A Sponsored Initiative

Genentech’s purpose-driven culture

Contributor: Jacob Adler

Work and Life is a radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by Wharton. Every Tuesday at 7 pm EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community, and the private self (mind, body, and spirit).

Nancy Vitale is the Vice President of Human Resources for Genentech and Regional Human Resources Head for Roche Pharma North America. She leads a team of nearly 200 HR professionals dedicated to creating a great place for the organization’s 14,000+ employees to do their best work.  Before Genentech Nancy held high level HR positions at Gillette, P & G, and Deloitte Consulting.

The following are edited excerpts of her conversation with Stew Friedman. Full podcast.

Stewart Friedman: Genentech often lands on the Best Places to Work for lists. What’s the secret to your success?

Nancy Vitale: Nancy VitaleWe make medicines to treat some of the world’s most challenging diseases. This includes discovering, developing, manufacturing medicines. This year, we’re celebrating our 40th anniversary. One of our secrets to the success of being a Best Place to Work for is our culture. That is the secret sauce. We’ve been dedicated to creating a connected, inspiring culture for the 14,000 employees who come to work everyday and deliver on that mission to help people who suffer from serious diseases. We’ve been pushing scientific boundaries for almost 40 years, and given this, we’re also aware that success as an organization is tied directly to engagement and resilience of our employees.

SF: A lot of companies talk about creating a culture that engages and supports people, about resilience in the face of adversity, and about things like the capacity to persist, be creative, and diligent in getting important work done. Let’s drill down a little further on that.  Nancy, if you could tell our listeners some of the things that you do to ensure that you’ve got the kind of culture that does have that kind of impact.

NV: A lot of companies will point to programs and benefits and specific offerings, but I’d say the thing that is most meaningful to us is clarity of mission and purpose. It’s actually one of the most fundamental components, in my opinion, to building a great place to work and a healthy culture. For us, people who can anchor to our mission, focus on creating, discovering, developing medicines that can treat individuals, they feel passionate about that. Our employees absolutely feel passionate about the work that we do. It helps them to remain engaged, find joy in their work, it’s very much part of the fabric of who they are, even in times of change and uncertainty. For us, it’s clarity of mission. It’s always focused on being science-driven, patient-centered. These are important pillars to our culture and we know that inspires our employees.

SF: What’s so interesting about that is that you demonstrated that in your first words to me. The first thing you talked about was the purpose of your company and what you do, so it’s clear to me in the way you spoke about it that you take this seriously and personally and it did seem to infuse your words with a sense of pride.

NV: No matter who you would ask, they would point to that. It could be a manufacturing technician, it could be a scientist, or a business partner. I think that’s what binds us all, is this community of individuals trying to deliver on our mission each and every day.

SF: It’s such an important element of what makes for a culture that truly does draw on the passions and interests of people.  Having worked in this field for 30+ years, I can recall in the mid-80s that many of the leading firms that were in the vanguard of change – thinking and acting differently about work and the rest of life – were in the pharma business and it’s in part for this very reason. There’s a direct connection between the mission of providing life-giving services and treatments with the inspiration that people look for at work. It’s not surprising that you find that in the pharma industry.

NV: I think you’re right. For me, I’ve worked at Genentech almost 10 years and it’s the longest I’ve worked at any place. I think that speaks to the personal level of connection that people have with our company.

SF: How do you make clear the purpose and mission in such a way that each and every one of those 14,000 people feels like it’s his or her own?

NV:. There are banners that greet employees in every campus that they go to. We bring in patient speakers that are a regular reminder of why we come to work, speaking to the employees about the impact that the medicines have had on them. Our scientists are expected to publish papers and to share their research openly, so there is clear evidence of what we do and how we keep those elements of the culture and mission in front of the workforce.

SF: You bring in patients that have benefitted from your medicines?

NV: That’s right.

SF: To talk to research scientists, to talk to HR people?

NV: Everyone. In fact, every other year we have an event where anyone can sign up to attend and we bring in about a dozen different patients who are being treated with a number of different medicines that we make. But many functions, when they have a town hall or a big event, will bring in a patient speaker for that particular one. It doesn’t matter the function you’re in, it’s a long-standing practice that we have.

SF: What an awesome idea, and it’s one that must seem very natural to the people in your organization now.

NV: Typically, there’s not a dry eye in the audience because going back to your comment, the emotional connection that people have when they feel that they’re part of something bigger. They understand that their efforts are contributing to something bigger and having a big impact on society at large.

SF: Everybody wants that and we know especially young people today are demanding that in their workplaces.  So you find organizations of all types – financial services companies, tech companies, manufacturing companies – all trying to do what you’re doing. How do you translate this idea of clarity of mission and purpose to impact and significance of the work itself? How would you transfer that to other organizations where it’s not so obvious?

NV: I think going back to this notion of culture, there is no right or wrong recipe for a great corporate culture. For individuals outside of biotech or pharma industry who may not have that view of what it is as a patient they’re serving, I think going back to an understanding of what is our specific mission, understanding the values, the customs, the creations, the achievements and failures of the different individuals within that organization that really do define the culture. I think companies evolve. Some of the lessons that we’ve had might be applicable to other folks in other industries as a leadership team to take a self-examination of what is the culture you’re aspiring to versus the culture you are experiencing in the day-to-day and understanding what you need to do to nurture the culture, the work environment. That’s instilling a mission that resonates with your people. What is the purpose that unites all the employees that make up a particular organization? Inspecting that culture for cracks in the foundation, where are we missing in terms of expected and actual culture? For us, a lot of that has started from the top. We’ve had conversations at our executive committee about the type of culture we want, recognizing that we also need to evolve that culture, and rewarding employees for the behaviors that reflect the culture that we aspire to. Those would be the few applicable lessons that I would say apply to any industry.

