Last month, at a sold-out executive healthcare leader seminar, held at Duke Health and sponsored by Value Capture, leaders had come to together to see and learn how leaders can create healthcare organizations of enduring excellence at a time of multiplying challenges. Today there is a rising imperative for agility, creativity, and efficiency, and a crying need to regain the trust of patients and team members alike. Here are some of timeless principles and current examples they shared with one another:
1. Leaders Modeling the Culture They Desire; Making Respect the Foundation
When leaders at Alcoa transformed their safety culture, they didn't just talk about respect, they demonstrated it through consistent actions. Bill O'Rourke's work in Russia showed how treating workers with dignity transformed a dangerous workplace where several people died every year to a world-wide leader in work safety, and delivering results.
Walking the Talk
Effective leaders:
- Start every meeting with safety
- Follow the same rules they expect others to follow
- Listen to concerns from all levels
- Make themselves visible where work happens
Speaking Truth About Performance
Respect means being honest about what's working and what's not. At Duke Health, leaders create environments where discussing problems is seen as a commitment to excellence, not a sign of failure.
2. Clarifying, Powerful Measures; Giving Teams What They Need to Succeed
Clear metrics help answer the second essential question by showing teams exactly what success looks like and how their work connects to the patients, families and communities they serve.
Making the Invisible Visible
Effective measurement systems:
- Transparently track and share "routine things" like lab result timeliness, supply availability, and bed turnover
- Display results publicly and through unit scorecards
- Connect daily work to patient outcomes
- Focus on what matters, not just what's easy to measure
Theoretical Limits vs. Traditional Goals
Setting aspirational goals (like "zero harm") rather than incremental improvements helps everyone understand the true purpose behind their work. Mike Bundy, CEO, made this real when he shared Ricky's story. [paraphrased] Mike was coming into work and passed Ricky in the hall and asked Ricky how the night shift went. Ricky, finishing his shift as an Environmental Services Technician, replied "It was great, no one was puking in a bucket." Mike, stopping to learn more from Ricky, asked for more details. "Well," said Ricky, "we had 83 room turnovers, averaging 42 minutes from patient out to room ready. We beat the goal by 3 minutes, and the units were able to bring the patients up from the Emergency Room without delay. And since the ER wasn't holding onto in-patients, they were able to bring their patients back from the waiting room right away. And, when the patients are roomed and receiving care in the ER, well sir, that means no one has to puke in a bucket."
Ricky knows he is a member of the patient care team and how his work impacts each patient. Ricky knows his numbers, how he is doing against goal and what this means to his teammates and to those that they serve. Ricky is doing meaningful work that brings pride and ownership.
Ricky knows he is a member of the patient care team and how his work impacts each patient. Ricky knows his numbers, how he is doing against goal and what this means to his teammates and to those that they serve. Ricky is doing meaningful work that brings pride and ownership.
3. Daily Management Tools That Connect Everyone; Recognition Through Structured Communication
The third essential question about recognition is addressed through systems that make good work visible.
Tiered Huddles That Connect Frontline to Leadership
Effective huddle systems:
Start at the unit level with safety and daily goals
- Lead with celebration, of what is working well and new problems found to fix
- Make time for peer-to-peer and team recognitions
- Connect frontline concerns to organizational priorities
- Escalate issues that need support through clear channels
Go & See Leadership Rounds
When leaders regularly visit work areas to see challenges firsthand, they show respect for frontline expertise and create opportunities for recognition. At Duke we saw artifacts of Daily Engagement; and we saw local ownership. The huddle board in Infusion had the same bones as the one in Endoscopy, but they had been completely adapted to the culture and personalities of the local team. While the tools had the same purpose, the ownership and pride of how the teams engaged was palpable. Team members shared how the boards are active and updated throughout every shift, and how teams were encouraged to make this communication tool work for them. Both boards reflected 'the temperature' of the staff, one measuring on an IV bag and the other by the color of the contents in a specimen cup. One team uses small magnetic clipboards to track problem solving progress, and the other uses different colored markers to handwrite the progress. There are safety alerts on both boards, and the messages are unique and specific to the work and local risks. These tools are obviously well-used, much like your favorite pen or sweater, perfect for the task at hand and the go-to for everyday use.
Visual Management That Tells the Story
Boards and digital displays that show:
- Current performance against targets
- Ongoing improvement work
- Success stories and recognitions
- Clear connections between daily work and patient outcomes
Putting It All Together
The path to healthcare excellence isn't found in grand strategies alone, but in daily habits that reinforce respect, enable meaningful contribution, and recognize good work. When leaders build systems that consistently address these three essential questions, they create environments where excellence becomes habitual rather than exceptional.
As demonstrated at Duke Health and other leading organizations, this approach delivers both improved patient outcomes and more engaged teams. Most importantly, it transforms healthcare work from merely following procedures to pursuing a shared purpose: providing the safest, highest quality care possible.
The journey begins with leadership commitment to these principles and consistent application of these practices every day, with every team member.
Written by Shana Padgett
Shana Padgett is the Chief Executive Officer of Value Capture, a Certified Facilitator and Examiner of the Shingo Institute, and a Shingo Alumni. With a passion for improving patient care and healthcare systems, she has led transformational change in more than 25 organizations across diverse care settings. Known for exceeding client expectations, Shana is a seasoned coach, trainer, and leader specializing in strategic improvement, organizational alignment, and leadership development.
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