seen in the removal of the previous administration. The board created a work environment predisposed to transformative change. If the only action had been to replace the CEO, San Antonio Community Hospital most likely would not have achieved the excellence it has. The conclusion here is not that boards should disembowel their organizations to get real change. Rather boards should possess the kind of internal commitment to change that the SACH board exhibited in taking the risk to create disequilibrium in the organization’s culture that they exhibited in shaking up their executive administrative structure in order to excise behavioral malignancies that impeded execution.

Third, successful organizations leverage the use coaches/consultants to focus and accelerate learning and change. Coaching was a significant factor in the focusing and sustainability of the changes that Mr. Moreau and the board sought to engender. Coaches engage executive leaders and managers from outside the organizational political and symbolic realities. As a result they are often able to intrude into areas in need of change or refinement without the imagined or real threat of retaliatory or marginalizing behavior.

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