University of Louisville Hospital
Five Stories: you can make a difference

by
Birute Regine and Roger Lewin

We tell these stories in the spirit of amplifying what is possible, as a way of setting our sights further than what we might imagine, in spite of the difficulties, and as a way of learning from each other. These stories, a small example of the changes occurring at ULH, are unique, due to personalities and context, but they all share similar traits and patterns in their way of working and being. This approach to the workplace is powerful, because this is the way people really want to work-with a sense of a supportive community, an opportunity to learn and grow, and where work and the workplace can be personally fulfilling. And it works because these behaviors engage the dynamics of the workplace as a complex adaptive system.

The Psychiatric Unit

Under the leadership of nurse manager Lee Tyson, the sentiment on the psychiatric unit has transformed from a place of low morale to a sense of family-the nurses share a common purpose and a sense that they are all in it together. The amazing aspect to their story is that the stress and overwork that fueled low morale became the impetus for learning a different way to work together. This was not an easy transformation, least of all for Tyson, who faced hard lessons in order to embrace a complexity style of management. One of the hardest of which was learning to let go-letting go to allow for mistakes, to allow people to find their own way, to see and accept the limits of control. This is how Tyson described her journey. As you read hers and others stories notice how similar elements of a different way of working come into play.

"I'm letting my charge nurses do a lot of things that I used to do myself, such as staffing and scheduling. It was so hard to turn it over to them, because I'm accountable for our scheduling because of the money attached. I just didn't want to let go of it. And then when I finally let them do it, I'd want to sit and watch over their shoulder all the time and want to say, 'No, you didn't do this right.' The staff would all come to me and say 'We don't like the way this is done.' And I'd want so much to fix it and go tell those charge nurses, 'No, you have to do it the way I did it.' Over a period of time, I just let go, I can't really explain how, but now when the staff comes to me, I say, 'I don't even want to hear about it-go talk to the charge nurses.'

I still look at the schedule and see things on there that aren't quite the way I would do them, but I just bite my tongue and don't say a word. The charge nurses know they have to deal with the good and the bad. They can do anything they want with the schedule. And when there are staffing shortages, they are the ones that are going to have to deal with it. Even though letting go was really hard for me, my life is better than it use to be. I don't have to fool with that schedule anymore; it's like lifting a huge iron yoke off me. And the nurses prefer it, too. Yes, they complain about what a terrible job scheduling is, but they sure don't want it taken away from them either. They'll tell me how horrible it was doing it, but they are all in there huddled together doing it, talking about it.

"Now we have our meetings, and we talk about our goals and I just hope they see clearly as to how to get there. I don't go back anymore to tell them to change things. They do it and I leave it alone.

"My own attitude has changed-I'm less uptight about the whole thing. I kind of do my own thing. I guess I feel secure that people know me and they accept me so far. I know there are certain things I do well and certain things I don't. I'm kind of a cheerleader type person, cheering my people on, and I do that well. So why spend a lot of time on things I don't do well? Let people who can do them well, do them, and forget about it. Why do I need to be good at that when I'm good at these other things? My job is a whole lot more fun for me if I can do the things I can actually do well. Also, I think I can be a better leader if I'm not obsessing over details. It gives me more time to get out there with my staff and talk to them and listen to what they have to say. We kid around too, and find out about each other's families, so there's a connection there.

"This is something new that I'm really excited about. Mr. Taylor wanted the nurse managers to come up with ideas to turn around the nursing situation-the burn outs, the problem with retention. He said he didn't want us to care about how much anything cost, but to come up with our best ideas and that he would take them very seriously and would try to do the things we came up with. Well, he did. He keeps his word. I was prepared to not trust him, but in fact I do trust him.

"We came up with lots of ideas. For example, we gave employees a survey to fill out to say what was causing them stress and what they thought would help. Over and over again, they said it would really help if we had an exercise area, soft music--a wellness clinic, which I've been working on. There would be people like massage therapists, even manicurists, and the staff could go down to the clinic during lunch break or whatever. We could do educational things there, too. So it's a really exciting project-nurses are taking care of people all day long; it's about nurturing the caretakers."