SF: Absolutely, but not easy to implement. The idea of focusing in any kind of organization on why we are here, what we stand for, the impact that we’re trying to have on making the world better in some way and being super clear about that and as you said, inspecting for cracks in the foundation, I think that’s a powerful, marvelous idea, but one that requires a serious commitment, time and energy, to look at and to be willing to be wrong or find problems and invest in not only finding them but to fix them. Most companies would find it difficult to sustain that sort of commitment. What drives your company to take that issue so seriously?

NV: It’s a recognition and acknowledgment of what’s the secret to Genentech’s success. I think there’s a clear acknowledgment from our founders 40 years ago that it was about the people, it was about the individuals that come to work everyday. One of our founders I think once said the greatest asset of our company walks out in sneakers everyday at the end of the day and I think that has carried thtrough. But I think that you’re right, it is a discipline. It’s the rigor and discipline that goes into that inspection. We’ve looked at a number of different sources of information and we constantly examine those different sources of information, whether it’s engagement surveys or external surveys and recognition that we receive, or information on a site like Glassdoor that might inform in a simple way. Is there a crack in the foundation? Is there an opportunity, something that needs attention? And you’re right. It is a discipline, but I think it’s part of who we are for the 40 years that we’ve been a company.

SF: When you think about how you want your employees to live and to work, what’s your conception for how you make real the value proposition of embracing the whole person and investing in who each individual is and what they can bring that’s unique to them and also enables them to live the kind of life they want to lead?

NV: I think you raise a very important point. In order for people to do their best work, we need to support them as a whole person … in their work and life so they can bring their best self to everything that we do. One of the things we’re continuously reinforcing is these wellbeing pillars that we have adopted from a book called Wellbeing: The Five Essential Elements by coauthors Tom Rath and Jim Harter. I don’t know if you’re familiar with that work, but these pillars are centered around career well-being and social wellbeing, financial wellbeing, community and physical. These five pillars encourage people to understand their own level of wellbeing within each area of focus, because this can be something very much personal to the individual. How do I seek my own level of wellbeing? It’s about providing resources for people to explore that, a framework where people can better understand for themselves how they’re doing against these five areas of focus.

SF: You’ve also done some investment in facilities that provide resources for people to take care of themselves, is that right?

NV: That’s right. Our headquarters is in San Francisco, California and we’re actually building an expanded employee center. This center will house an expanded medical clinic that people can go get primary care services, preventative screenings, an expanded fitness center, so gym memberships are free to every Genentech employee. They can go in at lunchtime, before work, after work, whatever is convenient for them. There is also a career lab, which is an actual lab where people can explore their development desires, career development aspirations, they can have one-on-one consultations with a career coach.

SF: That’s cool. So that’s part of the wellness center?

NV: It’s part of this employee center, which is this anchor around wellbeing. We’re trying to touch upon each of these five elements within this one center, but the biggest part of it is the physical wellbeing.

SF: Yes, because that is core to everyone’s vitality and sustainable engagement, right?

NV: Right, and I say for us specifically, as we’ve been looking at this in taking a particular look at total healthcare strategy for our organization, we found that as a healthcare company, less than half our employees were getting the preventative screenings that they should get. One of the things that is challenging for that is people will say they’re too busy to go get the screenings. We’re trying to put convenience in the equation, and if you can get to the employee center readily, it’s easy for you, we anticipate that we’ll see more adherence to people getting preventative screenings.

SF: Of course, that reduces your total healthcare cost structure, right?

NV: Yeah, I’d say that’s not a major driver, it’s more centered around improving the overall health of our employees. It’s also centered around addressing the healthcare needs of employees. And you’re right that doing it could potentially reduce the overall cost.

SF: I actually wasn’t surprised by the relatively low participation rate in the total healthcare offerings because that’s typical for many companies. What else are you doing besides convenience to ensure that people take advantage of health screenings and services?

NV: There’s a lot of different theories on how to approach this notion of wellbeing and wellness and as I said, the journey of each individual is very personal. Interestingly enough, I discovered my own journey last year and some of the challenges that I experienced. Last year, I was diagnosed with very early-stage breast cancer, and it was caught during a routine mammogram screening. Early diagnosis is one key in treating a disease like cancer, and after a successful surgery, I’m going to frequent screenings, hormone therapy, and I’m doing really well. What this taught me is that my own cancer diagnosis made me think about our employees and ask this question about why aren’t people putting as much time and energy into their own health as they do the health of the patients we serve, going back to the mission. This last year, we’ve take on a renewed focus on this physical wellness component and people getting preventative screenings. One of our efforts has been in people sharing their own stories and leaders talking about their own wellbeing. I just did with you but I did with the masses at Genentech last year and had a feature story in our company intranet. The point of me doing that was to spark action by sharing my personal story and the impact it’s had on me. I don’t have any data to say we’ve jumped up that number from 50% to 80% but I think we’re on a good trend. Anecdotally, I had an employee reach out to me and say because you shared your story I went in for an overdue mammogram. She was three years overdue and something was uncovered, she was diagnosed with an early-stage breast cancer, and she said you made a difference in at least one person’s life. That was the point.

SF:  Why do people undervalue their own health, as a business issue? Why is it that people are so reluctant to invest the time and energy needed to take care of themselves?

