Hope as a Leadership Discipline With Russell Cox

Russell Cox:
[0:00] People burn out because they, for some reason, have lost that connection with the why. It rarely is anything else.

Jon Clifton:
[0:11] They are the heartbeat of a region, heroes providing care for millions at the intersection of life's most fragile moments. At the helm of this giant is a leader who doesn't just manage a system, he fuels a mission, guided by the drive of Achiever, the vision of Futuristic, and an infectious Positivity and Woo. His strengths carry him through a world where pressure never sleeps and excellence is never optional. This is the CEO of Norton Healthcare, Russell Cox, and this is Leading with Strengths.

Russ, great to see you. Thank you for being here today.

Russell Cox:
[0:46] Thanks so much for inviting me.

Jon Clifton:
[0:48] One of the things that we study closely is trust. And you can see that trust is collapsing kind of with how Americans feel about any institution. In fact, there's a lot of trust collapsing around the world. But the survey that we did recently is we asked people about individual professions. And there's one profession that people really trust: nurses. Now you have a lot of nurses throughout the entire organization. What is it about nurses that Americans trust so much and still trust in an environment where trust is collapsing kind of everywhere?

Russell Cox:
[1:22] Yeah, well, let's just start at the beginning. The decision to be a nurse is one that is made with a full knowledge of a lifetime of service to others. Servant leadership comes absolutely into play when somebody decides to be a nurse, because what you're committing to is on a daily, hourly basis, meeting the needs of people who are not having their best day. So the very notion of who I am as a person to make that decision for a career really builds credibility with the people who use the service. And by the people who use the service, I mean the patients and the families.

I also think that nurses do an unbelievably good job of not just taking care of the patient, but taking care of the entire family, the entire extended family, the caregiving and support unit. So often, that has such a great impact on patients' views of the care that they're getting and who's giving it, that that has made a big difference in building that trust factor.

And let's just be honest about this. The number of minutes, the number of interactions that happen when a patient is under the care of any hospital or inpatient, outpatient facility, they have the most. They have the most interactions. They have the most conversations. And the caring nature that they bring builds trust. The constancy of communication builds trust. The transparency, the willingness to explain and educate. It's such an important configuration of skill sets that its outcome, one of its many outcomes, forget clinical outcomes for a second, but one of the other outcomes is trust. But I think that's really why it always has been true that they've been very high. Nurses have been very high in the trust side of things.

Jon Clifton:
[3:30] You know, Americans trust nurses, but there's a place that they are struggling with in a lot of respects because we ask Americans more broadly about healthcare. And we find that this is now one of our record highs, but 23% of Americans are saying that they think healthcare in this country is in a state of crisis. What are your thoughts on that? And are there things that you would say to Americans that would assuage those concerns?

Russell Cox:
[3:56] You know, I think that there's been so much narrative about healthcare. And there's been so much that is brought forth about the problems that we're dealing with in healthcare and the funding, the reimbursement, the structural methods by which that we're able to provide care and pay for it, have it supported from a financial perspective. There's been a lot of focus on that side of it.

Because what you find is that the people who are utilizing, who need healthcare and are utilizing it, have a completely different view of that. And I understand that because healthcare is only important to you when you or someone you love is in need of it. It's an assumed product that's there. And it's very easy when you're not a user, you don't have the need, you've been blessed to not have someone who is in need of healthcare. It's very easy to get subsumed with the narrative about all the things that are wrong with healthcare.

Walk into a hospital. Walk into a pediatric oncology unit. You're going to find a whole lot of things about what's right with healthcare. You're going to find a whole lot of things about where research, where innovation is changing lives. 
But when you go outside those doors and when you watch news or when you hear political rhetoric, you're going to think, you know, this system's in disarray. Its funding, its financial support systems are constantly under duress. And that's where the narrative is. But again, inside those walls, and if you're in need of healthcare, you trust healthcare.

Jon Clifton:
[5:48] You know, we talked about that the original design, of course, for these discussions was for college students, because so many of them actually go through CliftonStrengths and they're trying to figure out what exactly do I do with these particular strengths? And I think one of the great tensions that exists with maybe Woo and Positivity is delivering bad news. And as an executive, you are always faced with doing that. Is that a tension for you? And if so, what do you do about it?

