Harvard Pilgrim Health Care's Collaborative Strategy to Sustain Success: An Interview with Deb Hicks
by Kali Saposnick

from Leverage Points Issue 51

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Deb Hicks is vice president of human resources at Harvard Pilgrim Health Care (HPHC), an organization that went from being placed in receivership in 1999 to producing a $44 million profit in the face of stiff competition in 2002. Deb is part of the leadership team that helped turn the company around and is now developing a collaborative approach to creating a culture that can sustain its success. She will be speaking at the 2004 Pegasus Conference to be held on December 1–3, 2004, in Boston, Massachusetts. In the following interview, Deb talks about some of the challenges of building a collaborative culture.

When a company on the verge of bankruptcy achieves a major turnaround in less than three years, you know a lot of blood, sweat, and tears went into achieving that result. Harvard Pilgrim Health Care's journey from being put into receivership in 1999 to becoming highly profitable in 2002 exemplifies the dedication and loyalty of its staff, who did whatever it took to make sure the company survived. But when the dust settled and senior executives finally had a chance to assess their progress, they realized that the behaviors that had enabled the company to produce outstanding results in the short run might not be sustainable over the long run.

Deb Hicks, who was involved at the inception of the turnaround, describes some of the difficult dynamics that had developed in a culture just trying to survive. "In the face of extremely tight deadlines, bold challenges they had set for themselves, and media pressure, teams and individuals had very little time to focus on the quality of their collaboration," she explains. "People were exhausted and didn't necessarily treat each other very well; there were blow-ups over critical issues that were accepted as a necessary part of doing business. After the successful turnaround, it was clear that we needed to rally around a strategy for the future, which focused not only on what work needed to be achieved but also on how we got this work done through our own leadership and treatment of others."

Expected Behaviors
The leadership team then explored how to shift the dynamics so the company could continue to thrive while remaining true to its core values. Convinced that certain ways of behaving would enable this shift, team members made an explicit decision to discipline themselves to create a more collaborative culture. Under the leadership of CEO Charles Baker, they articulated a set of expected behaviors that they would work to integrate into their business performance:

• Treat others with dignity and respect
• Support and promote intra- and interdepartmental teamwork
• Understand and consider the needs and impacts of your own work on others
• Demonstrate an ability to problem solve and make timely decisions
• Actively seek and receive feedback for improvement
• Consistently share knowledge and information

As vice president of human resources, one of Deb's first steps to support this goal was to bring in an outside consultant to assess the practices of the leadership team. "At the same time, I performed 360-degree performance reviews on all the executives," she says, "and identified highs and lows as a group, such as the fact that we were very business- and results-driven—key practices to achieve a turnaround—but that we didn't necessarily have a lot of people skills or conflict-resolution skills. In this next stage, we're probably going to have to be more thoughtful about resources and issues of working together."

Using this information, the team formed a subcommittee to talk about the expected behaviors and how to roll them out into the larger business. "This subcommittee did not include HR so it would not seem like an HR initiative," Deb points out. "We wanted the operations people to be grappling with this."

One outcome of these conversations was that senior executives began to look at how their own behavior was inhibiting collaboration. For example, one leader recognized his tendency to get into little "sword fights," or side arguments, with another player. These skirmishes not only diminished the input of the group, they inhibited people who didn't want to be drawn in from putting issues on the table. As a result, decisions got made that people didn't buy into. The gratification the executive got from debating with others, unknowingly at the expense of group participation, ultimately led to less desirable outcomes for the organization.

"It was important to uncover these types of revelations in the group process," says Deb. "It helped us see how challenging but necessary it is to hold senior leadership to the same standards as the rest of the organization. If people at lower levels don't behave well around expected behaviors, they usually get dealt with. But senior levels seem not to be held to those same rules. So we've been grappling with that a lot. The solution really is to stay focused on the behavior, which can be altered, and not the personality, which cannot, and try to have people show support where they can."

Pilot Programs
Another result of these conversations was that, as early as 2002, the team incorporated the expected behaviors into all of their performance plans and appraisals. In 2003, they conducted a two-day retreat to figure out the next step in bringing the expected behaviors into the organization. Later in 2003, the Expected Behaviors Project was created to launch pilot programs to see if teams could improve their business results by explicitly collaborating around the expected behaviors.

So far, five pilot teams have been created, all of which are core to the achievement of corporate initiatives, and many of which have to follow rigorous project management criteria. To support these pilots, a cross-functional core team was formed to provide ways for the groups to practice the expected behaviors as they do their work. For instance, each team has a triad structure that includes a team leader, a team steward (someone responsible for learning the expected behavior tools and helping the team leader think about how to integrate them into the work processes), and a core-team liaison (someone who is part of the expected behaviors core team and serves as a resource and link between the pilot team and the core team).

The core team has also identified a set of support tools that correlate to each expected behavior. For example, "rules of engagement" is a process of identifying upfront the key elements for how a group is going to work together, such as preparing an agenda for every meeting, providing the group with minutes from the previous meeting, not interrupting each other during the meeting, and figuring out how they're going to solve problems and make decisions. Another tool provides ways for a group to assess their progress, such as checking in at a meeting by asking, "On a scale of 1 to 10, are we addressing the things that need to be addressed?" or by using a confidential online survey to assess how they feel they are doing on their performance on expected behaviors.

Deb explains, "Our goal is to follow each team and see where they're getting stuck. They might be having difficulty getting full participation or making effective decisions together. Then we're going to introduce some of the tools that can help them get through those hurdles. The purpose of these tools is not so much about forcing people to do the expected behaviors but about helping them understand how they help to support getting the work done. I'm less hung up about anybody using a particular tool. If that's how people think about it, we probably will have failed. I care most about people engaging in discussion and conversation about how behaviors can be improved for the good of the business."

Building a Collaborative Culture
Based on its large investment in this initiative, HPHC's leadership clearly believes that a collaborative approach is key to achieving the company's goals. The executive steering committee for expected behaviors includes the CEO as executive lead, the vice president of human resources, the senior vice president of strategic planning, the vice president of financial planning and analysis, the vice president of treasurer, and the director of the project management office. They plan on running the pilot programs, which have just started, for six months. At the three- and six-month mark, the group will evaluate whether the expected behavior tools have helped each team achieve their required business results and, if so, how. If the evaluations are positive, the leadership team plans to expand this approach to the rest of the company.

What advice would Deb give other organizations trying to build a collaborative culture? "Have patience," she says. "We came up with the expected behaviors in 2001, and here it is the middle of 2004, and we're still trying to figure out how to roll them out. This kind of initiative happens much more incrementally than any of us has patience for. But we're committed to creating a culture that people want to work in and that's good for our customers and our staff. You might say we're trying to prove that, by not taking the time to do this, you're going to be paying in rework, bad decisions, and lack of support across teams around the work they do. By doing it, you'll sustain a culture that supports the results you're trying to achieve."

Kali Saposnick is publications editor at Pegasus Communications.