NV: It’s a great question, and part of it is that we get caught up in the day-to-day. The frequent thing that we neglect is our self. It does take a commitment as a parent, as a partner, to focus on others. As a leader, I’m focused on my employees. But I think what we neglect to realize is that fundamentally, the first person we should be taking care of is our self, and we’ll have a lot more to offer to others. That’s why I think sharing personal stories and being open about this as a topic and role-modeling the behaviors that we desire is so important for us as leaders.

SF: For sure, and if you go a little bit further, what is the main inhibitor or barrier for people to take seriously the commitment to their own health? What do you see as the most important issue there?

NV: I think people will point to time and convenience, and that’s part of our focus and my hope is that other employers will focus on it as well. How do you create convenience for people to take care of themselves, how do you create flexibility for people to take care of themselves, how do you expect that people will take care of themselves, and how do you role-model that? Those are the things, when you talk about programs and offerings that can have a meaningful difference, is helping folks to focus on that number one person, and that’s themselves for their health.

SF: As you look to the future, what’s the most exciting to you as you think about how your company is going to evolve over the next five years in terms of its culture?

NV: As I said, this year we’re celebrating our 40th anniversary and it’s exciting for us to look and see what are the things we need to continue to nurture. So 40 years of successful history, how do we continue to nurture those elements but how do we also continue to evolve as an organization. What’s most exciting to me personally, as I think about our workforce, is how energized and passionate I know our people are about the company’s mission. I see that growing with the evolving healthcare landscape. For me, I’m excited about the possibilities as I think about our pipeline and making medicines that will help people facing these very daunting diseases.

About the Author

Jacob Adler , W’18,  is a sophomore at Wharton and a contributor at The Daily Pennsylvanian, numberFire, and Fake Teams.

How to Invest in Your Employees’ Health — Dan Calista, CEO Vynamic

Contributor: Sathvik Ramanan

Work and Life is a radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by Wharton. Every Tuesday at 7 pm EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community, and the private self (mind, body, and spirit).

On Work and Life, Stew Friedman spoke with Dan Calista, founder and CEO of Vynamic, named #1 boutique consulting firm, as well as Best Small Firm and Best Places to Work. Vynamic is the Philadelphia-area’s largest management-consulting firm focused exclusively on the healthcare industry. Mr. Calista discussed how CEOs can help create a sustainable and hospitable working environment for employees through company values and vision.

The following are edited excerpts of their conversation.

Stew Friedman: A lot of CEOs say a company is only as good as its people. It’s easy to espouse that value but to enact it is another matter. What are some of the key practices that you do to make that come alive?

Dan Calista: dan calistaLet’s get into some examples. One that’s been fun at Vynamic is what we call “Zmail”. The Z stands for catching some z’s – catch some sleep. It’s an email HR policy at Vynamic where we ask that everyone on the team does not spend any time on email during Zmail hours — 10 p.m. to 6 a.m. Some people think that’s shocking – like how late 10 PM is and other people think what’s the big deal, shouldn’t we be sleeping then anyway? And the other big part of this policy is no emails over the weekend. Now if something urgent does comes up, we’ll take care of it by special exception and prior arrangement.

SF: So do people put a delay on so you get hundreds of emails flooding in at 6 a.m. Monday?

DC: It’s amazing. When you really put that filter on your work, you realize what is truly urgent, truly important and what isn’t.

SF: You become more conscious of your choices.

DC: Yes. So the evening’s winding down and you may want to get one or two emails out if something is important, but you start mentally thinking Ok, now I’m shifting my day. And on the weekends, it’s the same idea. This is not a work curfew. I believe in a flexible work arrangement that lets people manage their own schedules. You can get work done when you want to including the 10 PM to 6 AM time, but unless it’s essential and urgent to involve others our norm is that we don’t send emails during that time. Now, if you send something at 9:59 PM, that’s called a Z-bomb because now I cannot write back to you and I’m thinking about your note!

SF: So maybe you should be a little bit more relaxed about that boundary. Is it a slippery slope once you open it up?

DC: Eight hours of sleep is all I’m asking for. Zmail is a company policy and I have to make sure I’m doing it, but it’s also managed by the team.  So we don’t unplug servers, but our team enforces the norm. Someone might say, “Hey, I might have to email you this document. I might not get it done in time, but I know you need it in the morning. Do I have your permission to send it later?”

SF: So you have to negotiate that?

DC: Yes, you just have to ask.  Set boundaries. And reading a lot of your work, I found that to be part of the conversation as well.

SF: Having conversations about mutual expectations and respecting boundaries are essential ingredients to successful work/life integration and smooth team functioning. So what else are you doing that helps your employees to be whole people and bring their very best selves to your business?

DC: Well, the idea that we are whole people. We’re committed to the idea of being healthy in mind, body, and balance. So for example, one of the early investments that Vynamic made was to have someone on staff dedicated to training and continuous learning. Part of life is continuous learning especially in management consulting. A more recent example is that we have someone committed to what we call health and care, which is basically kind of in the wellbeing space. Given that we’re in the healthcare industry, our health and care staff member is there to help with the health and care of our team – whether that’s walking meetings, treadmill desks, healthy snacks, and more. One of our team members expressed interest in this area. She had been a management consultant who took the initiative to study and get certified as a coach and really learn the area. And then the opportunity came up, and we created a role for her. Now that’s her full time job.

SF: So how do you justify that investment in terms of its return?

DC: That’s the power of the values. They drive our decisions at Vynamic.

SF: So what I’m looking at here is a beautiful sheet of paper in different colors that describes the Vynamic values: living, leading, learning, growing, and thriving with the Vynamic vision of being the healthiest company in the world. What a simple, powerful idea. How does that guide your decision making every day?