Russell Cox:
[6:16] It is a tension. And it's one that we have to understand has a necessity to it. Our industry went through perhaps its most difficult time in 2020 with the pandemic. We were dealing on a regular daily basis with sometimes bad news, but sometimes unknown news. And unknown can also be decoded as bad. What we've always intuitively known, but what we saw play out real time on a daily basis in 2020, is the importance of transparency, the importance of candid conversation, the importance of letting your emotion be visible when you're having to share this information. It builds a credibility. It builds a humanistic side of what that bad news is. It shows that you're not necessarily just rote in doing it, that you recognize that it's not good, that you recognize that it's difficult, that you recognize that we're going to work together to get through this though.

We have to provide hope with bad news. We can't just go out there and say, this is awful and here it is. We have to also with it — and this might just be some of that Positivity that's also close in my heart with the Woo — to let's make certain that we're offering people an opportunity to experience and understand there's not futility here. There's hope.

One of the things that I find very exciting about healthcare is that I've always believed that in chaos, there's great opportunity, and we have a whole lot of chaos. So I always try to stress to people that the very thing that frustrates us sometimes, that creates bad news, if you will, creates a great opportunity for us and creates something, maybe a burning platform that forced us to really look at things differently and do things differently. So, I think that bad news thing is one that we have to be very credible with and be very transparent, be very willing to say exactly how it is, but also be willing to talk about how we're together going to solve that and find a better way.

Jon Clifton:
[8:46] You know, for those 23% that think that we are in a crisis right now, what is the immediate opportunity that you see?

Russell Cox:
[8:52] Well, education, awareness, understanding and a better literacy of what healthcare is. There might be validity in what they're seeing in that 23%. But I'll venture a guess that if we had the opportunity to better educate, and especially from a health literacy perspective, what is being done in healthcare? How's it being done? Now, with the advent of artificial intelligence, what we might be able to do becomes exponential. So I believe we're going to evaporate that 23% pretty quickly. The likelihood that we're going to need services of some kind is going to continue to grow. We have the engagement of people when they have that need. So incumbent on healthcare, I think as an industry, is better education.

Jon Clifton:
[9:45] Your top five. We've talked about this before too. Positivity and Woo are your two and one, I guess. I had them flipped, but you have an unusual ability to remain optimistic about anything. And I mean, you, your leadership has presided over some of the most difficult times that Norton has faced. But you also talked about the tension that exists for individuals that might have Woo or Positivity or how do you deliver a message that's truly authentic? So somebody doesn't say, oh, there he is being, you know, overly optimistic again or being Pollyanna. How do you do that?

Russell Cox:
[10:23] Make no mistake about it. My number one is Woo. And I embrace and own that because I think that so much of what we talk about, so much of what we do in healthcare is helping people feel good and connect with the why of what they do. One of the things that I've always tried to employ is bringing a message that connects people to why they chose to be in healthcare. That seems to get people out of the side of thinking that this is Pollyanna. But it connects me with yeah, that's exactly why I chose to do what I'm doing. And I can be positive about this. I can be optimistic about this. I chose this career to make a difference in people's lives, to be able to change people's lives, to be able to bring about new ways of taking care of people. So no matter whether your Woo is way up like mine is or you have other things, the common point that we have in connection is the why we chose healthcare.

Jon Clifton:
[11:32] Well, what about the sort of Achiever issue more specifically? I mean, you know, people with Achiever, they want to be seen for how hard they grind. It is, we probably are seen as weird to many in the world that, you know, we like work. We want to get a lot of things done. But it can also drive others totally insane, especially, you know, from a leadership perspective, if what we're conveying is we need more hard work. How do you thread that needle in an environment, especially in healthcare, you know, where burnout is such a major topic, even in some of the studies that we do, which face physicians, which face nurses. What do you do about that?

Russell Cox:
[12:10] It's a constant problem that you have because so often ... We used to be seasonal. We used to see busy spurts at certain times of the year, flu seasons and whatnot. Healthcare now has become a much more smooth constant. There's a lot of people needing service. We may see blips and they're up and down. But I want to talk a little bit about the issue of burnout.

