Case Study | A Large Academic Health System Uses Coaching to Lead Cultural Transformation Their Way

At a Glance

The Organization

UW Health is a large system tied to the University of Wisconsin School of Medicine and Public Health, encompassing 21,000 employees across multiple hospitals.

Key Decisions

• Developing their own system-wide management and improvement method, called the UW Health Way
• Calling on outside transformation partners for coaching, strategic guidance, and improvement team capability building
• Drafting clear cultural commitments and creating training and accountability around them
• Expanding focus from quality improvements to support pandemic response when the landscape suddenly shifted

Key Results

• Staff engagement metrics improved or sustained during the first 24 months of the pandemic
• Updated tools and frameworks to support improvement workshops and training for both in person and virtual environments
• COVID-19 testing and vaccine centers set up in 5 days each
• Successful ongoing partnership between UW Health executives and Virginia Mason Institute transformation partners

The Context

Safety and engagement are common but elusive goals

Every healthcare organization believes in protecting patients, but many still struggle to reduce rates of preventable harm. According to a recent review and meta-analysis of observational studies by the British Medical Journal, half of all patient harm incidents worldwide are preventable, affecting about 1 in every 20 patients.

Another common goal among organizations — staff engagement and retention — is facing its toughest headwinds in decades due to the COVID-19 pandemic. A 2021 study in JAMA Network Open found that additional work stress related to the pandemic has led more than 1 in 5 healthcare workers (21%) to consider leaving their jobs.

For long-term solutions to these challenges, leaders at UW Health rightly focused on the organization’s cultural and operational DNA. They developed a system-spanning management approach, called the UW Health Way, to set clear and consistent methods and expectations for quality improvement and teamwork. An Organizational Improvement team, led by then Director Amy Topel, is responsible for training and support.

“I want UW Health to be the safest place for patients to receive care and an employer that proves we care deeply about our staff,” Topel says. “An approach like the UW Health Way is key for us to do that.”

The Challenge

Building continuity in a sprawling system

While the UW Health Way defined their aspirations, Topel and her fellow leaders found it difficult to activate. For example, quality improvements were meant to be owned and carried out by everyone, but in practice they fell overwhelmingly to the improvement team. For a large academic health system encompassing 21,000 employees across seven hospitals and more than 80 clinics, they knew this wasn’t enough.

“We’d get called in to fix a problem, then we’d step away, and the problem would come back,” says Topel.

Turnover and vacancy rates are a challenge as well, with staff surveys revealing a lack of enthusiasm and connection with the organization’s culture. Some of this was caused by the size and complexity of the organization and its lack of consistent norms and goals.

To strengthen and sustain their efforts to transform the organization, UW Health’s leaders knew they needed help from someone outside the organization. Vice President and Chief Human Resources Officer Betsy Clough led the search.

“We had parts and pieces, but we needed that perspective and provocation from the outside to guide us. Virginia Mason Institute was just the right fit.”

The Solution

Coaching leads to cultural breakthroughs

Transformation partners at the Institute provided coaching to Clough, Topel and other leaders tasked with shepherding the UW Health Way. In addition to talking through explicit challenges encountered by the group or individual leaders, the coaching sessions allowed the team to observe and experience exactly the kind of leadership they wanted to embody themselves.

“They demonstrated things like framing a problem rather than solving it for us, and for me and others it was a real ‘ah-ha moment.’ We finally saw how we could coach the improvement and not always be the ones to do it ourselves,” says Topel.

The partners also advised the executive team on tools and aspects of the UW Health Way to help make it more effective. These included setting and organizing goals and establishing a reliable framework for conducting improvement workshops. The framework enables teams to quickly test and implement quality improvements that last, by enlisting frontline workers to help improve the tasks relevant to them and measuring results for months after changes are implemented.

Perhaps the most tangible product of the partnership was a cultural platform known as Respect for People. This is a set of core commitments and behaviors like “Listen to understand” and “Appreciate and encourage,” based on a platform originated at Virginia Mason Franciscan Health. Far more than a poster on a wall, Respect for People was designed to be a practical and pervasive guide for how staff communicate and interact throughout the UW Health system.

“Everything we want to achieve — in quality, patient service, staff experience — starts with respect,” Topel explains. “So internalizing these behaviors is critical.”

To that end, everyone on staff received introductory training on the Respect for People commitments, and the commitments were later incorporated into performance evaluations as well. Leaders can access a suite of additional tools and training online to help instill Respect for People with their teams.

The Results

Transforming culture during one of the hardest years in healthcare

UW Health succeeded in revitalizing its staff despite pandemic pressures, as well as tackling sudden pandemic needs with thoroughness and efficiency.

The impact of Respect for People came through in staff survey results, such as:

• “I believe that everyone can have a positive impact” — 91% agree (higher than pre-pandemic)
• “The Respect for People commitments provide a consistent set of expectations for how we treat others and our patients” — 75% agree

COVID-19 breakthroughs include:

• Setting up testing and vaccine centers in under 5 days each
• Accurate inventory of personal protective equipment, infusion treatments and other key resources at all times

More generally, the coaching sessions and new approach to improvement workshops have opened up a new way of working, which leaders are eager to apply to improve patient safety and other value streams in the future. Vice President Clough admires the energy that comes from involving frontline staff in problem solving and the insights that come from involving patients. She also appreciates the nature of the partnership that helped them grow to this point.

“Virginia Mason Institute’s influence on our executive team has been phenomenal, and they’ve also given us space to build a system that is truly ours,” she says. “That’s extremely rewarding.”