How Civility Transformed an Operating Room—and an Entire Hospital System

I started my career as a cardiothoracic surgeon in Green Bay, Wisconsin, in 1997. At age 34, it was my first real job. I joined an independent practice of surgeons who were the only providers of coronary artery bypass surgery in the community. We looked at ourselves as a valuable asset to the hospitals, an important profit center for them. 

That’s why, as a young surgeon, I viewed myself as a customer of the hospital and believed that their job was to provide me with the resources I needed to succeed. In that mindset, I viewed everyone around me as resources. My attitude toward them was: “Give me what I need to do well.” 

 I was working hard to achieve excellent patient outcomes—a laudable goal—but I was immature as a leader. 

Over time, I realized that I was part of a group who didn’t get along. In fact, we didn’t really like one another at all. This dynamic set a powerful tone for everyone around us. The relational environment became toxic and resulted in a lot of employee turnover.  

I realized that I was a part of the problem and needed to take responsibility for that. And I realized that a big change was necessary. 

Valuing your people as much as your product

During this time, I started attending the Global Leadership Summit. One speaker I heard was Horst Schulze, former president and COO of Ritz Carlton Hotel Company. He talked about how, in the hospitality industry, you’re not only taking care of your guests, but you’re also taking care of your employees—how you need to value your people as much as your product. 

That marked me. I knew that my product was the health of human beings, but what would it mean to value our employees in the same way? Pondering this concept—valuing our people as much as our product—changed everything for me. 

On a typical workday, I would go into the hospital at 7 a.m. to prepare for surgery. I’d walk through the lobby and past a woman sitting at the front desk to greet people. But on this day, I realized that I’d been walking through the lobby for 10 years and I had never spoken to her. I certainly didn’t know her name. 

In the surgical suite that day, I actually looked at the faces all around me and realized that they had the desire to help me be successful as much as I wanted to be successful. They were there to achieve the very same goals, but I had discounted their purpose. 

Instead of looking down at the ground, focusing only on what I needed to do to execute my surgery well that day, I started looking up. It was a night-and-day transition for me. For the first time, I actually “saw” those around me and realized that we were all in this together. 

Setting a new tone

I realized that as a leader, I was setting the tone for how we all interacted and nothing would change if I did not change.

I began by meeting with our staff regularly to allow them an open forum to ask questions and hear their perspective. I began to understand more clearly what motivated them. I also took time to teach them in a relaxed and safe environment. (An intense and high-stakes heart operation, where there is no room for mistakes, is the worst place to teach someone kindly and with compassion.) In these meetings, I took time to explain why things needed to be handled in a certain way and why I was concerned about specific dangerous circumstances. 

Efforts like this, which required a minimal amount of time and energy, began to show our staff I cared about them and that they were valued.

In just a year’s time, I no longer faced the stress of thinking I had to monitor and control everyone else’s job. Instead, because we were all on the same page, I trusted them to do their job and do it well. In return, I was able to focus on my responsibilities and execute surgical tasks at a higher level. 

In a short time, something remarkable happened.

The remarkable outcomes of trust 

In one of our sessions, I explained how I hoped to capitalize on everyone’s expertise and how important it was for them to feel safe to suggest improvements or identify problems. In response to this idea, one of our perfusionists (the experts who run the bypass machine) brought forward literature suggesting we should change the type of salt solution we used during our heart operations. We made this change, as well as other changes at their suggestion, which improved our outcomes.  

In just one year, the number of patients returned to the operating room after bypass surgery went from 16, to just one! How could this be explained? To this day, I don’t entirely know—except that I was trusting the people around me. What I do know is I was no longer feeling the need to focus on their responsibilities, so I could focus more intently on my own.  

In the years to come, I saw our team of people unite in a formidable way. Our turnover improved, and they began to see one another as part of a family. They cared about each other in and out of the operating room. Our experience together left the toxic environment behind and became one of encouragement and joy. 

Bringing civility to an entire hospital system

Years later, I was appointed Vice President and then President of the Medical Staff, in part because of the soft skills I had gained through attendance of the Global Leadership Summit. Using concepts I heard and embraced from the Summit, I began to think about how I could contribute a lasting impact as president.  

Initially, I was faced with handling complaints of negative or aggressive physician behavior. Thinking about what may have driven seemingly good-hearted people to this negative behavior led me in a new direction. Instead of just targeting the behavior and applying corrective action, I suggested we ask ourselves what in our culture could lead good people to go bad. The idea of civility in the workplace kept coming to the surface. What if our culture served to embrace those struggling and encouraged them in a positive direction before they became fully derailed? 

I envisioned a system-wide cultural transformation called “Civilitas.” Being granted a team of amazing people, the program was formulated on principles such as psychological safety, interpersonal empathy and, of course, valuing our people as much as our product. 

I was initially concerned my physician peers would reject the program as “obvious” or silly—or would view me as weak or soft. Honestly, it took some courage on my part to propose it. But I was amazed at how mistaken I was! Most of my colleagues thought it was a breath of fresh air, badly needed and supported it wholeheartedly. 

Remarkably, the program launched only weeks before COVID-19 hit, and it quickly became evident how it impacted the way people interacted with one another. Virtual meetings became the norm literally overnight, and the kindness and consideration exhibited was palpable. Our CEO lead the way in effective communication during this time, and we pioneered the national effort to restore the abruptly halted activities in healthcare. In fact, our little health system in Green Bay was recognized by a visit from the United States Secretary of Health to encourage our efforts at “getting back to healthcare” after COVID. 

Over the course of a 27-year career, I evolved from someone who was focused on the importance of my reputation and my responsibilities to one who “looks up” and actually sees the people around me. I did not change overnight. I had to learn the hard way through mistakes and lots of bruises. Ultimately, though, the change imprinted in my heart became indelible. 

People will often ask me, “Why are you smiling all the time?” as if I know something they do not. Perhaps I do. I smile because I have such joy, and my people make my role easy. I love the work, and I love the people with whom I work. And, I no longer have to try so hard to do well—OUR patient outcomes seem to take care of themselves.