writing of this book, including my immediate family – Rosemary, David, and Michael – and my extended family, the employees and physicians of Scripps Health, and my teammates in the San Diego County Sheriff's Department. I owe a debt of gratitude as well to my colleagues, friends, and editing team at Scripps Health, June Komar, Elliot Kushell, Ph.D., and Don Stanziano; our organization's senior team, Richard Rothberger, Vic Buzachero, June Komar, John Engle, Richard Sheridan, Jim LaBelle, M.D., Tom Gammiere, Gary Fybel, Robin Brown, Carl Etter, Rick Neale, Shiraz Fagan, Barbara Price, Glen Mueller, and Marc Reynolds; Scripps Chief Medical Officer Emeritus Brent Eastman, M.D.; the many members and alumni of the Scripps Leadership Academy and Scripps Employee 100; and physician leaders at Scripps.
I'd especially like to thank the Scripps Health Board of Trustees, for whom I've had the honor of working these past fifteen years. Their leadership, guidance, encouragement, and constructive feedback are unmatched anywhere in health care. Thank you as well to the other organizations and individuals who have also contributed to the experiences described in this book: the Monterey Park Police Department, the San Diego County Sheriff's Department, the Price School of Public Policy at the University of Southern California, the California Emergency Medical Services Authority, the United States Public Health Services, Surgeon General Richard Carmona, M.D., and the American College of Healthcare Executives.
Finally, I seek to honor my deceased parents, Harold and Mary, for their love and support and for instilling the ethics and principles on which this book is based.
Introduction
In 1973, I was a hospital security officer working the graveyard shift in the basement. One night when I was the only one on duty, it was lonely and dead quiet, until I heard the sound of approaching footsteps. I looked up to see a man walking toward me. It was the CEO of my hospital. I had never met him before, but I had seen his picture; as a security officer, I was expected to know the administrators by sight.
Who knew what the CEO was doing walking around in the basement at that ungodly hour, but it didn't matter: This was my chance to meet the big boss. I thought how cool it would be to chat a little bit, make a connection. I grew up under modest circumstances in nearby Alhambra, and I knew this CEO lived in San Marino. As a teenager I had delivered newspapers in the same plush, upscale neighborhood where the CEO now lived.
Checking first to make sure my uniform was crisp, I straightened my posture and cleared my throat, readying to say hello and shake the man's hand. Instead, the CEO walked right by me, like I didn't even exist. Without making eye contact or even acknowledging my presence in that empty hallway, he turned the corner and was gone.
It was a demoralizing moment, one that clearly I have never forgotten, but it helped shape me and my views on being both an employee and a leader. That CEO saw me as “only” a security guard, but if a crime were being committed, who would have intervened? I would have, which would have made me, at that particular moment, among the hospital's most important employees. An organization's first priority, I reasoned, was to take care of its customers, and front-line staff were the ones doing that work. I resolved that if I ever took on a leadership role, I would remember this and treat employees accordingly.
I've since had that chance. After college, I went into law enforcement and spent several exciting years on the front lines as a police officer. When a devastating on-the-job injury ended my police career prematurely, I had to find a new path, so I went back to school to get a graduate degree in health care management. Over four decades I have served as a clerk in an emergency room, a manager of a hospital lab, and in higher-level management and leadership roles at several California hospitals.
In 2000 I became president and CEO at Scripps Health, one of America's most prestigious health systems. Since then my team has presided over the most dramatic turnaround in the organization's history, catapulting Scripps from near-bankruptcy to a dominant market position. While hospitals and health systems nationwide have laid people off or closed their doors, we've become financially healthy and added almost five thousand employees. Facilities in our system routinely appear in the U.S. News & World Report ranking of America's best hospitals. In 2014, we opened a $220 million proton therapy center, one of only a few cancer treatment centers of its kind in the United States. We also continued building a $450 million cardiac facility on our campus in La Jolla, among other major projects we are pursuing throughout our region. Best of all, we've solidified our reputation as a marquee employer, recognized year after year by Fortune, Working Mother, AARP, and other national news sources as one of America's “Best Places to Work.”
People congratulate me on my success and ask how I did it. I tell them I didn't do anything; the people around me have made me successful – first and foremost, our front-line staff. All I do as a leader is take care of our people so they can provide superior care for our patients. Our leadership team spends time regularly with clerks, secretaries, doctors, nurses, IT technicians, environmental services personnel, front-line managers, parking lot attendants, and others, listening to their concerns and bonding with them on a personal level. It may sound unbelievable, but I respond to every single employee email I receive, often within minutes. I get out in the trenches to resolve staff issues through dialogue and the exchange of information rather than by dictating a solution from on high. At Scripps, we use systems that push authority, responsibility, and accountability as far down the chain of command as possible. All this amounts to a comprehensive, “front-line” approach to leadership, one that extends to every action our leadership team takes.
When our team makes a decision – whether it's about access to capital, investment in new technology, organizational change, the hiring of executives, or anything else – the first thing we consider is the implications for front-line staff. Likewise, and perhaps most important, we have made a public commitment to use layoffs as a last resort as opposed to a quick fix. This forces our leadership team to become more disciplined in our planning, so that we can ensure that we have the financial resources required to retain our employees, as well as systems in place to use employees effectively as our business changes. It forces us to become more innovative, so that we can anticipate market trends and protect jobs.
It is easy to talk about connecting with front-line workers, but many executives I meet tell me they don't know how to bridge this divide in practice. Beyond lip service and rhetoric, executives at some companies still remain removed from those employees as well as from the managers who oversee staff performance. The Front-Line Leader seeks to change this by showing executives not only how critical it is to connect with line personnel but also, in practical terms, how we have done it. Organizations could become far more successful if executives only understood what it is to lead authentically from the ground up, and if they committed themselves, as we have, to that approach. If connecting with front-line workers could yield success for a large health care company, just imagine what leaders in less volatile and less regulated industries could accomplish.
You may wonder whether our intense focus on front-line workers is too rigid or narrow. Can it really be wise to avoid layoffs at all costs or to spend so much time listening to employees' daily concerns? It's true that focusing on front-line workers requires sacrifice; for instance, the time I spend with employees means less time with other senior executives or community leaders. Yet the sacrifice is worth it. Paying attention to workers isn't only helpful – it's essential. Engaging with front-line employees emotionally, intellectually, and financially produces incredible loyalty. This in turn improves the kinds of metrics important to any business: retention, employee satisfaction, productivity, quality. It's not rocket science. When you have employees who feel cared for, they tend to care more themselves for the organization that provides their paycheck.
Beyond the business benefits, front-line leadership is simply the right thing to do. Do you find yourself thinking that we leaders today are losing sight of our true purpose? Rather than take care of our people, we're taking care of ourselves and our investors. Surely leaders have an obligation to increase stockholder and customer value, but we also must accept a profound responsibility to our people and their families. This responsibility goes beyond simply providing a fair paycheck, to also include some promise of job security and a real future. People say that the traditional, paternalist employment covenant between companies and employees is dead and buried, and with it the guarantee of a lifelong career at one employer. Maybe so, but we would do