When we talked to Tyson's staff, it became clear to us that her leadership had instigated a different way of working and being. Although there is a lot of draw in the community for nurses to go out and work someplace else for more money and less hardship, people like mental health technician Dwight Lacy are willing to take a $4 per hour pay cut in order to work in the psych unit. Why? Because it's a great place to work. Following are people's experience of working in the psych unit.

Nurse Lou Landt:

"I've worked a great number of places and this is the easiest by far as management goes. Lee lets us do our own thing. I mean, if you really went off on some weird tangent that had no benefit, she'd come in and say you're way off. But if you have an idea for a group or a project or something special you want to do, and it wasn't totally crazy, you would be able to implement that. For instance, we have permission to go ahead and cross train. I really like cross training; there's so much versatility in it. It's not like there's one title; but many jobs in one. Before I reached psych, it was like you do your job and you go home and hit it again the next day. Here people know your personal issues, they remember things, the little things that people don't usually remember as co-workers. That makes a huge difference."

Social worker Michelle Sheridan:

"I feel much more positive about the hospital, my job, about how things are going here than I did four years ago. I just feel like there's a tremendous amount of energy right now in the staff and administration. People are wanting us to succeed, and I see staff wanting us to succeed. We want to be good at what we do and that doesn't seem like that was here much before. Before there was a division that I saw between goals that administration and department managers might have versus goals that staff might have. There was a kind of ivory tower view and the real world view. Now they're more together."

Art therapist Brenda Kasdin:

"There's lots of reinforcement for new ideas and a job well done. We have fun together. There's a connection there that comes through. This hospital is notoriously short staffed. Most of the time we are short staffed. That's a true test of how well you get along. When you're short staffed it may test our nerves, but we feel accountable to each other. A lot of us put in a lot of hours making sure we don't leave staff, our people, in the lurch. I don't want to leave Dwight alone for love or money, nor would he me, so we try to help one another."

Dwight sums it up nicely:

"It's never dull. There's always somebody or something interesting. Usually I learn something every day."

Radiology Department

Gerald Johnson joined ULH in mid-1996. During his 27 years in the health care industry, he steadily embraced the philosophies of Edward Demming, such as participative management and reducing hierarchy. Early in 1999 Johnson initiated some projects that he hoped might help increase morale in his department, and ultimately, perhaps beyond the walls of his department. One of them is the fireball contest:

"The idea is that whenever anyone sees someone doing something that is above and beyond their duties, they run into my office, pick up the Polaroid camera we keep there, and take a photo of what's going on. The photo then goes up on the wall for that month's contest, and the 'fireball contest nominee' immediately gets one of those atomic fireball candies. At the end of the month, the team leaders get together to decide which of the nominees-and there are usually a lot of them-is the winner, who did the most outstanding thing that month. The prize is four hours pay, which comes out of my pocket. I didn't want to get the hospital involved; it would be too much hassle. The hospital pays me well, and this is a way of giving something back.

"You get the biggest of smiles when the winner gets $60 or $80 in cash in their hands, believe me. Monetary reward does make a difference, no matter what people say. But it's more than that, too. People love the recognition it brings, with their photo up there on the wall. People love that, because everybody who walks by-and a lot of people do, not just from our department-sees the photos. I think it's generated a sense of people wanting to do more, doing things they didn't do before. You know, a lot of people have been here a long time, and they get set in their ways. Here's a way of breaking out of that.

"The contest has been going on for three months now [it started in March, 1999], and so there are a lot of examples of what people have done. For instance, one person volunteered to do three extra shifts in a row. Someone else, while they were on their way to lunch, saw that a patient needed a wheelchair, and so they went to get one and took the patient to admitting. One girl, who won the month before last, saw that a lady who had come in for an arteriogram had brought her two young children with her. So Stephanie took the children to the cafeteria, paid for their lunch, and ate lunch with them, keeping them occupied. When they were done with lunch, the lady had had her procedure. The kids were happy. Everybody was happy. People do the most amazing things. I can't be there all the time saying, "Good job!' So this is a way for people to recognize each other, the great things they do. It really is shifting the behavior in the department.

"I can't wait 'till someone from outside the department is a winner, because it is open to anyone, anyone who passes through here. We've had nominees from outside, from Housekeeping, for instance. Last month we had three nominees from Admitting. They didn't win, but we wanted to recognize them, so we arranged a pot luck lunch for them. It was the most positive thing we could have done for them. And they loved it.

