Chapter 6

A People-Focused
Organization: Development
and Performance Practices at
Children’s Healthcare
of Atlanta

Larry Mohl, Vice President and
Chief Learning Officer

What’s in this chapter?

• How to implement a people-centered strategy
• How to move toward a successful develop-and-perform strategy
• How to design a comprehensive measurement system

 

Try an exercise in imagining. Think about your company. Now imagine that you know exactly what talent you need, now and in the future, to meet your company’s strategic objectives. Imagine you know what mix of hiring, development, and internal movement is required and makes economic sense. For the talent you need to hire, imagine that you know where to find, and how to attract, the best of the best. As candidates apply for your openings, imagine that your selection process confidently and automatically moves the most promising people forward, based on a deep understanding of what makes a successful employee. Then, once you’ve hired all these talented people, imagine that they understand where the company has been and where it is going. New employees are welcomed into their new roles, easily find a network of trusted colleagues, and quickly add value to the organization.

Imagine that managers in your company fully understand the link between their employees’ engagement and their results. Your managers know the specific engagement needs of their teams and are taking action to fulfill those needs. You never, ever lose someone from your organization due to factors that could be addressed by that person’s manager. Imagine that everyone in your company has an honest understanding of his or her talents, strengths, and development areas. Now imagine that managers and employees are in an active partnership to achieve excellence. Managers are crystal clear about expectations and how each person contributes to departmental and company success. They are skilled at providing frequent feedback and actionable coaching.

Imagine that, when leadership positions become available, you fill them quickly with just the right mix of internal and external talent. Your internal leadership pipeline is robust, and your comprehensive process identifies and develops leaders at all levels. You have leaders ready for the future before it arrives. Now, imagine that your leaders take ownership of filling the pipeline with their leadership talent. Leaders actively develop their leaders and so on throughout your management hierarchy. Hiring managers are willing to take risks on internal talent because they are confident that they can provide the coaching required to develop someone in a role.

Imagine that all the information needed to make more proactive and leveraged talent decisions is at the fingertips of employees, managers, and the human resources (HR) team. Do you need to know the correlation between new employees’ performance and their school of origin? Click here. Instead of wrestling with data, you are making new connections and asking questions you didn’t even know you needed to ask. You are past the stage of proving that investments in people pay off through improved company performance. Instead, you are busy optimizing your portfolio of people investments to gain the highest return. Imagine this were all true—today. As the song says, “What a wonderful world it would be.” At Children’s Healthcare of Atlanta, we like to dream big, and big dreams are needed to accomplish our important vision and mission.

 

 

Children’s Healthcare at a Glance

Children’s Healthcare of Atlanta has become one of the top pediatric hospital systems in the country, operating three hospitals, 14 neighborhood locations, and the Marcus Autism Center. Our organization has 7,500 employees, 1,400 physician partners, and 20,000 volunteers. Research and teaching partnerships with Emory and Morehouse Universities as well as the Georgia Institute of Technology enable the organization to fulfill its mission of enhancing the lives of children through excellence in patient care, research, and education. In 2008, we cared for more than half a million children.

Strategically, the key issues facing Children’s Healthcare are multifaceted. Over the past 10 years, the population of the Atlanta metropolitan area has exploded, and with it the resulting need for pediatric medical services. Children’s Healthcare has responded with the largest hospital building expansion in the history of Georgia. In the last four years alone, we have grown from 300 beds and 5,500 employees to 525 beds and 7,500 employees. Most estimates predict that the pediatric population growth trend will level off to some degree but continue to climb.

Although rapid growth is generally positive, it also brings challenges. Local and national shortages of pediatric medical professionals make it difficult to keep pace with expanding staffing needs. Nationally, Georgia ranks low on standard child wellness indicators that are based on health and economic status factors. In addition, 50 percent of children in Georgia are either uninsured or insured through state government programs. The result is that more than 50 percent of the children Children’s Healthcare serves are enrolled in insurance programs that do not reimburse the hospital for the full cost of services. Though the organization must respond to more complex medical needs, increasing costs and uncertain reimbursement, our top priority remains clear: Children’s Healthcare strives to deliver the highest levels of quality and patient safety.

These challenges are, now and for the foreseeable future, the reality for Children’s Healthcare. They define the type of talent we look for and how we equip our workforce to be successful. We are grounded by our senior leadership’s conscious decision to build a culture recognizing that health care delivery is, at its core, all about people—their passion, their expertise, their productivity, and their pride.

 

 

The People Strategy of Children’s Healthcare

To continue to address the challenges we face and, at the same time, deliver on our strategic plan, Children’s Healthcare has developed a comprehensive framework that operationalizes our focus on people, which we call our People Strategy. This strategy describes the vision of who we want to be as an employer. It translates organizational goals and strategies into the specific people goals and strategies we pursue.

