The Case for “Carism,” Putting Patients First and Going Beyond Health
Despite the political jockeying and outlandish rhetoric health care endures today, at the center of it is people working for something greater than themselves. Ignoring the political climate and misinformation on the Internet, true caregivers rise to any challenge and put the well-being of others first. Any conversation about transforming health care must center on this — on the passion and dedication worn on the sleeves of these heroes that can never be outpaced by better tools or facilities alone.
This is what my team and I uncovered to reframe how we think about health care in San Luis Obispo — a rural community on California’s Central Coast a few hours away from the hi-tech centers of Los Angeles and the Silicon Valley. My experience that follows required us to challenge ourselves to think bigger than we ever had and changed my mind forever about the role that world-class care can play in the future of a small town.
In 2004 when I arrived in SLO (our local shorthand for San Luis Obispo), I was presented with the challenging assignment to turn around the struggling French Hospital Medical Center. This wasn’t like other turnarounds I had shepherded. I walked into dilapidated buildings with outdated medical equipment that hadn’t been properly managed or maintained. Despite its illustrious history, many people might have closed this place. I quickly learned, however, that some members of the hospital’s medical staff in partnership with a local developer had purchased the property in order to save the venerable and historic facility. I had to find out why they would go to such extraordinary lengths.
I led off by running exploratory town halls and phone surveys with nearly 1,000 residents to find out what French Hospital meant to them. I dared ask “Why should French Hospital be saved?” and the outpouring of stories I got — many that spanned generations of care — showed a unique (what I called) “carism culture.”
New parents felt safe trusting the same caregivers that had brought them into the world because those caregivers took personal interest in them their entire lives. This sentiment was echoed by every group I talked to from expectant moms to those recovering from orthopedic surgery, from patients being treated for cardiac conditions to those enrolled in cancer care. In such a small community as SLO, caregivers at French Hospital performed at a much higher level than expected across the spectrum of patients, friends, families and neighbors I talked to. I knew right off that I had to preserve this culture to save this hospital.
Having spent years traveling the globe, I learned that a hospital’s culture couldn’t be bought or manufactured. French Hospital’s carism was deep, sincere and different. I observed it being lived daily by the staff of dedicated caregivers who went above and beyond what I had expected to find in such a neglected facility. I spent my days walking the halls to discover more about what made THIS facility so different than others I had visited or worked in. It was all crystallized for me in a chance encounter with one of our nurses who said:
“Other hospitals do what’s necessary. French does what’s right.”
This authentic desire to do “what’s right” resonated with me. It fired me up to not just save this hospital, but to give it the resources and recognition it deserved to take its place as a model for exceptional care that shifted the conversation from “things” to something much harder to acquire — true commitment.
I wanted to know what fueled this commitment, so my staff and I dug into the unique draws to the area. It turned out that as San Luis Obispo grew over the years, the complexion had been changing. Once a sleepy town that proudly embraced “SLO Life,” it had recently become known by its neighbors as “Silicon Valley South” because of the area’s highly-respected university, California Polytechnic State University at San Luis Obispo (Cal Poly).
Employers in high-tech businesses were sourcing telecommuters and setting up shop in town — companies like Apple, Google and Amazon. Successful startups like Jamba Juice and MindBody were born here. Farms had replanted their crops with grapes, and it had become the fastest growing wine region producing internationally awarded wine.
The large population of retirees from all over the United States also grew, attracted to San Luis Obispo’s mild Mediterranean climate and unspoiled nature. Student population exceeded 20,000 as Cal Poly’s reputation continued to climb, spurring a growth in technology and the arts. Plus, more young families moved to the area for its active year-round outdoor lifestyle, farm-to-table restaurants and wineries.
The resulting explosion of tourism and population growth from all sectors meant more people from major metros with higher expectations for their health care. We had to figure out how to quickly grow not just the town’s care, but the entire region’s care where populations were spreading to. If we couldn’t figure out how to keep up, the area could be economically devastated from the fallout.
Prior to its operational decline, French Hospital had historically been a leading hospital, but now I was on a mission to make it THE leader. It was time to begin looking to the future to ensure its longevity and establish its place in SLO as a valued contributor to growth and economic vitality. We embraced the idea that the community “deserved” the kind of care they may expect from larger cities. With that idea, the hospital’s not-for-profit Foundation set out to define what that meant.
- Our first insight was that the hospital needed to continue to expand its services to the community in a way that exceeded their unique and evolving needs and expectations.
- Second was the idea that no patient with a critical need should have to travel outside the area for world-class life-saving care.
- Third was steadfast commitment to always staying ahead of technology trends, and inviting more leading-edge caregivers to move to the area.
- Finally was the growth of a campus that provided more than just treatment — one that cared for the whole body, mind and spirit by incorporating indoor and outdoor spaces that were more private, comfortable, serene and even artistic. We would become a total healing environment because carism doesn’t end with a positive outcome.
With priorities identified, and solid support from the hospital’s staff and core supporters, the challenge quickly became how to articulate the vision and inspire the community to fiscally support what we defined as the need — a massive, $125 million expansion.
“I pay no attention to the competition,” I’ve said. “I am focused on what this community deserves.”
My team and I focused first on personal relationships with the Community and Foundation Boards, as well as its volunteers and donors. This group turned out to be more special than any I had seen elsewhere. Not only had they gone above and beyond in the past to save the hospital with personal resource commitments, they, just like our caregivers, elevated our carism everyday and everywhere.
