The American healthcare system faces several challenges, including lower reimbursements, staff shortages, burnout, technological evolution, information security concerns and legislative uncertainty. Healthcare leaders need to shape decision-making processes. Strategic planning provides a useful construct to guide the ways an organization’s leaders can frame the present in the context of the past and desired future.
Although there is no single right way,1 most models will include key elements such as:
- Mission: why the organization exists,
- Vision: what the organization aspires to become,
- Strategic issues: critical areas requiring attention,
- Goals: measurable targets to achieve the vision,
- Action plans: priority actions to achieve the goals.2
There is another key element that may be overlooked in the process — organizational values, or the guidelines on how colleagues in all roles interact with one another.
Leadership discussions often focus on culture when discussing values. In some interpretations, the hard-to-define concept of culture includes organizational attitudes, tacitly understood rules guiding staff engagement — the human glue — and the shared learning. All these organizational experiences contribute to the assumptions, values, norms, patterns of behaviors or rituals that characterize daily life. As leaders evaluate strategies to optimize performance, modeling actions that reinforce explicitly desired attributes and values is essential to shaping culture. Reinforcing values shapes who we are and how we relate to each other.3 This article will deepen the discussion of values as an organizational leadership strategy.
Significance of values
The idea of values was introduced more than 2,500 years ago by the philosopher Confucius.4 Confucius supported compassion as a value all individuals should possess. Compassion continues to ring true as a value by individuals, teams, and organizations across industries. Compassion lends itself to making a difference in the world through values alignment. Alignment between an individual’s personal values in congruence with their workplace values enhances organizational well-being and decreases staff burnout,5 and is extremely significant on the path forward.
Values help guide decision-making,6 shape character,7 and influence behaviors and performance.8 The lived values will always trump espoused values. Living values requires intentionality and commitment. Those who wish to create a legacy and be a good ancestor to the future generations remain mindful of the ways positive purpose may contribute to the overall betterment of the world. According to Victor Frankl, senses of meaning and responsibility help provide a profound depth of purpose.9 This mix of values, purpose and meaning also leads to what is known as Ikigai — a long and happy life.10
Values are powerful silent influencers. Values tend to be deeply embedded within individuals from a very early age. As has been quoted by Gandhi and other renowned leaders, it starts with beliefs, moves to thoughts, words, actions, habits, values and ultimately leads to destiny. Even though individuals may not be aware of or able to articulate personal values, they are present. Personal and professional success and satisfaction can be enhanced by knowing individual core values. Being able to identify personal values and having a sense of purpose shape pathway thinking and the quality of one’s future.11 From a professional standpoint, values awareness helps individuals be intentional about their choice of job types and work environments.
When an organization’s values align with its employees’ values, it leads to a better work environment, more productivity, higher job satisfaction, and decreased turnover.12 One way to understand employee values is by exploring a values-based model. The VIA (Values in Action) Character Strengths Inventory includes six virtues and 24 strengths (Table 1). The VIA Character Strengths Inventory helps identify an individual’s signature strengths. The top five to seven signature strengths are what one values most, because these are the strengths the individual acts upon daily, and research shows that everyone possesses all the strengths.13
In Character Strengths Interventions: A Field-Guide for Practitioners, Ryan M. Niemiec14 suggests four ways to practice and apply character strengths for deep reflection and value alignment:
- Formal: Having a regular routine of journaling or meditation in the morning or evening
- Informal: Recognizing times when your body is stressed and pausing
- In-the-moment: Taking an assessment of your routines and making sure you are not on autopilot
- Cued: Being reminded by something in your environment of a pleasant experience that you then align it with a character strength.
When individual values are openly discussed within teams, it provides an opportunity to identify and create shared values to help drive team effectiveness. Values alignment is crucial to team productivity and vitality. Open discussion and alignment promote an engagement and commitment, whereas imposing values on team members may create cynicism.15
Developed in 1981 after studying team effectiveness, VIA Character Strengths has been embedded in industries such as counseling, coaching, project management, education, and healthcare.16,17 A team-values approach looks closely at individuals’ character strengths and positive team roles as a formula for workplace success.18 Teamwork and working as a unit continue to be essential ingredients to optimal job effectiveness and organizational performance.19 Several of the 24 VIA Character Strengths equate to providing a team approach in respect to positive work performance and job fulfillment.20
Therefore, there is no one value-based model that is a perfect fit for individuals or organizations to follow. In Mindfulness and Character Strengths: A Practical Guide to Flourishing, Ryan M. Niemiec suggests a simple three-step model to apply:
- Awareness: Bring awareness of the character strengths to your team and have them take inventory.
- Explore: Discuss their findings in an open setting, allowing space for questions and reflection
- Apply: Ask your team to set goals based on what they learned.21
The Belbin approach introduces the relationships between values, roles, and team effectiveness.22 In the Belbin approach there are nine team roles in which team members interact with one another to determine team success. Team roles in the Belbin approach are defined as, “a tendency to behave, contribute, and interrelate with others in a particular way.”23 Team roles are broken into three categories that function as the action product of an individual:
- Thinking role
- Action-oriented role
- People-oriented role.