The thinking behind the People Strategy of Children’s Healthcare is the work of a dedicated and talented group of HR leaders led by Linda Matzigkeit, senior vice president of HR. Linda’s drive to create a truly strategic HR function that plays an important role in the organization’s success drew many of us to Children’s Healthcare. Deploying an integrated People Strategy requires an integrated HR team. Under Linda’s leadership, we have built trusting relationships and put the needs of our employees and patient families ahead of our own function.

The People Strategy of Children’s Healthcare addresses employee, manager, and organization perspectives. Our employees want to know how they can best utilize their skills and abilities. They want to grow and contribute to the organization’s mission. Our managers want to know how they can best utilize their precious time and energy to find, engage, develop, and retain their talent. At the organizational level, we must set overall direction and specific annual targets in the key areas we use to measure success. We must invest in areas that have the greatest leverage, balancing local and organization-wide needs. We must integrate and orchestrate talent actions in a way that creates a coherent experience that is uniquely Children’s Healthcare. We must have an architecture that is stable enough to be repeatable and dynamic enough to flex with changing needs.

The execution of our People Strategy is owned by the entire organization in partnership with our HR team. The organization’s leadership makes it a priority to attract, engage, retain, and develop employees. They establish goals and invest in developing the capabilities of their people. The HR team provides thought leadership and innovative programs, as well as analysis and counsel, on a wide variety of organizational issues. In addition, we are employee advocates and strive for operational simplicity in all we do.

An organizing framework for many of the components of our People Strategy is shown in figure 6-1. Ultimately, everything we do supports the strategic plan of Children’s Healthcare. The actions we take in our

 

 

 

 

People Strategy are based on a deep understanding of our unique culture and the type of talent that excels in our organization.

We are proud of the results our People Strategy has yielded. We have been fortunate to perform at industry benchmark levels on most of our key measures. A sample of specific organizational results is displayed in table 6-1.

Perhaps one of our most exciting accomplishments was to be the first pediatric hospital system in Fortune magazine’s100 best places to work in America. This distinction is owned by the entire organization and is one that we have been honored to receive for four consecutive years.

This chapter covers several aspects of our People Strategy. First, I briefly touch on our system of filters that work to guide our strategies and approaches. The bulk of the discussion then focuses on the practices in our Develop-and-Perform Strategy. As part of this strategy, I explore our approach to leadership development and performance management. Finally, I highlight several key aspects of the technology infrastructure we are currently implementing.

 

 

Filters That Guide

One of the key planning efforts Children’s Healthcare undertakes uses the simple idea of supply and demand. In most markets, the goal is to match

 

 

Table 6-1. System Results and Trends for the People Strategy of Children’s Healthcare

Scorecard Item	2008 Results (percent)	Trend
System retention	90.5	Up from 83.4 in 2002
Nursing retention	90.7	Up from 85.3 in 2002
System vacancy	2.5	Down from 4.9 in 2002
Nursing vacancy	2.9	Down from 6.6 in 2002
Employee engagement	88.0	Up from 86 in 2006
Internal leadership hiring	64.6	Up from 40 in 2005

Source: Data from Children’s Healthcare of Atlanta.

 

 

supply to demand in a way that creates a return-on-investment. In talent markets, we must understand first what talent is needed over different time horizons. We must then meet the need with a smart mix of hiring, development, and retention actions. Our workforce plan is designed to create projections of demand based on the Children’s Healthcare strategy. Then, using retention and other assumptions, estimates of supply are created and talent gaps are identified. Our resulting workforce plan thus forms an important filter that guides the overall mix of the external and internal talent we will require to execute our strategic plan.

Although all people may be created equal, strategic and operational priorities call for different investments in different segments of the Children’s Healthcare population. As a result, goals and strategies change from segment to segment. In traditional market segmentation, the idea is to leverage solutions by grouping people with common characteristics, wants, and needs. Talent segmentation provides the same benefit, but it also helps define what capabilities exist and may need to be developed. Examples of talent segments at Children’s Healthcare are people leaders, business operations managers, first-year nurses, and all nurses. Talent segmentation thus serves as another filter that guides the type and degree of investment in any given segment of our population.

Perhaps our most important guiding filter is the voice of our employees. Our Employee Promise was developed with input from employees, who identified specific aspects of the Children’s Healthcare environment that would be necessary to create the ideal workplace. Our listening process uncovered four central themes: mutual respect, learning, work-life success, and total rewards. Our Employee Promise thus forms a filter that guides our organizational commitment to employees and, in turn, the commitment the organization asks of employees to pursue excellence in all we do.