"The idea for the contest came from a doctoral thesis I'm doing, called Quality Improvement: case in point. What I'm trying to develop is a tool, a method that anybody can take, anybody can make things better. The name of my program is "I can make a difference." It's about involving people. And the message is that anybody really can make a difference, if they want to. They can think, 'I can stop and help a patient. I can stop and take a minute to help someone.' It's the small things that make a difference.

"I'd love to think that the idea is spreading. For instance, I noticed last week that there is a bulletin board in Housekeeping, with people's pictures on it who were having a birthday that week. That wasn't there before. It's similar to what we are doing, in spirit. Everybody can do it their own way. For us, it's the fireball contest right now. I don't know how long it will last; maybe only a few months, who knows. But then there will be something else."

Financial Services

During 1998, the Finance Department was experiencing a chronic problem: namely, an unacceptably long time between when a patient is admitted and when the account is finally collected. One factor that was judged to be important in slowing the process was the number of times the account was touched for some kind of transaction: an average of about 40. It was obvious that if that number could be significantly reduced, so too would be the collection time. How to achieve this? The traditional way would be for the CFO, Steve Short, to assemble a small committee of managers, who would figure out the answer, and then have their staff implement the solution. Instead, Short decided to embrace the complexity science approach, which says that the people closest to the problem-the people who deal with the accounts day by day-are the ones who know the problem best and, given an opportunity to collectively organize, are likely to come up with the best solution. So, at the end of 1998, Short hired outside facilitators, The Wunderlin Company, to spend two and a half days off site with about 40 staff from the department to try to do just that. It was an experiment that, by May 1999, was not common at ULH but was in line with the kind of management style that Taylor is nurturing.

The staff split into two groups of 20, and, aided by facilitators, broke down the account-collecting and other problems, and sought solutions. At the end of each day Short would arrive and hear what had transpired, what recommendations people had developed. "We said, this is the problem, this is the solution we're recommending, and this is how long we think it will take," explains Nancy Overall, an internal auditor in the department. "Steve gave us a yes or no right there. We got a lot of yeses, and one no, I think." One of the benefits of this approach, aside from generating pertinent solutions, is the impact the process has on those involved. "We were the ones who came up with the plans," says Christy Murphy, an auditor in the department. "We were the ones responsible for implementing those plans and seeing it all the way through. We've seen some great accomplishments. And it's given us a sense of pride because we were genuinely empowered to make decisions, and people listened and respected our decisions. It brought out a lot of hidden talents people didn't know they had or knew they had but weren't allowed to exercise."

The experience wasn't easy, however, and some people were extremely frustrated, uncomfortable, angry even. "There was some suspicion that we weren't really free to make decisions," observes Overall. "And there was the suspicion that, maybe, the supervisors were a little bit afraid that if they let this go, if they let people start making decisions, then they're going to hear it from higher up, that they're not really going to allow this." The work did get done, however, decisions were made by non-managerial staff, and they were accepted. But, as Murphy comments, "the vision's not there for everybody. Not everybody bought into the process, probably because it is so different from the way we're used to working."

"I think it was a good start," says Short. "We made a lot of changes, and people saw what they could do. But some people still live in an environment where there are managerial walls, or they think there are managerial walls. It takes time to break down a long-ingrained culture of being told what to do, and feeling safe in that. But that's what we have to do, break it down."

Environmental Services

John Doe (a pseudonymn), who joined ULH in February 1999, is a relative newcomer and works in the environmental services. His story is a testimony to the power leaders and managers have-the power of example and how the new style of leadership affected him. One thing is for sure, people are watching their leaders, closely. In many ways Doe embodies the new spirit of the workplace:

"I toured the hospital twice before coming here. I met individuals in environmental services, and everybody had such a positive attitude towards me. They treated me like they had known me for twenty years. Because I had previously worked at the Detroit Medical Center in Detroit, which is three times the size of this hospital, which was a totally different environment, I was very excited about working here. In my previous job, you couldn't troubleshoot as far as cleanliness. Once I got here I noticed a difference. I was excited because here we don't just deal with cleaning up the hospital; we were able to do more because we weren't running into all these do's and don'ts. I knew right off the bat that it was going to be a warm feeling working here.