Because Achievers do. They want to grind. And me having some of that in me, I'm also prone to tell you how hard I'm working on a regular basis. So we like that idea. Achievers also get energy from achieving. So we kind of can, in some ways, be very Energizer Bunny that can drive people crazy at times. But I always get back to this. You know, that whole Achiever thing and how other people relate to it. People burn out because they, for some reason, have lost that connection with the why. It rarely is anything else. And as I talk to people who come and talk to me about burnout, I try to get back to what was the reason that you decided to do what you did when you first decided to do it? And what you find is there's been a derailer along the way.

A lot of times with physicians, the advent of documentation, the administrative burden, the feeling of the whole time I'm with a patient, I have to be entering on a keyboard. So what we've tried to do is to say, what are the derailers from why you got into this? Now, sometimes we have to be honest with ourselves and say, you know, I've changed. You know, I don't, I'm burned out. I mean, this, my why is no longer what it was. And I think in that case, you've got to look at a very different strategy for how you help people find a new why. But 90% of the time when I'm talking to people who are burned out, there's been a reason that they've lost connection with the why. I also think we lose sight of this with this Achiever.

You know in healthcare, we have little cities that are called nursing units, or we have little towns that are called clinics or doctor's offices. And as a leader, you're the mayor of your city. And it takes all kinds of people within a unit to make that unit successful. So you need a few Achievers in there. You need a few Woos in there. You need a mix of people who can drive you to the place you need to be. We all understand in our towns, if you will, our little cities as I call them, that not every citizen is the same. And there's a time in the day where we need a certain strength that someone else brings. And there's a time when they need the strength that I bring. But being willing to embrace that and being willing to value what those things are is another way that we keep people from being burned out. And I think knowing that I have a contribution in a strength as a part of a team really helps me stay connected with my why.

Jon Clifton:
[15:56] We actually have data that says exactly what ... you're right, that the burnout is not always by hours worked. In fact, it's never the single biggest driver.

Russell Cox:
[16:04] Well, here's another thing I'll tell you about that. There are people who, once they get reconnected with it, want to grind harder because they're back. I mean, they've – and I've seen it's almost a revival or renewal. And it's really interesting because we have students come out of med school that have gone so hard grinding in med school and residency that they're exhausted. And it's like you have a conversation with them and they hadn't thought about why they did that. I mean, all they've thought about is passing anatomy and getting, I mean ... So we almost have to do a revival and renewal when they're coming out of residency. So that tells you how intense, that intense nature, and by the way, most of those medical school students are Achievers. That's how they got in.

So we almost have to do a reset at times, you know, and say, remember, go back to when you were a junior in high school. You know, I always ask them when they come in, what was the one event that made you decide to be a doctor or be a provider? What happened that made you want to do that? And there are some who say, my dad was a doctor. You know, there are some who say, I had a science teacher who said I was smart and should be a doctor. 75% of them talk about an experience of someone losing a life to a disease or losing a sibling or my dad was, you know, I lost my dad. It's the connection of I wanted to make a difference. And if we can get them plugged back in. But the reason I tell you that is because there is some research that says, oh, it takes 25 years or 20 years to be burned out. You can be burned out right out of the box.

Jon Clifton:
[18:02] What are your strengths do you feel like draws you to listening? I mean, you mentioned this, that you do these surprise visits. You also take these notes. You read all the emails that patients have when they're not happy about something. And sometimes you'll actually just go do a surprise visit with them and sit with them. What strength is it that draws you into that?

Russell Cox:
[18:19] Well, I think there's part of that Woo that doesn't want anybody unhappy. And if they were inspired enough to send me an email, I think it's a personal relationship that we have. I'm your classic Woo who, I want people to like us. And I feel like I can go over and convince them that we're not that bad. So I think that drives a lot of it. I think the Achiever in there also feels like we've failed maybe. But I'll put Learner in there too because I think the way that I understand it better is to go and ... I don't know that I was ever a great book student, but I have always been a immerse me into it and let me feel it and I can learn it much faster. So I think that Learner probably kicks in a little bit there.