Planning for the future, segmenting our talent, and listening to our employees are vital for all our strategies. To bring to life the desire for learning expressed in our Employee Promise, Children’s Healthcare has developed a strong development culture. New knowledge is absolutely exploding in all aspects of health care delivery, and our organization realizes that learning and performance improvement must be a continuous process. Delivering on this promise is accomplished through our Develop-and-Perform Strategy, which organizes and focuses our efforts to effectively serve the needs of our different talent segments and the organization.

 

 

The Develop-and-Perform Strategy

The Develop-and-Perform Strategy of Children’s Healthcare focuses on several areas. The first focus of our development is on demonstrating foundational skills. These are skills essential to delivering safe and effective care. Our second focus is on building strategic capabilities. We define these as capabilities that require significant change and propel us toward the future. Our goal is always the same. We strive to convert learning and development into improved performance. Achieving this goal requires a continuous commitment from the organization to understand that development goes far beyond the delivery of training events.

People leaders are one of our most important talent segments, and our organization has made a significant investment in their development. Over the past several years, we have developed and begun implementing an integrated approach to leadership development. Through this approach, the organization has gained significant traction in improving the effectiveness of leaders in their current roles, readying leaders for the future, and delivering tangible impact along the way.

 

 

Leadership Development as a Business Improvement Process

In late 2004, a central challenge was recognized by the Children’s Healthcare Executive Team and Board of Directors. With the explosive growth of the Atlanta metropolitan area and the corresponding growth of Children’s Healthcare, a leadership gap was emerging. Analysis of hiring trends showed that for every open position for manager or above, we hired internally less than 40 percent of the time. With a hiring rate of more than 100 leaders a year, representing almost 30 percent of our entire leadership core, the sheer number of externally sourced leaders would need to be very high. Though hiring externally is not necessarily bad, we worried that the large numbers could send a message to internal talent that leadership opportunities are slim. Also, would the unique Children’s Healthcare culture be put at risk?

The quality of the Children’s Healthcare leadership was also in question. Our senior leadership realized that the leader of the future would be different from the leader of the present. The growth of health care needs and the increasing complexity of the process for delivering care would require new capabilities. Acting strategically, demonstrating business acumen, leading change, and managing complex relationships would become much more important. The days of purely managing the current operation well were quickly coming to an end. We would need leaders capable of both leading us into the future and managing the dayto-day realities of the one of the country’s largest pediatric health care systems.

In response to these realities, the Children’s Healthcare Center for Leadership (CFL) was formed and officially launched in 2005. The CFL’s goals were to

• develop a robust pipeline of internal leaders so that our internal hiring rate could reach 70 percent
• build the brand of Children’s Healthcare as a great place to be a leader to retain and attract the best leadership talent available
• deliver direct business value through the leadership development process itself.

This third goal was the cornerstone of our entire philosophy and approach. The CFL could not be seen as a training program. Closing the quantity and quality gap required a comprehensive approach, spanning every level of leadership, with an architecture designed to ensure that learning is applied in ways that create impact. Figure 6-2 shows the CFL core processes and business logic at a high level.

 

 

Leadership Talent Planning

Leadership talent planning is a process performed annually, through which Children’s Healthcare analyzes both our projected demand for leadership positions and our current supply of leadership talent. Our leadership supply is analyzed in two basic ways: through nine-box mapping and succession planning. We map all our leaders in the positions of manager and above across the organization. Our nine-box axes are based on performance and potential factors. We have created a standard definition for each box so that we can achieve greater levels of consistency from group to group. Initial mapping is done by individual leaders, followed by successive rounds of talent reviews aimed at calibrating the analysis. Strengths, development areas, and movement opportunities are captured for use in subsequent steps of the overall process. These reviews play an important role in helping leaders to learn more about the talent with whom they are not familiar.

 

 

 

Although each box in our nine-box map has its own meaning, three aggregate pools emerge. The first pool is our top talent. These are leaders with high potential and performance. The second pool is referred to as the leverage talent pool. These leaders are new to their role, solid contributors, or well-placed high-performing individuals with little desire for promotion. The third pool is the performance pool, which comprises leaders who may have performed well in the past but are currently struggling, leaders who have reached their limit in terms of advancement, and leaders who do not belong in leadership positions.

This three-pool segmentation of our leadership talent provides guidance for individual leaders working to develop or improve the performance of their leadership talent. To make this a practical reality, we have defined specific development and performance improvement approaches for each box of our nine-box map. The entire nine-box mapping approach and the tools required to maximize the return-ondevelo pment is taught to leaders as a core part of their CFL development experience. This analysis also has enormous strategic value. The distribution of talent across the nine boxes provides incredibly useful insights into the state of our leadership core.

Information from our nine-box talent map is used to create succession plans for key senior leadership positions. These plans consist of both named successors and pools of individuals who have the potential to fill key positions in the future. This approach creates a good balance between a fairly rigid replacement planning approach and a more flexible acceleration pool approach.