DC: It’s about making decisions based on those values. Growing for our people and not at the expense of our people. Let’s talk about the vision statement – to be the healthiest company in the world. So how can this little Vynamic company grow to be the healthiest company in the world and what does that look like? It’s about internal conversations like What would the healthiest company in the world do? Yes, we would have somebody that would be full-time dedicated to working on health and wellness. We would have programs to develop our female management-consultants because this is an industry that doesn’t have enough females. At Vynamic, we have 51 females as management-consultants. 54% of the entire company are females. These are things that get layered on to the business as we grow. Companies have to make decisions based on a scarcity of resources. Because we know our values and what we stand for, our values drive our decision-making.

To learn more about Dan Calista and Vynamic, visit www.vynamic.com.

Join Work and Life next Tuesday at 7 pm on Sirius XM Channel 111.  Visit Work and Life for a full schedule of future guests.

About the Author

Sathvik Ramanan Sathvik Ramananis an undergraduate freshman in the Vagelos Program in the Life Sciences and Management at the University of Pennsylvania.


Technique vs. Human Touch: Tensions in the Evolution of Healthcare — John Kimberly

Contributor: Sathvik Ramanan

Work and Life is a radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by Wharton. Every Tuesday at 7 pm EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community, and the private self (mind, body, and spirit).

On Work and Life, Stew Friedman spoke with Dr. John Kimberly, Professor of Management, Entrepreneurial Management, and Health Care Management at The Wharton School. He is also a distinguished visiting scholar at INSEAD, Penn’s partner school in France. Professor Kimberly received his BA at Yale and his MS and PhD at Cornell. Friedman spoke with Kimberly about how changes in healthcare as a profession are affecting not just healthcare professionals, but all of us.

The following are edited excerpts of their conversation.

Stew Friedman: How did you first get into studying healthcare as an industry?

John Kimberly: John KimberlyThere’s an easy answer to that question Stew. I wrote my dissertation a little more than 30 years ago when I was a doctoral student at Cornell University. I was in a program in organizational studies, and serendipitously a faculty member with whom I was working closely got a big grant from the National Institute of Health to study the diffusion of innovations to hospitals. That was a project that I was fortunate enough to be involved in. I actually wrote my dissertation on data we collected from that study, and it turns out, at least in my case, that you become what you write. I started writing more about hospitals and innovation, and invitations to speak and consult and so on began to emerge from that. There was a bit of a tipping point there, where the kind of opportunities that were coming my way were largely in healthcare, and so I ultimately picked up that ball and ran with it.

SF: You’ve seen a lot of changes as the world of healthcare management has been radically transformed. Let’s start with a picture of the current state of things: What’s most distinctive and unique about healthcare today vs 30 years ago?

JK: The changes have been considerable and profound. Obamacare,  the Affordable Care Act,  is just the tip of the iceberg. I think what has changed has to do with the nature of contact and interaction between us patients and the healthcare professionals. It has to do with organizational arrangements that are changing rapidly. It has to do with the introduction of a vast number of clinical innovations. One of the most exciting things for me is how we’re finally beginning to move the needle on prevention. We´re beginning to focus on community-level health outcomes and the wellbeing of communities as opposed to the medical care of individual people.

SF: Can you define what you mean when you say prevention?

JK: If you look at this country’s healthcare system, you´ll find that the vast majority of expenses are on medical care; we call it ¨healthcare ¨ but what it really is is medical care. It’s interventions that are made by professionals in the medical care system to deal with the problems of people who have gotten sick. Think about a world in which there was investment in prevention at even one-quarter of the magnitude of the investment in medical care,  a world where the incentives were to keep people healthy, to keep people out of the hospital.  Think about the kind of investments it would take at a community level to make sure people are healthy. It’s beginning to happen.

SF: What’s been most significant about how the work of medical professionals, doctors in particular, has changed, and why is that important for us as consumers?

JK: I think the most profound change has been the shift from the solo practice, where physicians were individual entrepreneurs and managed their own practices, to a model where increasingly physicians are becoming employees of large healthcare systems. What they’ve traded off is the independence and autonomy that they enjoyed when they were individual entrepreneurs for a life which is dominated by productivity targets and other things which essentially impinge on their ability to make independent decisions on how they spend their time.

SF: Not to mention their own diagnosis and intervention choices, right?

JK: Those are obviously constrained by the system in which they work. There are guidelines for the kind of equipment they use and the kind of clinical context in which they work. What’s really important is the disruption of the historic physician-patient relationship.

Forty years ago, when you got ill and called your physician, at some point in the next five or six hours, there’d be a knock on the door. The physician would be there with his or her little bag and would ask some questions and would look you in the eye and would give you what you needed in order to get you better. A part of that healing process was the personal relationship between the physician and the patient. Now, that process is much more technically-based, and physicians, who are employed by these large systems, have production quotas to meet. The time they spend with their patients is not in eye-to-eye contact because the physician has to be looking at his/her keyboard to enter data into the health information system. So there’s something fundamental that’s changed about the relationship between the doctor and the patient. Now, some people will say, “Well, of course, this is the nature of things. There’s been technological progress, and physicians are now able to see more patients in less time, so the efficiency is enhanced substantially.” There’s certainly some truth to that. However, I also believe that in the course of moving down this path, we’ve lost something important. One of the interesting issues here (the answer to which we still don’t know) is the question of how much of the healing process is a function of technical interventions versus how much of it hinges on a relationship that you develop with someone who you trust and who you think has a personal interest in you. This is an interesting area of research, and by no means are the answers in on that score.

SF: Wow, so that is an important question. You’re saying that it’s a topic that hasn’t gotten a lot of attention in the research literature on healthcare outcomes?