I watched many of them tirelessly uplift others. They worked passionately for the smallest needs of patients and their families, frequently showing up to comfort them, cry with them, and celebrate victories together. It was this deep personal connection to patients that had led to funding beautiful things like “the kissing corner” in the hallway leading to our operating rooms so families could provide the emotional boost their loved ones needed to enter surgery more calmly and confidently. Artifacts of these connections adorned angel wing art on the walls throughout the hospital filled with stories, wishes, memories and thank-yous.
A local agency, Matchfire, with a nationwide reputation for helping non-profits create social movements, worked with the Foundation team to develop a compelling brand — one that echoed both deep relevance to the Central Coast community and a resonance that would inspire word-of-mouth sharing. They focused on words they heard me use to inspire people that showed commitment to something larger — words focused on the passion I had for exceeding expectations at every turn. With that, “Beyond Health” was born.
We took this brand very seriously, and in the course of its rollout realized that we were actually creating a MOVEMENT. It was this that convinced me that Beyond Health was going to be a success. I saw this brand all around me in the staff who could be making more money serving a corporate entity rather than making a personal sacrifice by rising to the higher calling of caring for the ill and vulnerable. They were already living a purpose much larger than any health care entity, regardless of its size or for-profit or non-profit status. They were focused on doing as much as they could for their community both inside and outside the hospital’s four walls.
“My universal call to think beyond was simply a reflection of what I had already grown to love so much about my staff. They were the brand — I was just its amplifier.”
We created inspirational videos of our staff, caregivers and patients and shared them alongside a full 3D rendered video fly-through of the new campus and facilities. These, along with promo items and a new Go Beyond Health campaign website, were shared during open and honest question-and-answer town hall sessions with hospital management, staff, physicians, volunteers and board leadership who were asked to keep the brand secret, but to wind up enthusiasm for the hospital-wide release.
All staff were asked to watch their emails for an exciting update, and upon receipt of the email, the hospital was buzzing with excitement and offers of help. Social media lit up with activity, people were proudly wearing new schwag, and I got lots of engagement in every forum, as well as lots of new hallway conversations.
It was only after all staff questions were addressed that the campaign was rolled out to the press. Among emotional stories of having to save the hospital from a developer’s bulldozers during its tumultuous and financially difficult times were real patient testimonials that described the carism culture from the patient perspective. These proof points, or “reasons to believe,” were critical to the launch of the brand that could otherwise seem more aspirational than attainable. Since the success of any campaign today relies on honesty and transparency rather than empty promises, these stories cemented for journalists and the many other attendees just how relevant and important this growth campaign was to real people in our community who depend on us.
As of the authoring of this article, the campaign has already attracted a number of major donations, and a groundswell of smaller ones. In fact, one of our earliest was from the hospital’s caregivers themselves who generously donated even before they learned of the new brand. They had already looked beyond what was asked of them. Past supporters have inspired new ones, and going Beyond Health is resonating as both an aspirational and achievable call to action. So what’s next?
The campaign has promised world-class care delivered at the doorsteps of the community, so in order to maintain this promise, French Hospital will continue to evaluate and invest in leading edge technologies. These investments will require similar attention to attracting specialized caregivers to operate the equipment and perform new procedures — investments estimated to draw nearly 300 new head of household jobs and millions more dollars into the San Luis Obispo economy in commensurate salaries.
There is also a rethinking of what healing is. There are mounds of clinical evidence that purport that privacy, serenity, and the presence of family facilitate faster and higher quality outcomes. As a result, the hospital will continue to monitor and invest in more gardens, patios that open up to the fresh air and scenic views of mountains, water features, and even art exhibits. New rooms are either single private rooms or welcoming family-friendly ones, and a new restaurant quality indoor-outdoor cafe will serve good food and nutritious options to patients, loved ones and staff in a beautiful, relaxed setting.
This brick and mortar buildout is necessary to house new capabilities and an expanded staff, but our real focus is not on the building or stuff. We strive to drive change and foster innovation both inside and outside the walls of our hospital. We have massively re-engineered processes and reset our community’s expectations. We are bringing everyone we touch into our culture of carism to reposition ourselves past routine care and truly go Beyond Health.
“This time in our city’s evolution, just as in the rest of our world, requires more than just another promise — it requires a movement such as ours.”
The movement is working. Every day, in countless conversations both inside the hospital and around town I get asked about our philosophy. It has captured people’s imaginations. I believe it has shown that we are authentically vested, that we have listened, and that every brick we lay and improvement we make has purpose to it — purpose driven by the people we put first in every interaction.
Walking the halls of French Hospital is unlike other facilities I have been in. If reverence was quantifiable, it would be the sum of the parts of this special place. It is full of humility, humanity and compassion. People view their work here as their vocation, not their job. Its walls are filled with notes from past and present patients. Every caregiver has a story of having personally contributed to the hospital’s success instead of relying on a corporation to do so for them. Families with members who were born and raised in SLO choose French Hospital when they can because that’s who cared for their parents and their parents before them.
New members of our community increasingly choose French after researching our national awards for quality care, technology leadership and commitment to safety and service. Most important to me, however, is that French has earned the reputation as the community hospital of choice because everyone at French — administrators, physicians and support staff alike — always put our patients first.
I learned from the very start of this experience that health care is constantly evolving in our own backyards in unpredictable ways, just as it is globally. To address this requires both honest awareness of the present condition and forward-looking problem solving. It challenges us to think differently and to think bigger in ways that stretch but don’t break us.
The environment surrounding our chosen profession can seem untenable at times, but for all of us, our starting point should always be to look beyond ourselves at what our community needs and provide them what they deserve. At French Hospital, every conversation now begins with “how will this decision benefit the patient experience?” and results in thinking beyond what we’ve ever imagined before.