Analysis in and of itself is not worth much unless it leads to action, which takes us to the next steps in our process. In simple terms, the ninebox talent map leads to actions that are either primarily development focused or primarily movement focused.

 

 

Developing Leaders

All development is grounded and guided by a set of leadership competencies. These competencies, defined by our senior leadership team, are tailored to each level of our leadership hierarchy. They work together so that what is required to progress in the organization is clear. Each of our eight competencies is described by a summary statement, eight highperforming behaviors, and eight low-performing behaviors.

Figure 6-3 shows the four distinct segments to which leader development is delivered through four main experiences within an architecture designed to drive application and impact. As shown at the bottom of the figure, our Supervisor Certification and Management Certification programs are foundational. They provide new leaders with the skills and tools they need to manage effectively at the unit or department level. Content is tailored from tried-and-true management fundamentals programs.

As shown at the top of figure 6-3, the Management Acceleration Experience and the Executive Experience are designed to develop more strategic leadership capabilities. For these programs, it was important to create a language of leadership and set of methods and tools that would be used as the standard leadership practices across the organization. This idea was central to CFL becoming persistent in the organization. If new methods are learned in a workshop but never seen in the day-to-day workings of the organization, content soon becomes “shelfware.” Working with functional leaders across the organization, we developed Children’s Healthcare models for strategic planning, leading change, and building capability. These models, along with an introspective component called Personal Mastery, and a healthy dose of more advanced business management concepts, form the core of these learning experiences.

 

 

 

At the time of this writing, more than 490 leaders are enrolled or have graduated from one of these programs or experiences. A total of 110 people have either graduated from or are enrolled in the Executive and Management Acceleration experiences. Just over 100 participants have graduated from the Management Certification and Supervisor Certification programs, and more than 270 participants are currently enrolled. This level of involvement encompasses a substantial percentage of our leadership core.

An analysis of our leadership transitions data highlighted a troubling situation. Too many managers were struggling after being promoted to director positions. As we dug deeper into the issue, we came to the conclusion that the transition from manager to director was perhaps the most challenging to make successfully at Children’s Healthcare. Making this transition requires a completely different orientation and set of skills. The primary orientation for most managers is to focus down and in. They need to make sure their operation runs smoothly and efficiently. Director-level positions require a much stronger system orientation and the ability to look up and across, so to speak. Directors must tackle a wide variety of complex issues that requires them to lead change and exert influence through a complex web of stakeholders. Our Management Acceleration Experience was designed specifically to improve our manager-to-director success rate. Through our talent planning process, cohorts of 12 to 15 top talent managers are selected to participate in the experience, which lasts about one full year.

Our Executive Experience brings together cohorts of administrative, clinical, and physician leaders for an 18-month journey. One of the less tangible, but no less important, aspects of this approach is the relationship building that takes place. As the organization grows, it is important that our ability to collaborate grows, so that our increasing size becomes a benefit and not a risk. The Executive Experience serves as a platform for leaders to come together in a unique way. They hear each other’s perspectives, learn together, and make positive changes. With all the content being delivered by Children’s Healthcare executives, a healthy dialogue is created, which leads to new insights for everyone and practical solutions to leadership challenges. The Executive Experience journey is shown in figure 6-4.

All our experiences use the same architecture, including assessment, workshops, coaching/mentoring, follow-through support, and action learning. The Management Acceleration and Executive experiences utilize the most advanced implementation of this architecture. They involve multidimensional assessments used to create robust talent profiles and customized workshops. Assessments and workshops are necessary, but not sufficient, to ensure application and impact, our primary goal. The key is to surround the learner with support systems and application opportunities at every turn.

 

 

Learning, Application, Impact

The available research on learning transfer points squarely to the role of the direct manager as perhaps the most vital link in the transfer chain. Though highly motivated people will generally find a way to apply their learning, more people create more impact when their managers are actively involved in the learning process. Before any leader starts a CFL development experience, his or her manager is briefed on the specifics of the experience and the expectations for the manager’s role in maximizing the experience’s effectiveness. The manager and participant meet to discuss mutual expectations and opportunities for impact. The delivery of workshops over time provides a rhythm whereby managers are engaged with participants to discuss what is being learned and how it can be applied in their local context.

The application of learning is, first and foremost, about not forgetting what you have learned; and, second, using what you have learned to do your job more effectively. We all know that developing new skills takes practice. Because the skills are new and we may not be all that good at them, trying to use them can end up at the bottom of our to-do list. This is where application management and action learning, along with coaching and mentoring, come in. In each of our workshops, reflection time and coaching are used to help participants define specific development goals that they feel will have tangible impact. Their goals are loaded into an online system set up to provide regular reminders of what they have committed to accomplish. The tool asks participants questions about what they are learning and tracks their progress. In addition, it gives them the opportunity to request online counseling from people they have identified to support their development. Aggregate information from across our different cohorts helps the CFL core team understand which competencies our participants are focusing on and how they are progressing through the experience.