JK: That’s exactly right. It´s understandable. Why? Because in the fascination for technological progress, the focus has really been on what’s the latest, greatest, shiniest, new technology that we can bring into the system that will have both financial impact and health outcome impact. I think what’s happened along the way is this other part of a doctor-patient relationship has gotten lost.

Join Work and Life next Tuesday at 7 pm on Sirius XM Channel 111.  Visit Work and Life for a full schedule of future guests.

To learn more about Professor John Kimberly and his research click here.

About the Author

Sathvik Ramanan Sathvik Ramananis an undergraduate freshman in the Vagelos Program in the Life Sciences and Management at the University of Pennsylvania.

Radical Innovator in Healthcare — Stephen Klasko

Contributor: Akshat Shekhar

Work and Life is radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by Wharton. Every Tuesday at 7 EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community, and the private self (mind, body, and spirit).

On Work and Life, Stew Friedman spoke with Dr. Stephen Klasko, President and CEO of Thomas Jefferson University.  Dr. Klasko has advocated for a more holistic approach to health care delivery, along with the smaller iterative changes that make such an approach possible.

The following are excerpts of their conversation.

Stew Friedman: Tell us about “interactive action” and why that’s so important.

Stephen Klasko: Stephen KlaskoPart of what we’ve done in healthcare is focus on the past. Think about everything you can do as a consumer online.  The Friday after Thanksgiving you can be in your pajamas watching Game of Thrones and do all your holiday shopping.  But if you have a stomachache can you put “stomachache” on your iPhone and get an appointment with a doctor?

SF: WebMD—doesn’t it do that?

SK: No because with WebMD you cannot get an appointment with a doctor or really do “telehealth” like you would do anything else.  My goal is to look at what’s going to be obvious 10 years from now in healthcare and just start doing that today. A lot of that is changing the DNA of the system one physician at a time. The number one thing about the Affordable Care Act that hasn’t really been talked about is that we haven’t changed the physicians. Our physicians are living in the 80s and 90s, and yet we’re trying to build a 21st century healthcare system.

SF: Let’s stay on this concept of “interactive action,” and then talk in more detail about what you’re doing to change both the mindset and skillset of the medical community. How does “interactive action” come into play?

SK: We’ve gone to our docs and said, “I want you to visualize yourself as a patient, figure out what you would want if you were in their shoes, and then just start doing it.” I’ll give you a couple of examples. We started a model where our doctors, nurses, and population health professions are all working together in a simulation. We have things happen that would normally happen in a hospital, and we look specifically for their first communication. After, we talk to them about what they can do to change the way they interact with other folks in order to be more effective. There’s almost none of that in medical school. I never learned how to interact with a team member until I learned by doing when something went wrong.

SF: This simulated environment is for the seasoned professionals already on the job, right?

SK: Actually it’s for both. We created the Center for Transformation Innovation not only for the seasoned professionals, but also for our medical students. Everything about medical education is ‘look to the left of you, look to the right of you—only one of you will get in.’ It’s constant competition in medical education, but then we’re amazed when physicians don’t work together as high-powered teams. A lot of my research has been based on what makes physicians different from average people. Interactive action is about taking steps to go from having physicians being autonomous, competitive, and hierarchical creatures to having them become more interdependent and members of a team.

SF: Wow, that sounds radical, Steve. So what does it mean for a physician to become a member of a team?

SK: It means you have to teach doctors more “followership” as opposed to leadership. We thought it was a big revolution to teach doctors leadership, but some of us are pretty good leaders already. We like to give orders. Now it’s about how we become followers. Maybe the nurse knows more about something than you do, and you have to listen. It’s about listening skills, interaction skills, and ultimately making those practices an important part of what they do every day. We’ve shown that this model provides better care because medical teams are communicating better.  In an accountable care organization in Florida we showed improvements in the triple aims of patient satisfaction, cost, and quality, just by communicating and interacting in a different way. Rather than doctors giving orders, we encourage getting teams together and making decisions together.

SF: What resistance have you met in trying to push a different mindset and role for physicians in the medical community? What was the most important hurdle you overcame?

SK: I actually did a study with Richard Shell from Wharton about why doctors don’t understand collaboration and found that doctors blindly followed rules. When the MBAs didn’t get it, they said, “We failed.” When the doctors didn’t get it, they said, “I’m really sorry, but at least the other person didn’t win either.” The way we select and educate physicians now creates a cult around a competitive, autonomous, hierarchical, and non-creative bias.

SF: Non-creative?

SK: The issue is not that we’re not creative, but when we asked MBAs and entrepreneurs if creativity was something that helped them in their profession, they said yes. Doctors, not so much. When I went to Wharton, they said, “You are so lucky to be in a $2 trillion industry in transition. Things are going to be good and going to be changing.” Then I’d be back in our old lounge, looking at the same set of data, and doctors would say, “I wish things were still the way they were 20 years ago.”

SF: They were threatened by change.

SK: The MBAs felt change would help them come up with an answer, whereas we doctors felt we would be autonomous creatures losing control.  We found that to deprogram this cult that we doctors are entering into, we have to change the DNA of the system by selecting and educating physicians in a totally different way than we do in medical schools today.

SF: That’s a big agenda, Steve. Where do you start with the education and socialization of medical students?

SK: We still accept students based on science GPAs, MCATs, and organic chemistry grades.

SF: Well, I want my doctors to be smart.

SK: One thing is that we’ve been surprised that doctors aren’t more empathetic communicators. Is a doctor with a 3.9 in memorizing biology much better than a doctor with a 3.6 or 3.5? Or would you rather have a doctor with a 3.5, who memorizes 92% of the Krebs cycle instead of 100%, but also can communicate with you? We started a medical school admission model where we actually choose the students based on emotional intelligence. We’ve chosen 56 students a year based on empathy and social awareness. Once they reached certain academic minimums, we knew they were smart enough on science.