"I came here from a major divorce, to put space in between feelings. Once I got here I got involved with the hospital. Anything that was posted anywhere, I'd show up, whether it had to do with me or not. I'm learning a lot and what's really exciting is, whether it be the President and on down, you can sit down and individually talk and communicate with the people you work for here at the hospital. I got a sense of relief; it's a place to come and feel a lot better about what you do. I look forward to going to work because of the people here and because I feel a part of, if you know what I mean. And I'm grateful to be here.

"I look at the care that the patients, outside customers, and those who aren't even patients, are getting. I watch how my superiors and my colleagues are with people. Their attitudes, manners and the discipline. I watch and I pick it up. I've gotten great at communicating better. I feel good about having a smile on my face when somebody walks up to the place because I know it's the feeling I get. How different.

"I came here a few months before the Marriott consultants took over management of environmental Services. Communications was real good, but actually getting the job done, it was half of what it is now. Now it's a hundred percent. We've come a long way in a short time; that's what I'm so amazed about. A lot of stuff was very lax before. The greatest difference I see is we got great direction. Everybody is accountable now. And we've got great supervisors. My own personal supervisor, Denise Blackburn, she's very firm but she's fair. You know what I'm saying? She doesn't let you get away with murder, but then you don't have to walk on eggshells either. She wants you to put out a good productive job. Because when you walk in the door of this hospital, you want this hospital to say something to people; you're looking for the hospital to give a "wow." That's what makes me excited about being a part of what's going on here. When Marriott came in and Marvin Drummond headed the department, I knew what to look for. Anywhere you go in any institution, when you have an outside contract and they put him at the head of the department and give him the rule of authority, you're looking for him to come in and wipe the complete department out, change the staff, and bring in his own. He came in and did none of that. Instead he told us what he was going to do, which was unusual. I was real critical, watching him to see if he's really going to do what he says. Most of the time, they say a lot of good stuff to get their foot in the door but then they won't respond. But he responded tremendously.

He promised he would change the chemicals we were using. He came through. He wiped out the complete line of chemicals and solutions and brought in the newest germicidals and stuff, even a wax. This line is so great because you don't have to work as hard to get the job done, which gives us more time to pull off simple cleaning jobs which we didn't have time for before.

He also arranged meetings with us. He doesn't sit down in those meetings like he's the director and we're just little employees. He takes his sport coat off and hangs it over the chair and sits and communicates with us as if we're in a conversation. He listens to us. That really speaks out. You want to feel that your employer cares about you and your work.

He has an open door policy and you can address anything with him. I took advantage of that policy when I felt uncomfortable about something. I wasn't afraid. You're always in fear when you're the bottom people, the little people, that if you say something, you'll get pushed out the door.

He taught us the proper procedure for going into any room-locker room, patients room. You knock three times and then announce, "Environmental Services." He showed us the proper way to behave; we learned a professionalism that was real simple that I didn't know before. I feel like I'm being educated right on the job, and that's amazing.

I take this place very personally. If I can be part of something here, I want to know. They call me nosy man. The other night I went to the open meeting because I was so excited that our employer James Taylor himself would be there and I wanted to express my gratitude to him, and I did.

The other thing is our department is thinking about a recognition for the employee of the month, something that has never happened in Environmental Services. That says something, that our importance is not just that we come to work. You know, we're important even though sometimes we don't feel important. If you want to know what's going on in the hospital, ask us. We're everywhere all the time.

You know, we are the backbone of the medical facility. Without us sterilizing and cleaning, it's impossible to do anything. I take my job personally because what if my mother comes into the hospital. I want to be able to say she's well taken care of. So when I'm cleaning the operating room, this area has to be cleaner than anyplace, and I clean from the ceiling down, even under the sink where the pipes come down. Some people don't think it's important but it's real important wiping up under the pipes because certain germs get loose and you're dealing with open wounds there, and you get germs stepping in and you have another problem when the body goes to recovery.

Buffing the floor is an important job too because it protects the tile, otherwise they'd be all scarred. You've got wheelchairs going down those halls and you want them to roll and not run into bumps. Sometimes a body is so critical, and that body's got to roll real smooth. I do anything from scrubbing walls to escorting a patient. In the evening after work, I sit down with a patient-some patients are elderly and all they really want is somebody to listen to them.