 

 

 

Action learning is a well-known technique. However, delivering projects that have an equal balance of learning and business benefit is much easier said than done. Though our success rate is less than 100 percent, we always strive to achieve this balance and add real value to the operation. Our definition of “done” is that the project has been implemented or the conditions for implementation have been established. Projects are required in all our experiences. Projects for the Supervisor Certification and Management Certification programs are scoped at the department level and led by individuals. Management Acceleration projects are led by individuals and are scoped to achieve multidepartmental impact. The Executive Experience projects are performed in teams and are designed to align with organization-wide strategic challenges.

Staffing our cardiac care intensive care unit was one such challenge. With a historical retention rate of 74 percent and vacancy rate of 30 percent, our difficulty in finding and keeping qualified nurses in this unit had been a key risk for the organization for many years. Our action learning team composed of physician, clinical, and HR leaders tackled this challenge using the full suite of CFL methods and tools—with stunning results. Retention has improved to 91 percent and vacancy to 0 percent. The unit achieved a net gain of 28 nurses, up from a five-year average of zero. Even more impressive is that by using CFL principles for leading change, the team has transformed the nature of nurse-physician relationships in the unit. Nurse retention is now seen as everyone’s issue, not just a nursing issue, and an overall culture of improved collegiality has taken hold.

The accomplishments of other action learning teams include reductions in medical supply costs, improved care coordination, and developing a decision model that helps guide the geographic distribution of our services. Members of our organization effectiveness group work with these action learning teams to reinforce CFL concepts and stimulate personal reflection. All our projects provide a fertile practice ground for individual learning and, in the aggregate, help build skills in project management, leading change, and financial analysis.

Coaching and mentoring provides a powerful lever for impact. Participants in our Supervisor Certification and Management Certification programs primarily rely on their direct leader for coaching related to leadership development. The “leader as coach” is a core theme that runs through all CFL experiences, with skill building built into each. The Executive Experience utilizes a pool of Children’s Healthcare–qualified executive coaches for about 30 percent of the participants. All coaching is developmental. Participants are offered external coaching based on four key criteria:

• They must demonstrate a desire to make the required time available.
• Their development area must be “coachable.”
• The improvements they seek to make should generate tangible impact.
• The employee’s direct manager needs to commit to actively supporting the process.

This is a high bar and has served us wel in maximizing the return for the dol ars we spend. Participants who are not selected for external coaching or are not interested in it have a broad array of internal resources available.

Once a participant and his or her manager agree to external coaching, we go through a disciplined coach-matching and goal-setting process to ensure that all parties are aligned. Our coaches are a vital link in the application chain. We keep the pool small and have a mix of coaches that have expertise in each of our competency areas. We train all our coaches in our core models and tools so that they are prepared to help reinforce previous learning, where appropriate. We learn a lot about ourselves from our coaches. By bringing them together to discuss what they see during their coaching engagements, we gain valuable insights into the CFL and the organization, in general. One successful integration point we have implemented is having Executive Experience graduates act as mentors and coaches for Management Acceleration Experience participants. This approach has amplified everyone’s learning and provided essential role models for our up-and-coming leaders.

 

 

The Rest of the Process

Referring again to figure 6-2, let’s look at the rest of our CFL process model. As discussed above, talent planning can lead to development or movement actions. One of our goals is to become more proactive in moving leaders into roles that fit them well. A valuable deliverable obtained from our CFL assessment system is what we call “leadership orientation,” which describes the combination of business situations where a leader excels. Used wisely, along with other key factors, this information can help raise the probability of a good match between positional needs and leadership talent.

In the end, development and movement actions must come together to get the right leader into the right job at the right time. The strength of this match has a direct effect on our ability to achieve our operating plan. However, the goal of increased internal leadership hiring can only be achieved if hiring manager decisions are aligned with this goal. One of the lessons we’ve learned is that hiring managers are people, too. They are just trying to figure how to accomplish aggressive goals in a complex environment. If one of your leadership positions became available and you could choose between an external candidate who seems to have “been there and done that” and an internal candidate who seems to have all the right stuff but will require coaching to develop in the role, who would you select? This is an important, and common, dilemma faced in all organizations that does not have a simple answer. We communicate to hiring managers that they must make the right decisions for their specific situations and that taking risks on internal talent can pay off in ways that go beyond that one hiring decision. At the same time, CFL experiences are helping leaders feel equipped to take that risk.