SF: So technical excellence is needed, but you also need to be able to communicate effectively and listen well. Once you make a certain cut, then you test on other factors?

SK: We look for self-awareness and empathy, much like Google and the airline industry do. They want to conduct behavioral and clinical interviews. We take these applicants to art museums, for example, and we ask, “What do you see?” Half the kids can only see what they see linearly.

SF: Concrete thinking.

SK: I’ve delivered over 2,200 babies, and I know it’s easy to deliver a healthy baby. But if you deliver a Downs Syndrome baby and the mother asks, “Doctor, what does that mean?” you can’t reply “It means that the chromosome…” Consider that doctor compared to another who says “Your vision of what a perfect baby means might have to be adjusted.”

SF: Now you’re helping me understand.

SK: It’s about seeing versus observing. To see is to see linearly, to see the DNA, but to observe is to recognize what signals the patient is giving you. We believe the folks we accept based on empathy and self-awareness will be better partners, better fathers or mothers, and better in their work-life integration.

SF: Why is that important to you, as the CEO of Thomas Jefferson University and Health System?

SK: It’s important to me because I believe that in order for healthcare to fundamentally transform, it needs to be about the people that provide the care. If we have a more stable and caring workforce of physicians and nurses, patients will get better care, and we’ll be able to provide better access to them.

One of the things we do at Jefferson which I love is that we have a practice which includes standardized patients. We have the physician go through what they would actually go through in an examination, but then we have the patient critique them while videotaping the doctor throughout. Normally medical schools just check off whether or not you asked all the right questions, but we look at the communication skills, and we ask the patient how he or she did in that regard. If a doctor or faculty member says, for example, “That’s ridiculous, I wasn’t looking at my watch,” we can check at the video like when a golf instructor tells you you’re lifting your head in your swing.

SF: Does it break through to them once they see the data?

SK: Well, if they’ve been doing this for 20 years, they’ll say they think the video was doctored! For the medical students, they really get it: think about not doing that, and think about the fact that we unleash doctors on folks without any of that cultural bias training. Part of the training we’ve done is that we’ve coached these medical professionals and residents so that their overall professionalism skills will be up to where they need to be.

SF: The fact that physicians need to have lives that are enriched not just in the clinic, but also in what they’re doing in the home and community—why is that important to you and the future of medicine?

SK: That’s sort of my job, as a president of a university. I gave a talk on “Humans of Tomorrow” in the Hospitals of Tomorrow for US News and World Report, and I started out by telling my introducer, “You know what? I may never get invited back here after saying this, but I think you’re a big part of the problem in healthcare because what you judge us on is not based on what you personally would want in a doctor. You judge us on technical attributes, but not how our folks are doing after spending $200,000 at our university.” He looks at me and says, “You’re right—you’re right that you’ll never be invited back!” But since I charge these students $55,000 a year, I view an important part of my job as ensuring that five years from now, that doctor that came from Jefferson not only provides great care, but he or she also provides great caring. I also would like to know that they’re great mothers or fathers and partners, and I view that as my job too, not just teaching biology and cardiology and OB/GYN.

SF: How did you come to that understanding that an important part of your job is that people have lives beyond work that are enriching and meaningful?

SK: Frankly, a lot of it came from when I went to Wharton and law school and seeing that there are different ways of teaching. The way we select and educate physicians is not only maybe creating a cult, but it also might not be the right way to the future. I looked and saw that so many of my physician friends had gone through divorce and had not been happy in their profession. The Wall Street Journal says 70% of physicians feel unhappy 2 or 3 years out, and they’re also not happy about their futures. I think they’re unhappy because they’re autonomous, competitive, hierarchical, and they don’t think creativity.

Our goal is to create physicians that are excited, for example, about change, so that when something like the Affordable Care Act comes, they ask “How can I help?” as opposed to “How can I go back to where we were 20 years ago?”

If you go to a tennis coach for a year, you expect to be a better tennis player. At Jefferson, we’ve launched a pilot initiative to make our patients feel better a year from now. We’re bringing in more than just the typical physicians to help them do that. Medicine needs to go from these episodic sicknesses to continual and sustained wellness.

SF: That’s so exciting, Stephen. For people listening out there, can you share what you have learned about creating meaningful change in organizations that you’d like to pass on?

SK: If you look in my office, there are two quotes. One’s from Buckminster Fuller: “If you really want to change something, don’t try to change the existing reality. Create a new model that makes the old one obsolete.” A little further in my office is another philosopher, Mike Tyson, who says, “Everyone has a plan until they get punched in the mouth.” I believe if I’m running a mom-and-pop shop or academic medical center and something needs to be changed, I need to start by creating an optimistic view for people around the future. We have a great morale here because we’re trying to envision and create the future today.

Dr. Stephen Klasko, a Wharton grad,  is the President of Thomas Jefferson University and CEO of Jefferson Health System.  To learn more about his work follow him on Twitter @SKlasko.

Join Work and Life next Tuesday at 7 pm on Sirius XM Channel 111.  Visit Work and Life for a full schedule of future guests.”

About the Author

Akshat Shekhar akshat shekharis an undergraduate junior at Wharton and in the Engineering School.

How Work Affects Health — Robert Hedaya, MD

Contributor: Andrea Yeh

Work and Life is a radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by Wharton. Every Tuesday at 7 pm EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community, and the private self (mind, body, and spirit).