All I can say is they give us a chance here. And it's not like you have to do a lot of brown nosing and then get the chance. All you have to do is be yourself, do your job, and you really get an opportunity to advance and become something within this facility. And that's what excites me about the University of Louisville Hospital.

Engineering Department
by Birute Regine

Although the engineering department is a vital support--the backbone really--of any hospital facility, its people are often the unsung heroes. Daily maintenance such as plugged sinks, broken TVs, electrical problems, sprinkler system mysteries, water supply woes, recurring sewage problems, upkeep of elevators, air conditioning, vandalism, along with larger issues like the Y2K problem, being accountable to all the regulatory agencies-building codes, EPA, Joint Commission, insurance agents--just scratches the surface of the engineering world of being everything for everyone. They are the troubleshooters, the problem solvers, the guardians of the facility. A demanding environment, with forty to sixty calls a day--things all needing to be done immediately, of course--the "shop guys" as they call themselves, including two women, are used to living in what maintenance supervisor Doug Herberger calls "organized hectic" as they engage in their daily rally to effectively handle anything in a given moment.

But, like athletes, who make the difficult seem effortless, their skills and responsiveness can become invisible, and consequently often thankless. But when thanks do come on email to Director of Engineering, Karl Kifer, he immediately posts it so it is visible to everybody. "When my guys get thanks," he said, "they'll jump through hoops for that person and do more than they were even asked."

Because he recognizes the importance of appreciation within the department as well, Karl Kifer sets aside some money in the budget for staff get togethers throughout the year "as an opportunity to give back and say thank you to the shop guys, who keep everything going. They understand the importance of their job. If a patient calls down for something, they go there and do it. But I wanted somehow or other to let them sense how vital their contribution is to our hospital." During these gatherings the shop guys relax, joke around and for the most part enjoy each other's company, despite, or perhaps because of, the diversity of people. As the hospital painter Jim Marquess said, "Christian guys, partying guys, family guys, the whole gamut is there."

At one particular gathering, a dinner held a week before Thanksgiving in 1997, the department took a surprising turn. Kifer had been director for a year at that time and he decided to do something special. Rather than have a typical potluck supper which often meant burdening the wives with cooking, he decided to have the Marriott, the hospital caterer, prepare the food. The mood was festive and relaxed as everyone chipped in to transform the carpenter shop into a holiday dining room. People were laughing and carrying on, as they moved work benches, set up tables. Quickly the small windowless room in the basement, with heating and ventilation ducts hanging from the ceiling above and a concrete floor beneath, began to recede as tablecloths were spread, fine china and silverware laid, and candles lit. Soon the tables were a cornucopia of culinary delights-ham, turkey and all the fixings. Almost the entire staff was present, around 25 out of 27 people but there were also some unusual additions. CEO Jim Taylor was present, along with some administrative staff. Their presence added to a collective feeling of celebratory warmth. As Herberger stated, "In all the 23 years of being at the hospital, never has a CEO come and just mingled and talked to us. That he came meant that we weren't just somebody who punches in and out. Instead it showed that he had a real feeling for the people who work here."

As always, the meal started with an opening grace. For Mike Bradley, the groundskeeper, this was one of the most memorable moments. "We just sat down and blessed the table and joined hands and meditated for a minute. Sometimes people think if you and me are holding hands there's got to be something wrong with you. The way I see it, it's just good to embrace one another. Each moment we have together is a blessed moment, and to share that moment is an experience filled with joyful meaning."

The feasting began, and after everyone had eaten, full and happy and not really wanting to go back to work, Kifer stood up and spoke. In those moments he essentially brought life to the meaning of Thanksgiving, by giving thanks to his staff. He told the group how much he appreciated them, the personal sense of pride he felt for them and for all that they had accomplished throughout the year as a group. Then he made an unusual request; he asked each person to stand up and say what they felt good about that year, what they had accomplished or contributed to the hospital, what they appreciated. At first the request took some aback, some felt uncomfortable, and initially "it was like pulling teeth," Kifer remembered. "But then the comments started coming and it became infectious as we went around the group. One story would remind someone else of something, and we'd go back and forth."