 

 

Toward a Comprehensive Measurement System and Results

A comprehensive solution such as the CFL at Children’s Healthcare requires a comprehensive measurement system. Ours is based on several guiding principles. The first is that the measurement system must prove and improve the CFL’s impact. The second principle is that the system must demonstrate value in both rational and emotional terms. In practical terms, the CFL competes for funding with other important organizational initiatives. To understand its true impact, the logic of the CFL’s results must both make sense and be quantifiable. It’s equally important, however, to capture the spirit of the human journey of growth that our leaders experience. If the numbers make sense but CFL sponsors don’t hear and see the progress in their people and others, the value equation is put in serious question. The converse is also true. The measurement framework we established is shown in figure 6-5.

As shown in figure 6-5, the first area we assess is the CFL’s impact on each individual. Preprogram and postprogram 360-degree feedback is used to gauge competency improvements. Promotions are tracked, and nine-box grid movement is used to determine improved readiness to lead at higher levels. Our results show strong competency improvement in participants’ areas of focus. Feedback consistently points to leaders feeling a sense of increased confidence and a broader view of the organization. They are grateful for the investment in them, and many say the experience helped them realize for the first time that the organization’s future is in their hands.

 

 

 

The second area is system leadership impact. Since the CFL’s inception, our internal hiring rate has improved from less than 40 percent to over 60 percent, which puts us well on our way to meeting one of our primary goals. In a recent restructuring, leaders were needed for new pivotal positions at the center of our clinical delivery system. All these positions were filled internally. Leader retention has improved from the under 88 percent in 2004 to over 91 percent at the end of 2008. This improvement represents both more leader stability and the avoidance of unnecessary hiring costs. Our cardiac service line is one good example of the CFL’s attraction power. Our chief of service, a CFL graduate, uses the CFL as a recruiting tool to help hire new physicians interested in expanding their horizons beyond pure clinical care.

The third area is where the rubber really hits the road with regard to direct operational impact. This area explores the connection between what participants have learned and what they have applied, along with the impact both of these have created in their local operation. Operational impact is categorized into the areas of people, service, quality, growth, and finance. This schema is important, because these categories define our core business operating model. All organizational goals, initiatives, measures, and results are tied to these categories. Aligning the CFL’s results this way reinforces the idea that the CFL has a direct impact on our business outcomes.

The primary technique we use to understand the types, degree, and consistency of operational impact is the Success Case Method pioneered by Robert Brinkerhoff (2003). A detailed discussion of this method is beyond the scope of this chapter. However, the important points are that through surveys and structured interviews, success threads that weave from learning to impact can be discovered. The reasons behind why people achieve different levels of impact can be diagnosed and used to guide improvement efforts. Finally, both rich data and stories can be gathered. The key to ensuring a credible analysis is to include only those improvements that are directly attributable to the development experience. In our organization, we have interviewed every CFL Executive Experience graduate, and their stories and results are inspiring. All success threads that pass the credibility test are captured and verified in a database that currently contains more than 225 distinct impact items—including new staffing models, better leadership teams, improved customer service scores, safer care, expanded partnerships, and the launching of new services. Thus the progression: stories, data, impact.

Financial impact is the final area we evaluate. Though not every operational improvement is intended to create a financial benefit, our participants have implemented many changes that have achieved strong financial results. To stay aligned with our financial system, CFL results are classified as cost savings, cost avoidance, increased revenue, and increased extramural funding. Financial impact candidates are identified directly through the success case interviews. One of the interesting lessons we have learned is that people have a difficult time connecting the dots between what they have learned and applied and the impact generated. The success case interview itself seems to solidify the connection in participants’ minds and serves to reinforce the success they’ve experienced. This insight has led us to use “success case thinking” during the development planning phase of a participant’s CFL experience, because it helps him or her articulate tangible outcomes. Another lesson is that our participants have a difficult time converting from operational to financial impact. We learned that we need to provide concrete examples and keep asking questions. Let’s listen in on a typical interview:

 

Interviewer:	You said that you really applied the methods around delegating for development and got positive results. What happened?
Participant:	I delegated in this new way to one of my direct reports, and she stepped up in new ways, took on new responsibilities, and started delegating for development with her team.
Interviewer:	What did that lead to?
Participant:	We found we could redistribute the work in new ways. Originally, we thought we needed two managers to handle all the work, but since we started doing this, we realized that we will not need to hire the second manager.
Interviewer:	What impact has this had on your operation?
Participant:	People feel more valued and are growing in new areas. We are executing well as a team, and I am more focused on what I need to be doing.
Interviewer:	Do you think there is any benefit financially?
Participant:	I’m not sure.
Interviewer:	Was the second manager position budgeted, and have you definitely decided not to hire someone new?
Participant:	Ahh . . . I see where you’re going. Yes, the position is budgeted, and no, we will not fill it, so we are going to avoid that fully loaded cost this year.

 

Through conversations like this, along with subsequent analysis and verification of the financial results, we have captured more than $5 million in cost savings and avoidance, as well as more than $3 million in increased revenue and extramural funding. The biggest payoff, however, has been the ability to make improvements that matter. Targeted changes to participant selection criteria, assessment techniques, workshop designs, and action learning approaches continue to help us to improve the impact on participants and the organization.