On Work and Life, Stew Friedman spoke with Robert Hedaya, psychiatrist, founder of National Center of Whole Psychiatry. The following are edited excerpts of their conversation.

Stew Friedman: How did you come to look at your patients as whole people not just a picture of symptoms, but people trying to create harmony and integration in their lives and health?  What is it that shaped your thinking?

Robert Hedaya: Robert Hedaya. M.D.The short answer is that back in about 1983 or so when I first went into practice, I had a patient who was a 50-year-old woman.  She had one child and a marriage that wasn’t so good, and her child was going off to college.  She started having panic attacks, and I thought she was anxious about having to live with her husband or leaving her husband. I went through a series of standard treatments over the course of a year.  Nothing worked – not therapy, not various medications, not cognitive behavioral therapy. I went back to the drawing board.  I looked at her labs and saw that the size of her red blood cell count was a little bit larger than the upper limit of normal.  I did a little research and found out that it could be a B12 deficiency.  I gave her a B12 injection, and her panic attacks cleared up overnight.  I was blown away. And I thought, “Gee, this is important.  I wonder what else I’m missing.  What else wasn’t I taught, and what didn’t my teachers know?”  I eventually figured out that it is essential to remember that the head is connected to the body by the neck.  I learned all the different interactions between the body and the mind and ultimately how the mind is really influenced by every level of our environment.

SF: As you know, on this show we focus on work and the rest of life, including our minds and our bodies and our spiritual lives, as well as family and communities.  We’re looking at how the four domains of work, home, community, and self interact; how they affect each other in both positive and negative ways; and what can be done to maximize the former.  In the National Center for Whole Psychiatry, what is your primary mission, and how do you go about serving it?

RH: l I’ve shifted my focus recently, and I’ve decided to look closely at inflammation because inflammation really is the key factor for all of our chronic illnesses.  Inflammation is affected by psychiatric conditions.  Just take an example in the workplace:  If you have a boss who is abusive, if you’re having trouble with your colleagues, or if you’re frustrated and you’re having continual difficulties, these all cause changes in your immune system, which leads to changes in your gut.   Most of your immune system is around your gut, so then you get these immunological changes, which will bring out various illnesses over time.

SF: Inflammation – can you define what that is for our listeners?

RH: When you get a cut and you see redness and increased blood flow and heat, that’s a localized inflammation. We have more and more difficulty as we age in controlling inflammation, so we might have more aches, more pains, more joint problems.  We may have inflammation in our cardiovascular system, for example. And inflammation is at the root of atherosclerosis, the hardening of the arteries.  Inflammation is also at the root of dementia, osteoporosis, diabetes, etc.

SF: What are some of the most important aspects of the work environment that can cause problems like the ones you’re studying now with inflammation in various body systems?

RH: A useful metaphor is to think of concentric rings. On the outermost ring might be something like the stability, innovation, or financial condition of the organization that you’re a part of.  Then you move to a ring that’s closer into you, and you might have management issues, which might be having an even closer and more direct effect on you.  Of course if these are good situations, your health improves and wellbeing improve.  If there is an opportunity provided by the organization and management to grow – challenges, learning, stimulation, supportive relationships with you, your colleagues, etc. – that also supports your health.  Then if you move even a little bit closer in, it might have to do with your immediate work environment, say the floor you’re on, the office you’re in.  Maybe the lighting is affecting you in a positive way or negative way.  Maybe there’s a moldy environment.  Then you can move more intimately towards yourself to look at the relationships that you’re involved in on the day-to-day and the hour-to-hour basis at work and examine how those are affecting you.  Ultimately if you come in even closer, it’s worth asking how your skill set fits with the kind of work you do.  Does it provide you the opportunities that you as a person need to feel fulfilled, to find meaning in your life, and to be challenged?

SF: Let’s dig a little further into that if we can.  From a whole psychiatry perspective, there’s just so much you could look at, in terms of identifying the sources of physical and mental strain.  How do you know where to start?  Especially if the source of the problem is at work, how do you find that in your intake and diagnostic?

RH: I spend a lot of time with people. I’ll usually spend four hours on intake.  I’ll do a medical history and a physical, and I’ll talk with family members.  That’s something that’s not accessible to everybody.  I wrote a book about ten years ago that’s still available called The Antidepressant Survival Program.  The content of the book gives an analysis of different aspects of a person’s life.  Going through that might help you identify areas of vulnerability.

SF: So the book takes you through a kind of diagnostic checklist to look at things that might be affecting your health?

RH: That’s right.  I think that’s one way of doing it.  Another way is to think about where you feel best at work, and where you feel worst.  What are the stresses at work, and what are the strengths?  What is it you wished you had more of?  When were you happiest in your work life?

SF: I wonder if you could share an example of someone who you’ve treated where there was a work element to both the diagnostic and the treatment that helped.

RH: I have a good story about a woman who was in her fifties working for the government.   She started to become ill, and we went through the whole checklist of situations in her life, but nothing had really changed.  It turned out that an important factor was that she had recently advanced in her career and moved to a different building.  Many government buildings are old, and she moved into a building that was full of mold – it was a sick building.

SF: Sick building?

RH: Yes, it’s called “sick building syndrome.”  There was a lot of mold and toxins in the air.   It turns out many of the people that she was working with would become ill.  There was just a lot of subtle illness.  So when we got her to work at home, she just really cleared up.

SF: Amazing.  Bob, is there one piece of advice you’d like to leave our listeners with in terms of how to think intelligently about their mental and physical health and how their work affects it?

RH: I think the key comes down to finding meaning in your work; that is the most important thing.