Team success can be predicted by the mix of these nine roles (shown in Table 2). Through this method, individuals maintain awareness of their strengths and approach to a team environment. It is critical to note that a team comprising all like-minded individuals may not result in the desired success. Based on Belbin’s extensive research, it is determined that team success is heavily rooted in a balanced mix of team roles, values, and mindset diversity.
Leaders and managers can use the Belbin model to create a team that is built with balance and a complementary mix of personalities. This will result in a higher rate of productivity, optimal performance, and overall job satisfaction. When teams are smaller, members may need to adopt several roles for overall workplace success.
The collective organizational values support the culture and practices, from recruitment to development to retention to innovation and transformation. The most credible organizations use shared values for consensus building. These are particularly important in healthcare settings, where life-and-death decisions are made, and in times of crisis such as the pandemic experienced at the beginning of this decade.
Collective values make a big difference in organizational culture, employee engagement, and customer service. Kouzes and Posner suggest “when individual, group, and organizational values are in synch, tremendous energy is generated. Commitment, enthusiasm, and drive are intensified. People have a reason for caring about their work. Individuals are more effective (and satisfied) because they feel they are doing something meaningful. They experience less stress and tension.”25
True values can be seen in how employees treat those around them — colleagues, customers, and community members. As is evident at Mayo Clinic, strong values connect to organizational history and heritage, and provide a sense of sacredness for the path forward. The past can be a pathway to the future.26
In addition to individual and team lenses the topic of values should have an organizational focus. Dr. William J. Mayo, one of the brothers, stated three conditions were essential for Mayo Clinic’s future success:
- The continuing pursuit of the ideal of service over profit;
- Primary concern for the care and welfare of each patient; and
- The continuing interest by every member of the organization in the professional progress of every other member.27
This philosophy helped to shape the culture and values of Mayo Clinic. The culture of any organization will be shaped by explicit and implicit displays of positive values, how attitudes and values are embraced through behaviors, symbols, and rituals.28 Organizational values define what is important, shaping the organizational behavior and serving as a guide in making decisions, crystallizing the direction.29
Mayo Clinic appreciates the significance of reinforcing values and behaviors. Through strategies that support and encourage discussion and reflection, opportunities are created for open dialogue about the relevance of values to employees and how staff put the values into action to support the primary value of putting the needs of the patient first. Values are also included as part of HR functions such as orientation, performance evaluations and 360 feedback. An annual celebration of Heritage Days keeps employees connected to the historical roots of Mayo Clinic values. The Values Council is charged with leading efforts to infuse values — part of the DNA — into everyday actions. Council activities include:
- Presentations to groups across the enterprise incorporating discussion that focuses on values in action and accountability in individual work units
- Values toolkits for managers and supervisors that help start or continue the discussion
- Values reviews that allow departments to more thoroughly explore values in their work unit
- Financial support for values-based research or values-based quality improvement projects
The Values Council also formally recognizes staff who are committed to working in a way that demonstrates values on a consistent basis and are models of values in action.30 Members of the Mayo Clinic staff embrace and reinforce the primary value and regard it as a professionalism covenant: a collective, tacit agreement that everyone will earnestly collaborate to put the needs and welfare of patients first.31
Challenges in living the values: Strategies to consider
The challenges facing healthcare organizations are:
- Hybrid workforce. Our day-to-day activities may be more remote, more automated, more virtual in interaction.
- Staffing. Burnout, staffing shortages, and post-pandemic hybrid environments create a “new normal” in the workplace and organizational values are often overlooked.
- Individual versus organizational values. This “new normal” may affect our values system and how we define our values. It is important to understand that core values play a large role in what filter we choose to see the world through. Our own core values may or may not align with our company values.
- Defining values. In fact, it may be that our values are being defined differently. One individual may define family as a value and another individual may define an investment in time.32
How can we overcome any limitations that prevent us from putting values into action in how we work and interact with those around us? Strategies that can be utilized to overcome these challenges include:
- Introspection. Practice self-awareness, self-reflection, and mindfulness. Determine what top values you want represented. Lean on mentors, sponsors, and workplace advocates as good stewards.
- Integration. Strategies include reviewing and inviting discussion about how the values are relevant in the times we live given economic/social/political context, integrating values into continuing education, finding gratefulness in the challenges, focusing communications, acknowledging everyone, and giving hope.33
- Insight. Integrating explicit values assessments in performance evaluations, including 360 feedback, inviting open dialogue allowing staff to share struggles/challenges/accomplishments related to the values, and monitoring values alignment with staff satisfaction surveys.
The way we live out these values will influence what type of person we will be. In a world that has changed so much in the past three years, it is critical to stay grounded in our values and their alignment with our team and organizational values. This will help us overcome healthcare challenges and optimize our collective energy.
The authors acknowledge the assistance of Ethan Grove in editing.
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