As I stated above, converting learning and development into improved performance requires an organizational commitment to development that extends far beyond the delivery of training events themselves. This is perhaps the greatest lesson of our journey. HR leaders must provide the business logic for how employee and leader development initiatives will create tangible business results. We must actively engage the organization in the process, clearly defining roles and expectations. We must hold ourselves to a high standard of demonstrating impact and be transparent about what is working and what is not. We must balance principles with practicalities so that we do it “with” the organization and not “to” the organization. In my experience at Children’s Healthcare, as we do our part, the organization responds by providing the time, energy, and attention required to take advantage of the investment being made.

A foundational part of our Develop-and-Perform Strategy is performance management. The phases and activities of performance management define some of the most basic and important aspects of the relationship between a leader and an employee. A strong, ongoing process leads to increased goal clarity, robust development, and higher performance. Though managing performance is good, imagine what could happen if each employee achieved his or her personal best. Our goal is to drive excellence, and our approach is based on several key beliefs.

 

 

From Performance Management to Performance Excellence

At Children’s Healthcare, we believe that people deeply desire to contribute their skills and abilities to a worthwhile cause. We further believe that everyone has something to contribute and wants to know how he or she fits into the bigger picture. We believe that each employee is ultimately accountable for his or her performance. At the same time, we believe that the employees’ environment has an effect on whether they deliver at the highest level and realize their potential. We believe that what someone does and how he or she does it are equal factors in the performance equation. Finally, we believe that a strong partnership between the employee, manager, and organization is essential to stimulating and supporting higher levels of performance.

This does not mean that poor performance does not exist and does not need to be handled fairly and swiftly. It does, and we do handle it this way. It only means that building our system with an emphasis on telling people what they are not doing well runs counter to our overall cultural underpinnings. Our philosophy is executed through the high-level process shown in figure 6-6.

 

 

Performance Planning

Children’s Healthcare has established a long-range vision and strategic plan that we call Vision 2018. Each year, we analyze our results and develop a system-level annual operating plan. This plan defines goals that are critical to maintain ongoing operational excellence and initiatives that propel us toward Vision 2018. Goals and initiatives are aligned with our operating model categories—people, service, quality, growth, and financial. Specific measures and targets are set so that performance will be stretched in selected areas and will be maintained in others.

Once the system plan is established, we go through a process of setting goals and initiatives for our leadership core. Working with their teams, our senior leaders establish a set of five core goals that align with our system plan for each leader at the director level and above. These goals are articulated specifically, with quantified targets and a range that defines what it means to meet, exceed, or not meet the goal. Initiatives are assigned, and the process continues by cascading goals to our manager population. All goals and initiatives are loaded into our technology platform, where progress can be updated and tracked. Staff-level expectations are defined through job duties, and our Children’s Healthcare competencies are written specifically for our staff population.

 

 

 

We feel that development planning is an important part of performance planning. In our experience, both managers and their employees struggle to establish truly powerful development plans. We see two main issues. First, development goals are either direct copies of business goals or completely disconnected from them. Through the CFL and other avenues, we are working to educate leaders on how to set development goals so that the skills being developed are strongly linked to higher levels of achievement toward core goals. The second issue is that most people restrict themselves to a fairly limited set of development actions. Again, through the CFL, we are working to educate leaders about how development happens in the real world and how to expand their repertoire of tactics.

 

 

Perform and Develop

As you will notice in figure 6-6, the box for “perform and develop” is larger than the other two. This is because it’s where all the action is and where a large part of our philosophy must play out. It is well known that one of the keys to stimulating high performance is frequent and actionable feedback and coaching. It’s very important that leaders learn these skills early in their tenure, which is why they are the core focus of our CFL Supervisor Certification and Management Certification programs. Tracking progress and getting relevant feedback always seems to be an issue, given the hectic schedules most leaders keep. This is an area where technology can provide great value. Our platform allows managers to easily capture communication and documentation associated with their employees’ performance and development. Online social networks can be used to receive feedback on any aspect of an employee’s overall plan. Information such as this, captured during the year, provides the substance needed for successful coaching sessions. It also makes the preparation of annual reviews much easier.

 

 

Performance Reviews

In line with our performance philosophy, our annual review process assesses both goal accomplishment and the behaviors demonstrated for every person in the company. The process starts with self-assessment, so that everyone can reflect and provide comments on his or her own performance. For positions at the director level and above, all goals are scored as to whether the goal was exceeded, met, or not met. This is where the work put into the performance planning process to set specific quantified performance ranges really pays off. Leadership competencies are assessed on a scale of exemplary, frequently exceeds, meets, and needs improvement, using our behavioral definitions as the basis for the assessment. Training and tools are provided to help leaders make more objective judgments.

