How Summa Health Kindled a Cultural Turnaround: 3 Steps

Physician and employee engagement faltered. Then came a public crisis and leadership change. Here's how the Ohio health system got itself back on track.

This article appears in the January/February 2020 edition of HealthLeaders magazine. 

Engagement levels among physicians and staff at Summa Health, a four-hospital system based in Akron, Ohio, were above average a decade ago. That's not the case anymore.

The health system endured a very public crisis of confidence and a top-level leadership change. But, after an intentional effort to reengage its stakeholders, the organization has demonstrated a cultural turnaround is well underway.

Physician engagement scores fell from the 75th percentile in 2010, to the 61st percentile in 2013, then they plummeted to the 2nd percentile in 2015, according to Press Ganey data the health system released to HealthLeaders. Employee engagement scores, meanwhile, fell from the 73rd percentile, to the 70th percentile, then to the 6th percentile.

Summa Health President and CEO Cliff Deveny, MD, who was named to his current position in 2017, said senior leaders at the time were aware of slumping engagement but focused on other priorities.

"As you can imagine, there were lots of meetings and rationalizations of why this was happening," Deveny said during a recent HealthLeaders CEO Exchange gathering. "It was explained away, and nobody was really looking at the data."

"The operational performance continued to improve in the organization, but engagement scores kept dropping," Deveny said. "The board was focused on operational performance. The senior management was getting rewarded for that, and nobody was holding anybody accountable for engagement."

Crisis of Confidence

The conflict at Summa Health came to a public head when then–President and CEO Thomas Malone, MD, MBA, terminated a contract with the system's emergency physician group, effective New Year's Day 2017, amid a labor dispute. The end of the 40-year relationship, which resulted in the replacement of about 60 physicians, prompted outrage and a vote of "no confidence" from the medical staff, who called for Malone to be replaced, as Brie Zeltner reported at the time for The Plain Dealer.

The end of that contract also left 30 residents in Summa's emergency medicine program without faculty members, leading the Accreditation Council for Graduate Medical Education (ACGME) to place the program on institutional probation. (The program secured ACGME's approval to relaunch this year, as Ginger Christ reported for The Plain Dealer.)

The situation strained Summa Health's relationships both internally and externally, with the broader community, Deveny said.

"This became the focus of all the media in the community," he said.

Malone resigned in late January 2017 after about two years on the job, saying his continued presence could distract from Summa Health's goals. Malone declined to comment for this story.

Deveny was hired in March 2017 on an interim basis. He had previously served Summa Health about 14 years in a variety of roles before he took a job in 2011 with Catholic Health Initiatives. When he returned to Akron in 2017, he knew rebooting the organizational culture would be an indispensable component of any growth strategy.

"When people have a knot in their stomach and they can't breathe and they have anxiety [about the health system], they can't think strategically, they can't think about how they're going to do the turnaround," he said. "You kind of have to fix the individuals before you can actually do the work, so we spent a lot of time on that."

Summa Health's physician engagement scores rose from the 2nd percentile in 2015 to the 14th percentile in 2017, then the 47th percentile in 2019, as the organization executed a three-part cultural turnaround strategy. The health system's physician alignment indicator, meanwhile, rose from the 1st percentile to the 12th percentile, then to the 47th percentile. (Updated numbers on overall employee engagement were not yet available to release publicly, a spokesperson said.)

Here's how the system reengaged its workforce, in three steps:

Step 1: Figure Out What's Behind the Numbers

To get a better sense for what the sagging engagement scores mean, Summa Health directed physician managers to meet with each and every physician on staff, collecting their perspectives on the state of the organization, Deveny said. Staff managers did the same thing for nonclinical team members.

They found widespread problems of mistrust and conflicting communications.

"There were a lot of mixed messages. What was coming from senior management was different from middle management," Deveny said. "The whole middle management had basically become a negative 'you're gonna get in trouble' culture."

"Everybody was getting disciplined. Everything was on the negative instead of the positive. A lot of the physicians had lost trust, and there was no communication. And you had a lot of toxic leaders," he said.

Employees didn’t feel supported, and they were focused on financial results to the exclusion of other priorities, he said.

"The whole sense of teamwork had been lost," he added.

Step 2: Reengage Staff in Defining What's Important

To bring employees into the conversation about Summa Health's core missional identity and path forward, leaders recruited 25 of the organization's most-trusted "star" personnel from all levels below the senior management team, Deveny said.

The group met for two days to discuss what motivates them to come into work and why they choose to be part of Summa Health, he said. They distilled their discussions into a list of six key commitments: serve with passion, personalize care, value every person, take ownership, work collaboratively, and partner with the community.

Summa Health built a campaign around those central priorities. Then it went to employees with a pointed prompt designed to challenge toxic members of the workforce, Deveny said: "If you are not passionate about the work we do, if you are not feeling good about it when you're driving into work, you should probably leave the organization."

Step 3: Drive Engagement Strategies to Frontline Managers

To ensure that its engagement priorities would flow efficiently, back and forth, between the C-suite and frontline staff, Summa Health retrained 400 managers in two days on how to coach, teach, mentor, and align teams, Deveny said. The managers were also given new metrics to use in their performance appraisals, he said.

"What we really found was that a lot of managers stepped up and got better. A lot of them self-selected that this wasn't for them, that they needed to leave the organization," he said.

Ben Sutton, MBA, senior vice president of strategy and performance management for Summa Health, said the whole undertaking was about establishing an organizational culture in which individual employees and managers see their work as steering the health system toward success.

"I think one of the things that Cliff really brought is he came into Summa with a real drive to push accountability down to all employees in the organization and to our managers," Sutton told HealthLeaders. "The messaging really wasn't 'do it our way or get out.' It was about empowering them to own the outcome, to own what was going to happen in the future at Summa, and [to] set expectations around accountability."

As a result, the organization has seen improvements not only in engagement and alignment but in quality scores, market share, and the broader community's satisfaction and sense of pride, Deveny said. (After losing 3% of its market share within six months in 2017, Summa Health has regained 2%, as of mid-2019, and expects to continue to improve, thanks in part to a new tower it opened in Akron earlier this year, Sutton said.)

"We then used this position of strength to go out to the market and look for a new partner," Deveny said.

Summa Health announced plans earlier this year to become a wholly owned subsidiary of Beaumont Health, based in Southfield, Michigan. The parties are on track, Deveny said, to submit a final agreement to state and federal regulators by December 31.

Correction (12/30/19): An earlier version of this article misstated the date by which Summa Health and Beaumont Health were expected to submit a final agreement to regulators. The correct date is December 31, not December 21.

Related: Why Summa Health Wants to Be Under Beaumont's Umbrella

This solution was discussed among senior healthcare strategy leaders who attended a HealthLeaders CEO Exchange gathering in Park City, Utah. The program brings leading hospital and health system CEOs together annually for a custom dialogue on only the critical issues facing the future of their organizations. For more information, please email exchange@healthleadersmedia.com.