Kifer had invited them to speak from the heart, and his people accepted. "The guys just opened up, shared ideas, and talked like they would at a family gathering," Marquess observed. What occurred was a level of honesty that is unusual in work settings. A roomful of shop guys stood up and expressed their personal feelings to one another-- about each other and about their workplace. Like any sharing there were bits of negativity expressed, but for the most part it was positive. What was revealed was how deeply personal their connection was to their fellow workers and to the hospital and its patients. For the shop guys, work was personal. They unexpectedly entered into a new depth with each other that strengthened their existing bonds. Here are some of the comments made.

When groundskeeper Mike Bradley stood up, he said he appreciated how everyone got along, how everyone would pull together and work as a team to meet the flow of demands. Also, he recognized how often they did their job over and above what was needed. Doing things above and beyond is very much a part of who Bradley is. "I was taught that no matter what you do, be the best in it. If you don't try to be the best, then why bother doing it? I take pride in my job and I believe in going that extra mile. My job takes me outside, which I love, and if someone falls I want to be there to pick them up, or help someone out of the car, or help a wheelchair person. Some ask why would I want to do that, it's not part of my job. I think if I was in that position I'd want someone to help me."

Bradley doing his best no matter what the task is doesn't go unobserved by Kifer. "Mike is a spark plug. All the time he's working, he's talking. He must know everybody in the city of Louisville. He is so proud of the esthetic level we've brought to the exterior of the facility. We all remember how nasty it was in the past, how unkempt looking it had been. We've made tons of progress. Mike takes pride everyday in sweeping cigarette butts off the entrance way to the hospital. People will throw them right down in front of him as he's sweeping and he'll just put on a big grin on his face, and keep on going. He, like the others, plays a major role in contributing to making the place presentable for our patients, for our staff and visitors."

When Doug Herberger stood up, he expressed his appreciation to Kifer for having him included in the design process on some major projects that were going on, such as the ER expansion. This was no minor event for Doug because in his 23 years at ULH, it was the first time he was able to participate at this level. "I thanked my boss Karl for getting me involved in the design even though it was pretty much already designed out. I found a few flaws that could save the hospital money if we did it a certain way. Karl took my suggestions back to the designers and they went with a lot of our ideas, not just from me, but from other guys in the shop as well. Not that it wasn't designed well, it was just that we knew the building a lot better. Lots of changes had occurred that the designers didn't know about that we did. I felt good that I could help the hospital, not just to save money, but to also avoid headaches like having to shut down systems or interrupt patient care.

"But it was tough telling him thank you, how much it meant to me. Telling him alone wouldn't have been a problem, but to say it in front of the group was a completely different experience. I found myself getting all choked up."

That Kifer is highly valued, appreciated and cared by his staff is starkly apparent. This can be explained in part by Kifer's leadership style that emphasizes giving his people a sense that they can have an impact on the facility, that what they think and say matters, and that they will be listened to. As hospital painter James Marquess said, "One time, Karl asked everyone to list three things, jobs they'd like to see done at the hospital. It could be anything from fixing something, to hiring someone, to looking at a different way of doing things. 24 out of 27 guys responded. Karl looked at every one of those suggestions and did everything he could to address each and every one. He even gave out a sheet showing what he had done about them. Karl stays on top of things."

For James Marquess, what lingered in his mind about that Thanksgiving dinner was not so much what he said that day, but rather what he didn't say. "Asking us to stand up and tell a job we were proud of left me feeling uncomfortable. It was easy for me; I picked a three week paint job I did. It's harder for the floor guys who are always maintaining things. Their job is a thankless job even though it's much more important than mine. I get appreciation because people can see what I've done. But their work is so much more vital than mine even though it isn't as visible. I'm more appreciative of the floor guys who keep the place warm and take care of it if it's too warm, and are directly taking care of patients, nurses, and staff. My appreciation is of their work and I didn't say it at the time and I wish I had."

