Posted May 17, 2018

"Boots-on-the-Ground" Leadership: How Better Accountability and Leadership Development Helped McLaren Flint Achieve Alignment and Decrease Deficit

By Chad Grant, FACHE, President and CEO, McLaren Flint

When I came into McLaren Flint as CEO in February 2017, the organization was $6-7 million behind budget early into the fiscal year. It was a huge anchor around our necks. We had lost significant market share in the community. Our physician engagement was poor, and our volume was not where it should have been. We were struggling across the board.

The question I asked myself was, "How do we build and restructure our leadership and organizational accountability to get us back on track?"

Structure and Accountability

A year ago, we had an organization-wide lack of consistency. Our leadership team had a history of independence and the mindset was that each executive managed their own business and just did their own thing. Our work wasn’t coordinated, our thinking was siloed and our performance was suffering.

My first step was to reinforce the structure and expectations of our leaders and to make the things that were always supposed to be mandatory actually mandatory by holding people accountable. I started requiring that every leader in the organization hold monthly meetings with their direct reports to ensure people were actually involved in their departments and working toward measurable goals (consistently looking at the Leader Evaluation Manager®). I knew that if we continued to allow variance in our leadership standards, it would lead to confusion and ultimately chaos.

Staff accountability was also a major focus for us. In essence, we rebooted and went back to basics. We re-rolled out two tactics, AIDET® and Hourly Rounding®, and let people know that consistently demonstrating these behaviors was an expectation for all staff members. And what we found was that our team thrived when expectations were clearly outlined and validated.

Over time, we came to realize that if we want to decrease our budget deficit, improve our engagement and provide great patient care, we all need to be aligned on our priorities and work together toward those common goals. There shouldn’t be any question about what is expected of an employee or how that employee can contribute to the overall strategy.

Over time, we came to realize that if we want to decrease our budget deficit, improve our engagement and provide great patient care, we all need to be aligned on our priorities and work together toward those common goals.

But structure and accountability are about more than just tools and processes. In the end, it comes down to creating a compelling vision (the why) for these changes and connecting them to the organization’s mission. After you've reiterated a consistent vision, most employees get it, and want to be a part of the organization going forward. We want the people that work at McLaren Flint to really enjoy what they do, be proud of the impact they make in people’s lives and to be committed to our organization’s success.

“Boots-on-the-Ground” Leadership

I knew that to keep the momentum going, I’d have to get all our leaders on board with executing the plan. So, at the first monthly management team meeting, I reset the rules for our leaders. In the past, management team meetings were run by vice presidents, but I started leading them personally. It was important for everyone to know what my expectations were and that I was very comfortable joining them and leading from the front.

I also opened up lunch and learns and skill labs for those leaders who believed in the vision and wanted to be part of the team but lacked expertise in some areas. We leveraged Leadership Development Institutes (LDIs) to roll out specific content to enhance our leaders’ skillsets and review progress toward our organizational goals. The focus on education ensured that the leaders at McLaren Flint have the tools they need to be successful.

Every quarter, we carve out two days to educate our leaders on topics we think are important and timely. It’s protected time, and it is mandatory. At each LDI, we discuss the current healthcare climate and our actions to proactively address these changes. I think it’s important to level-set with the team to make sure we are all working from the same playbook. This also helps to connect to the why of some of the current initiatives and create a sense of urgency around our top priorities. If we aren’t hitting a hospital goal, as a team, we discuss the reasons why and formulate a plan to get where we need to be.

Boots-on-the-Ground Leader: bo͞ots / än,ôn / T͟Hē,T͟Hə / ɡround / ˈlēdər

  • A leader who is aggressive about proactively solving problems and removing barriers for his team.
  • An individual who is visible, leads from the front, rounds on staff and doesn’t over-delegate from behind a desk.
  • Someone who actively solves problems as they occur.

Synonyms: Transformative Leadership, Charismatic Leadership, Visionary Leadership, Inspirational Leadership

The ultimate goal of this training is to create a team of “boots-on-the-ground” leaders. I really want our leaders to understand our organizational priorities and be engaged with the vision so that they can help their teams execute toward their goals. Our leaders are proactively identifying any barriers and problem-solving in real-time to empower our staff to provide exceptional care efficiently.

I think everyone would agree it's better now than it was a year ago, but it probably took about six months for these changes to begin to stick.

Cultural Transformation

Apart from the overwhelmingly positive impact these changes had on our processes and people, our focus on structure and accountability has helped us to transform our culture. I love Quint Studer’s quote, “Culture beats strategy every time, but culture with strategy is unbeatable.” That’s what we are working toward at McLaren Flint — a thoughtful, patient-centric strategy that is driven by an innovative, engaged and focused team. The feedback we’ve gotten over the last year from our medical staff and community has been positive.

With that, we've seen significant improvement in metrics from patient experience to physician and employee engagement. We're not out of the woods, but we are improving. Ultimately, these advancements show that focusing on aligned goals and accountability is making McLaren Flint a great place to work, and the provider of choice in our community.

A Selection of McLaren Flint’s Improvements Over One Year

  • Overall Operating margin improved from 1% to 5%
  • Market share improved by 3%
  • ED “likely to recommend” and “overall rating of care” improved to scores greater than the 65th percentile due to improved hospital throughput
  • Inpatient HCAHPS scores have improved in 10 out of 10 domains
  • Employee engagement scores improved by 5% in 2017

For more information about how you can implement McLaren Flint’s leading practices for accountability and leadership development in your own organization, join us at What’s Right in Health Care®, where Chad will present a session on this topic.

For organizations looking to reset their organizational culture to drive toward accountability and alignment, I would suggest the following guidelines:

  • Start with setting expectations. Make sure everyone knows how to be successful in your organization.
  • Have checks in place to validate non-negotiable behavior. Anyone who is not willing to comply should be allowed to leave the organization.
  • Train your leaders, and make sure they have the education they need to effectively lead their teams.
  • Round on your team to remove barriers and problem-solve in real time.
  • Always explain the why. Make sure everyone (frontline staff to senior leadership) understand the vision and how to contribute to the organizational goals.

Chad Grant became CEO of McLaren Flint in January 2017. Prior to that, he was the chief executive of McLaren Oakland. He has more than 10 years of experience in hospital administration.


  • Chad Grant

    Chad Grant, FACHE, President and CEO, McLaren Flint

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