You can find meaning in work by the nature of your work, by the nature of the relationships you have, by helping people around you, and by being of service to the people around you. Hedaya’s work underscores the importance of evaluating our lives holistically.  Given that mental, social, and physical problems may all be interrelated, finding a resolution to an issue we face may require a multi-dimensional analysis.  As Hedaya suggests, we can ask ourselves, when we have personally found our work and life most rewarding, and what were the circumstances surrounding that satisfaction?  Have you experienced instances where your physical and mental well-being affected one another in a positive and synergistic way?  Share your experiences and thoughts in the comments section below.

To learn more about Dr. Hedaya, the Founder of the National Center of Whole Psychiatry and his work, read his book, or visit the National Center of Whole Psychiatry on Facebook.

ABOUT THE AUTHOR Andrea YehAndrea Yeh is an undergraduate junior majoring in Operation and Information Management and in International Relations.

Aging and Work: Nursing Professor Sarah Kagan

Work and Life is a radio program hosted by Stew Friedman, director of the Wharton Work/Life Integration Project, on Sirius XM’s Channel 111, Business Radio Powered by The Wharton School. Every Tuesday at 7:00 PM EST, Stew speaks with everyday people and the world’s leading experts about creating harmony among work, home, community and the private self (mind, body and spirit).

On Work and Life, Stew Friedman spoke with Sarah Kagan about the impact of aging on our work lives.

The following are edited excerpts of their conversation:

Stew Friedman: Why is aging an important issue for employers and employees?

Sarah Kagan: Sarah KaganWe’re seeing a big demographic shift.  We’re becoming much older as a society and all sorts of things cascade from that.  Your example of midlife women having to make choices about career and family responsibilities.

SF: And leaving the workforce because they feel compelled to take care of aging parents, disrupting their career progress and future earnings, as noted in The New York Times article at the top of the hour, For Women in Midlife, Career Gains Slip Away.


SK: You can see that as an economic cascade. It influences them financially but it also changes the workforce. We lose really valuable workers from a sector like education. How do we mentor and support younger teachers if everybody in that generation is busy taking care of mom, grandma, grandpa? All of a sudden we have a dearth of experience that has social implications, financial implications, families suffer financially and our economy suffers as well.

Around the world most elder care is direct care provided by women and the “instrumental caregiving” – organizing things, financing things is being done by the men in the family.  For the most part wives and daughters and daughters-in-law are doing a lot of direct caregiving which means that they have high absenteeism.  The work can’t be done remotely.  Unless you have a great deal of money you’re the one taking your father-in-law to the doctor.

SF: Wait. What about the man?  If it’s his father, why isn’t he taking him to the doctor? Why the daughter-in-law?

SK: Well, we still have a gender divide there.

SF: The study referred to in the article finds the burden is disproportionally borne by women.

SK: This means that stress is borne disproportionately by women, too.  If you’re caring for an aging parent with dementia, for example, it’s a big family stressor.  And if you’re facing that every morning it’s going to take a toll on you – the primary direct caregiver.

SF: What suggestions and advice do you provide for your students and others and what advice do you have for our listeners who might be in a similar situation?

SK: The first thing a recommend is to step back, even if only for one hour, take a breather and think about what really needs to get done and when, what’s a top priority, what’s a lower priority.  Then think about who needs to do it and what resources are available to relieve some of that load. And it helps to write out a plan and assess.

SF: But how do you do that when you’re in the throes of the problem?

SK: Sometime you need help to take a step back.

SF: But doesn’t everyone need that?

SK:  We’re social animals. We need to crush that myth of independence, and say, “hey, who can I reach out to?”  A friend, a neighbor, somebody in a similar situation who can help you step back and take a survey of the situation.

SF: So what more can this “sandwich” generation of women, especially, do to get help so that they can remain engaged in their work lives?

SK: After assessing, the next step is to think about other resources. And we have a tendency to think they have to do it alone. I recommend that people look for their local Area Agency on Aging.  And other people want to help.  Perhaps set up a meal schedule so you’re not doing all the cooking. Maybe the kid down the block who’s thinking about college would like some kind of service experience, resume builder, and something that brings generations together.  Put an 18 year old with an 80 year old and both of them are going to learn good things.

SF: So you’re thinking of the health benefits for teenagers and seniors for them to be working together.

SK: Real relationships not mediated by phones, computers, other technology and distractions and pressures.  Instead, slow it down.

SF:  What about FOMO?  Kids have a Fear Of Missing Out.

SK: I think we have to push back on that. FOMO should be replace by Slow-Mo.  Slow down and recognize that thinking about and caring about someone else, means we’re all stronger, we’re all better off.  The Druker Center for Health System Innovation at The Palo Alto Medical Foundation (PAMF) is doing some amazing work with “time banking.”  It turns out that social interaction is more important than physical activity for keeping your mind sharp.  They’ve created a “time bank” where people donate time to help with specific activities (driving someone to a doctor’s appoint,  garden clean up, piano teaching, driving to worship, getting to a friend) and others can use that time.  So it becomes a social exchange.

SF: It’s part of the new sharing economy.

Kagan is a MacArthur Fellow and the Lucy Walker Honorary Term Professor of Gerontological Nursing at the University of Pennsylvania School of Nursing who writes a column, Myths of Aging, and teaches a popular MOOC on Coursera, Growing Old Around the Globe. Hear more from her on Twitter @SarahHKagan and @OldGlobeMooc and read her Myths of Aging column at http://www.calkins.com/digital.html


Join Work and Life next Tuesday, July 22 at 7:00 PM ET on Sirius XM Channel 111 for conversations with Herminia Ibarra and Sam Polk.  Visit Work and Life for a full schedule of future guests.