Jon Clifton:
[19:21] You know, Learners can get dragged into wanting to study everything. And I guess the basement of it, I don't have it, but I deeply envy it, is that you can end up sort of learning everything and almost where they could feel not productive because you're just immersing yourself.

Russell Cox:
[19:38] Well, you could find yourself in rabbit holes. There's no doubt about that because you, the more you get into something, the more you want to know. But, you know, healthcare is about lifelong learning because in healthcare, we can't just say, I know everything I need to know today because it changes so fast. Technology changes. Procedures change. The ability to effect change changes quickly. So we have to constantly learn. I tell people all the time that sometimes the hardest part is unlearning what you know to learn something new. So for me, that learning part is just a really important part of healthcare is that I have to understand that I'm going to have to learn every day. And if I don't have the willingness to unlearn, to relearn, to accept new things, it's going to be a hard industry for me to be in. So I've always felt like that it's a necessary sort of skill set that people have to have in healthcare. And I think that's one of the reasons that I feel like I fit in healthcare was Learner.

Jon Clifton:
[20:54] You mentioned two words that I think are on the minds of every executive right now: artificial intelligence. I think there was even the IoT analytics did an analysis on earnings calls. And it was, if not the most mentioned thing, it was up there in the top three. CEOs appear to be obsessed with it. What are you doing with AI right now, and what's the experience like getting it integrated throughout the organization?

Russell Cox:
[21:19] The first is removing the fear. A workforce that has been trained from a healthcare perspective, and here's artificial intelligence, here's they're going to replace my job. And so I spend a good deal of time ameliorating the idea that this is going to replace you. I think it's a better and more digestible conversation to say it's going to give you tools to make you better at what you do. And that is the truth. I don't think we'll ever be able to completely turn over the reads of x-rays and MRIs and diagnostics to AI. I think we will be able to use it to help people better diagnose, better read, find new and better ways to treat. When you can run an AI report of every mammogram that's been done in your city for the past two years for a common sort of tumor and then extrapolate what treatment worked best to better make decisions to get better outcomes, that's a great use of AI.

So the second thing is, I think the governance of how it's used is critical. Because using AI or letting AI just proliferate in an organization independently is a very dangerous thing. So we have a governance group that everyone who has a stake in this gets a seat at the table. And we talk about how we're using it. What is the validity of it? Are we being intentional about not letting bias come into this equation? How do we see that being able to be managed in a way that is not reckless, but is very positive, can help us? And then communicating what we're seeing. So the governance of it becomes very important. If you're not making certain that the sources that you're seeking in AI are in fact credible and valid and without bias, your results are going to be that way.

You know, I think the third part is really pushing how do we launch it exponentially to move faster? You know, what are the things that we can apply it to? We've seen so many things that help us. We were able to put all of our policies and handbooks and every other sort of data into AI and give a manager a tool that they could go in right there at their workstation and say, I'm about to have to have a difficult conversation with a 15-year employee who's having difficulty doing X, Y, and Z. What can I learn about this before I have this conversation? And that AI is able to go into records that we've had for years, policies that we have that clearly delineate what it is, that talk about external sources that we validated to bring in about having that difficult conversation, what you as a leader should know. Then it allows that manager to then have a conversation with their leader of, I'm getting ready to have this conversation. This is what I've learned. This is how I'm going to do it, and then execute on that.

So there are so many good uses of how we can exponentially move to use that in a positive way. I didn't remove anyone's job in that scenario. And we certainly were able to enhance the governance piece of it by saying we're managing it proactively. But then it gives people tools to do their job better. Healthcare is one of the greatest things in the world because we love technology. I mean, tell us that we've got a better mousetrap and we're all over it. And the thing that makes me optimistic about this is AI is the ultimate tool that will help people do their jobs better.

We're going to have so many needs for workforce in the coming years that anyone who wants to be part of a healthcare system is going to have a place. There is a recent incidence where we just couldn't diagnose a patient. There was symptoms that didn't lead exactly to A, B and C, that didn't fall within the regular means of what we were looking at. We were able to put this medical record into an AI product, and it found seven people in the world who had had similar symptoms, similar genetic code, and said, this is what they had. These are the treatments that were used, and this is what got the best outcome. So I look at that and say that gives us hope for much better innovation than we've ever had at any point in time in healthcare.

