Iora's Fernandopulle: The Empowered Consumer Starts With the Empowered Employee

While the national media has focused on Iora Health's business model, processes, and technology platform as the keys to this primary care provider's success, Co-founder & CEO Rushika Fernandopulle points to something different: workplace culture. He explains here, and in his remarks at the 2015 Oliver Wyman Health Innovation Summit, the importance of an environment centered around creating engagement in teams:

Virtually all the efforts to fix US healthcare focus on one or more parts of what was eloquently described by Don Berwick as the “Triple Aim” - improving patient experience, clinical outcomes, and/or affordability of care. While these are all certainly worthy goals, they miss a critical aspect which high-performing organizations in other industries have figured out a long time ago - improving the experience of employees. Too many of the attempts to improve patient experience or outcomes in healthcare involve simply adding more on the already full plates of the workforce, and make their lives actually worse, not better. This is not just ineffective (it is unlikely that unhappy teams will create happy experiences for their customers), but it is also unsustainable.

I am co-founder and CEO of Iora Health, a new national primary care group that is building a radically new model of care delivery from the ground up. Our mission is to restore humanity to healthcare by rebuilding the system not on transactions, but on relationships. We work with progressive payers including employers, union trusts, and health plans to build new primary care practices for their members, and have shown dramatically improved patient satisfaction (sustained Net Promoter Scores of 85%+) and clinical outcomes, at a much lower total cost of care. While lots of articles written about us, for instance in the The New York Times and Inc. Magazine, focus on our different business model, processes, and technology platform, I think the key to our success has been very the different culture we have built, centered around creating engagement in our teams.

Like all the best service organizations in other industries like Southwest Airlines, Zappos, Disney, and the Ritz Carlton, we start by building great teams and making sure we create an environment that allows them to be engaged and fulfilled. Only then can they deliver world-class service and care delivery that will lead to healthier, happier patients. While we have the luxury of starting over to build such a culture, there are some principles that are applicable to existing healthcare organizations as well:

• The goal needs to be not just employee satisfaction, but true engagement. If you set the bar low, you may feel better about hitting it, but it is unlikely to translate into success. Employees are satisfied by very basic things like better work conditions, small perks, etc. but they are truly engaged when they feel like they can make a difference, that they are respected by colleagues regardless of role, and when they are empowered to serve others and to make decisions that make the system work better for them and everyone else.
• Employee engagement needs to be a priority for the organization, and this needs to come from the top, but also be reflected at every level. At Iora this isn’t an adjunct to what we do, it is core.  We look for leaders who demonstrate humility and elevate others. We tell stories that emphasize our core values and especially focus on the small things that team members do for our patients or for one another that demonstrate our ethic of service. We invest heavily in developing excellent managers because we know this is one of the greatest predictors of whether employees are engaged and fulfilled in their work.
• It is hard to build a great employee centric culture with the wrong people aboard. This means having the discipline and guts to hire the right people (and fire the wrong ones). Healthcare organizations typically focus too much on technical competence and too little on culture. While the former is certainly important, it rarely -- if ever -- should trump the latter.
• One of the keys we have found is to focus on building a culture of trust, not rules. Too many healthcare organizations do not fundamentally trust their employees, so give them strict rules and little latitude for discretions. Southwest by contrast allows their employees to be creative to meet customer needs, even if it means breaking a rule or guideline.
• Like other aspects of the business, employee happiness needs to be measured in order to be managed. We use a survey suggested by our friends at Zappos (founder Tony Hsieh is an investor), but the exact form is less important than actually tracking this and focusing on how to improve it.  Over the last three years we’ve learned a lot from our team members’ feedback and have made significant investments in manager development as well as more frequent performance feedback and clarifying what’s expected of each member of our team.

There has been some movement towards all this in healthcare, and increasingly experts in the industry have moved from talking about the “Triple Aim” to the “Quadruple aim”, adding joy in practice to the usual goals. These almost always however focus on physician happiness, which while important, is only a small part of the picture.  At Iora, only about 10% of our employees are physicians, and these are rarely the person our customers (patients) interact with first.  We believe in investing in the engagement of 100% of our employees in order to ensure an organization where everyone is valued and everyone is empowered to provide great care and service to patients.

If we want to truly and sustainably improve healthcare, we need to emulate the best companies in other industries like Southwest and Zappos and create strong employee centric cultures in our delivery organizations.