After an initial assessment by their direct manager, each leader’s competency assessment goes into calibration sessions. During these sessions, rating consistency is improved, and comments are captured in our technology platform. These calibration notes will eventually be discussed with the leader during his or her annual performance discussion, because they represent important input from multiple perspectives. The attention paid to the process of leadership calibration, along with the fact that leadership competency performance is equally weighted with goal performance, sends a strong message that we take leadership behavior seriously.

A new approach we are currently implementing for leaders at the director level and above addresses the issue of assigning an overall performance rating. What do you call someone who gets results but does it in the wrong way? Instead of trying to formulate an overall label that confuses the issue, each leader will now receive a separate rating for goals and for leadership. Our hypothesis is that this will lead to more honest assessments and clearer conversations about past accomplishments and areas for future focus.

Performance review discussions represent the moment of truth in the minds of many employees. The tone and substance of the discussion defines how well the company’s performance philosophy is truly understood. In many companies, performance management is equated with the performance review. We are definitely not perfect, but we strive to make performance excellence an ongoing process. If the first two steps have been executed well, disconnects between the messages sent and received during the review discussion can generally be avoided.

We have recently implemented the performance module of our new technology platform. If I could dispense only one piece of advice, it would be to use technology implementations as a way to clarify your organization’s performance philosophy and then figure out ways to embed it in your tools. We did just this as part of our recent implementation. We refreshed rating standards, communicated our beliefs, and engaged the organization in the process. With the aid of technology, our goal for performance reviews is to efficiently bring together employees’ and managers’ perspectives to enable productive dialogue and improved performance partnering. To make this goal actionable, we added a section in our online review that allows employees to comment on areas of development. It also enables them to identify the support and tools they feel they need to be successful. This small addition helps direct review discussions into areas that drive increased engagement.

Finally, although pay is absolutely connected to performance, we have learned that introducing pay into the performance review discussion makes it the central focus. For this reason, we separate these conversations.

 

 

People Informatics and Technology

In the previous section, I highlighted some of the ways technology supports the execution of our process at Children’s Healthcare. However, the larger theme of integration guides our efforts to develop the technology infrastructure needed to support our People Strategy. The movement toward a platform approach that serves multiple talent needs with a central data repository is one that we like and are currently implementing. One major benefit of this approach is that it will allow us to more easily weave information from one context into another. For example, the information obtained during the hiring process can be made available for development planning. Process automation is certainly a goal and is important to drive efficiency. The big payoff, however, will come from the ability to analyze currently disparate data sets to gain new insights and support smarter decisions.

If talent management is about supply and demand, then making smarter talent decisions requires up-to-date, reliable, and comprehensive information about positions and people. As part of our multiyear plan to implement a fully integrated talent system, we have begun development of the core position and talent profiles that live at the heart of the system.

Our people scorecard reports the data we gather monthly to track our progress in key areas such as candidate flow, retention, vacancy, and internal leader hiring. Our goal is to extend this capability so that these kinds of data can be easily brought together, based on different views of the organization. This will enable managers to see the talent in their organization through a new set of lenses and feel more equipped to make smart decisions. Ultimately, it will allow us to ask questions we didn’t even know we needed to ask.

 

 

Back to the Future

The world I imagined at the beginning of this chapter is fast becoming a reality. At Children’s Healthcare, our People Strategy is providing a road map to the future, and the practices I have outlined here are only a part of our overall approach. Important innovations in attraction, selection, engagement, and retention strategies have proved equally helpful in moving us forward. As we connect our strategies through the lens of our talent segments, we truly see the whole becoming greater than the sum of its parts.

Moving to the future in a sustainable way is a journey that requires organization-wide effort. The first, and most important, decision to make when embarking on this journey is not which strategy or program to implement. It is to recognize and accept that managing talent in a purposeful way is among an organization’s top priorities. Like Children’s Healthcare, many organizations have recognized that the key to sustained positive results lies in their people. For these companies, HR leaders are tasked with providing solutions to talent challenges that are more prescriptive, proven, and predictive. In turn, operational leaders must make talent solutions work by focusing more and more on the management of talent.

At Children’s Healthcare of Atlanta, we have made great progress on the journey defined by our People Strategy. We are not perfect, by any means, but our healthy dissatisfaction with the way things are propels us forward. Everything we do at Children’s Healthcare is for our kids and their families. We understand that there is a direct link between how well we manage our talent and moving toward fulfilling our mission of providing the highest quality of care. Think about your company. How do you make the link between talent and mission? Imagine. . . .

 

 

Acknowledgments

I would like to sincerely thank Linda Matzigkeit, Gail Klein, Michelle Reid, Tim Whitehead, and Liz Wysong for all their ideas, support, and encouragement in the writing of this chapter.