Jon Clifton:
[26:24] That message about this isn't going to take your job. This is going to actually enable us to do more, provide better healthcare. How do you know it's resonating? You know, you hear other things that CEOs are saying, no, this is going to be the most effective sword in battle. But employees are privately worried saying, no, that sword is going to be my executioner. And so how do you know it's landing?

Russell Cox:
[26:47] It's a consistency of message as well as making it convergently valid with your actions. And I think that's an important thing because we talk at Norton Healthcare about our true north is that interaction that happens bedside. That's our true north. In the outpatient setting, in a doctor's office, it's that interaction that the person who is coming there for care has with the caregiver. It is not the interaction that they have with their laptop, with their phone. It's a human interaction. And I believe that we continue to talk about the importance of great human interactions.

And as we talk about how AI comes into play with us, we reiterate, we don't ever see a Norton Healthcare where we don't have people taking care of people. It's not a part of who we are as an organization. It's not what our mission says we are. It's not who we've been for 150 years. But it's making people better and giving them more tools. I always remind people coming into healthcare, if you'll stay flexible, if you'll stay nimble, you'll always have a place to work, because healthcare is always going to be about people helping people.

Jon Clifton:
[28:09] How do you learn it? Do you experiment with it? Are you reading books on it? Do you take a course? What is your learning arc with it?

Russell Cox:
[28:17] One of my best tools is a group of fellow CEOs. I'm able to have access to about 15 others that are similarly situated, different parts of the country. We connect on a quarterly basis. I find that those are the type of relationships that really allow you to learn quickly, because everybody's doing something. We laughed not long ago about the fact that we get more value of the phone calls where we talk about what failed. It's like, great, that saves me time. You know, I don't have to worry about that. I just, I can move on from that. So I think that collaboration is the greatest learning tool for AI because everybody's got something. And everybody's doing it a little bit different or employing it in a different way and leveraging it a different way.

The other thing is, is that I go back to, let's look at, you know, what the people who are using what we have are telling us because a lot of times it becomes a prototype that we can just lay on other areas. So that's when I talk about how do we run faster? Because if it's working here this way, what are the implications for it to be replicated safely? I think that there is an opportunity for us in healthcare to set aside competition on this topic and say, how do we get the greatest minds around this and then agree to share in a way that is patient-centric.

Jon Clifton:
[29:58] How do you know when to delegate your Learner? Because your heart might say I need to know all these things to be effective, but you can't. How do you know when to delegate?

Russell Cox:
[30:09] It's never the same thing. It's never the same measure ever at any time. And I say that because how you know yourself and how you know your team says a lot about your willingness to trust. I know that there are certain people on my team that have certain strengths that I can delegate that quick. And I know that they're going to run with it because it's right in their power curve. And those are the delegations that you sleep well at night. You don't worry about it. There's others where you say this is not necessarily what their greater strength is. I need to stay involved in this one a little bit longer and delegate it a bit slower and stay a little bit more on point with it.

And I always use with leaders, let's learn this together. I need to know this too. And, you know, there are other things where I say, look, I'm going to turn this one over to you completely because this really is in your area. This really is something that you can run with and write up what you do. As a CEO, as a leader, I can't take all of them, but I have to have pretty good wisdom to understand which ones that I need to stay a little bit more engaged and delegate. As I always say, just delegate a little bit slower.

Jon Clifton:
[31:35] You know, there's a study, I think I saw it in HBR, but it talked about how CEOs spend their time. And I think one of the shocking ones was actually how little, again, I think it was private sector, but it said how little time they actually spend with their customers or their clients. What does your day look like? How much time do you spend with your executive team? How much time do you spend visiting patients, time with physicians, with nurses, with the community? What does it look like?

Russell Cox:
[32:04] The CEO role is very interesting from that because we've got a lot of stakeholders. We've got a board. I spend a good deal of time with our board, with keeping them informed about what we're doing, why we're doing it, what issues are coming up, how we need to look at heading in the right direction from a governance standpoint. So there's a portion of time every day that's there. There's a portion of time that's spent with your team.