Larry Kendalle, who is in charge of general floor maintenance, said how he appreciated the department's response time, especially during times of emergency- such as a flood or a fire that might, for example, affect the babies in ICU. "We do it quickly and I'm proud of our ability to do it," he said. He also expressed his appreciation to Charlotte Redman whose work as the dispatcher is to take care of non-scheduled incoming work orders. Appreciation for her work came from others as well who had a personal hands-on experience of her job. While she was away on vacation, people were assigned to cover her desk at different intervals during the course of the week. They saw for themselves what she went through every day. "I wouldn't have Charlotte's job," said HVAC mechanic Larry Ross laughingly. "The phone ringing, the computer going, and making sure everyone got their work order! I couldn't handle it!"

For Pat Clark, the locksmith, it was a deeply personal moment. He had had a heart attack that year and he was grateful for just being alive. For him, being alive was deeply linked to his hospital since it was his hospital who had taken care of him and enabled him to continue working at the hospital. The tables had turned for Clark-those he had serviced had taken care of him.

Some people only said a few words of thanks, others elaborated. But, regardless, people were seeing each other as people, not just workers. Al Walker, for example, whose sole job is to change light bulbs, is much more than his job. As Taylor describes him, "He's a pastor of a church; he and his wife have foster kids. He's so proud and so caring, and yet most people see him as the guy who pushes a cart all day long changing light bulbs."

Taylor was the last to speak. "I said something about appreciating them as good people. There wasn't much I could say after what had been said. I was feeling a degree of joy and optimism that this kind of emotion and openness could take place in our organization. Karl had made conditions so that this could happen and people felt comfortable enough with each other, trusted each other enough, to say things about themselves that normally don't get said in these settings. Typically at department gatherings, people come in and get their food and chat and then leave. When people say personal things about themselves and each other, there's something much more that happens. The connections and bonds are strengthened."

"Karl knows these people in ways that I don't but what struck me as I was listening was that I was learning something about each person, not so much about the work they do but what they felt about their work, their hospital and each other. It was remarkable. They really understand why we are all here."

Kifer has created the conditions for this level of discourse largely by instilling values. As he said, "I think when people are asked about me, what will always come out is loyalty and dedication to the organization. That's represented by the intensity of the way I work, the hours I work, how I demand quality from the people who work for me and around me. I look at traits of character in my people. Honesty is one and you can just write down the scout laws--trustworthy, cheerful, reverent, hardworking. The key factor for me is a positive attitude. It's hard. I need to have a positive attitude all the time and I don't always do that. Twenty seven people will become positive or negative depending on how I walk through the door in the morning. I have that responsibility and I work at that but I don't make it all the time." He may not make it all the time, but he obviously makes it enough, enough so that the staff is more positive than negative as was palpably evident during this Thanksgiving dinner.

After everyone spoke and there was silence; the room reverberated with a sense of personal pride in their work, with their openness and trust, with a felt sense of connection to each other-- feelings that left Kifer speechless. "It was a quiet reverence for just a minute when we stopped talking. I swelled with emotion. I'm an old barky bear, but I'm pretty emotional, and my eyes were glistening."

For Doug Herberger, it was a new experience. "I had never experienced anything like that with the CEO and chief engineer there-just asking us how we felt and them actually seeing everyone open up and talk. I think Jim and Karl were taken by surprise by our comments-the honesty of the shop. I think Jim got a better understanding of how we all feel about the hospital and realized how important our department is to the hospital. I learned a lot from that experience."

For Mike it was a poignant moment. "The sad part of it," he said, "is why does it have to be just at Thanksgiving that we come together, laugh, joke, share? It should be throughout the year."

Indeed, how to continue this depth of connection on a daily basis, how to have time to see people as people, is an important question and one worth pursuing, because a well connected organization is a robust organization. Nevertheless, this particular gathering left an indelible mark, as James Marquess observed. "Our shop is pretty tight. We've had many meaningful gatherings since. We might not be as formal about expressing our appreciation, but we sit down and talk about our problems and concerns, we get everything out in the open, air things out so they can be resolved or at least find ways to resolve them."

Holidays or not, the work of the engineering department continues. As usual the engineering department comes to the rescue, such as on Christmas eve of 1999 when it snowed. As Herberger recalls, "Karl came in knowing I was shorthanded with vacations and all and we were out there shoveling snow. Jim Taylor was at the hospital too and he stuck his head out and said, 'You take it easy and be careful.' You know, we're out in the cold and snow on Christmas Eve and a gesture like that goes a long way. It means a lot." So little a gesture; so large an effect.

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