I've always believed that a part of your day has to be in touch with, as I say, at the gut-check level of your organization. So some of the things I've tried to do through the years are things like unannounced, leave and go to an ED. Walk through the ED. People are going to be surprised — I don't want to be in the way — but just an awareness of what the intensity, what the volume is, and that I'm there. So unannounced visits are always a part of what I do. I've tried to also do some unconventional things to get me back where care is delivered.

If you sit in a leadership role, you get emails from patients who are not happy. What I try to do, if the family is still in the hospital, I try to, after lunch, get in the car and go where they are. And knock on the door and say, got your email. Sorry it didn't go well. Let's talk about it. And what I found is two things there. Employees appreciate it. You did come and listen. The patients can't believe that you actually did, but you learn more by that face-to-face sort of interaction about what's working and what's not working here. I try to keep a little notebook of trends of what things I'm running into, and then it gives me an opportunity to say, here are process things that we need to get fixed. Also in healthcare, we can be defensive of the process. And I always remind people, because it's worked for 20 years, doesn't mean it works today. So, I try to make sure that I'm staying in touch with what our core business is.

I have an external audience too. I have the community. And telling our story, getting our story out there, making sure that people know what we're doing and why. I spend a lot of time doing that. I'm an old teacher. I kick off our new leader onboarding, every session. I've done 33 in a row now, and I go to their graduation. So I block time to make sure that I'm spending time with the next generation of leaders. So there's a lot of my time that goes into the training and development. I spend a good deal of time making certain that we're staying in touch with a constituency that may be underheard or underserved. And by that, we have a lot of nonprofits in our city that do great work. But we're better from a community perspective if we all partner together. So I spend a lot of time with the not-for-profits in the community figuring out how we can bring together our services in a way that better leverage it for patients. No day is exactly the same, but those are the big components for me.

Jon Clifton:
[35:40] You mentioned in your industry there's a lot of change that's coming. But you and your team have walked through how each of you are going to play your unique roles and making sure that Norton is ready for that change. But can you talk just a little bit — you have Futuristic — what is your vision for Norton, especially in this sort of world where we're seeing so much rapid change?

Russell Cox:
[36:04] We've got a big agenda. I'm a big believer in access makes a difference. I believe that we're able to build relationships with people through increased access. So, how do we be not just relevant, but vital in our communities and in our region? Let's don't just think about it from the standpoint of the ZIP codes of market share. Let's think about it as being a destination. Frictionless, different. Those are the kinds of futuristic things that we've got to speed up to now. So we've got a lot of ideas as to how that we can become more of a destination and not just a local sort of healthcare entity, if you will.

Jon Clifton:
[36:52] Which of your top five strengths brings you the most joy?

Russell Cox:
[36:57] I would have to say Positivity.

Jon Clifton:
[36:59] Why?

Russell Cox:
[37:00] I would have to say Positivity. You know, I think it's easy for people to get caught up in all the things that don't work. I think that I love the Positivity because I think I'm able to, at times, provide that hope. And I know it makes me feel better. And you've got a choice. You can be positive or negative, and I've chosen positive. And I really think that people are attracted to positivity. I believe that in times of trouble, they seek people who are positive.

Jon Clifton:
[37:32] What about when there's a crisis? What about when you feel fear, debilitating stress or you feel like, oh, no, the problem has hit my desk that I just wish it wouldn't have hit my desk today? What strength do you draw on right at that moment?

Russell Cox:
[37:45] No doubt, Positivity. No doubt. Because ... If you're able to look at it as an opportunity and that we're going to get through this, you can get the energy to head straight into it. If you let it bother you, if you are one that wants to stew over it, one who wants to analyze it too much, it can begin to weigh on you, on everything that you do. So Positivity definitely is how I attack it, I think, is that, OK, this is bad, but we've survived worse and we will again.

Jon Clifton:
[38:19] Russ, thank you for being here today. Thank you for everything you're doing and for being a great partner to Gallup. Thanks.

Russell Cox:
[38:24] Well, you know, we believe that strengths guide us. We believe that there is a real competitive advantage that we have by how we employ that. So I appreciate your time too.

Jon Clifton:
[38:38] Thank you.

Transcript autogenerated using AI.