The Vice President of Human Resources of a large healthcare organization was energetically imparting the value of caring in the organization.  All of the staff espoused this value, and the Chief Executive supported it.  However, the Vice President of Operations was driving a relentless cost-reduction strategy to ensure the survival of the organization in a tumultuous phase of the healthcare industry's evolution.  Both leaders are people of impressive intellectual and moral stature, and both drove their campaigns hard.  Both initiatives were vital for the organization. Their two departments enjoyed excellent relations.  Yet the value of caring for patients undermined the strategy to limit costs and pursue efficiencies.  The staff could not align the need to reduce patient/nurse ratios with the value of caring.  They could not relate to the downsizing of certain departments in an organization that claimed to care not only for its patients, but also for its staff.  Not only did the organization fail to achieve its cost-cutting goals, it was also experiencing reductions in standards of caring.  More serious, however, was the loss of employee respect for leadership integrity.  The values initiative lost credibility, and employees saw the cost focus as the only thing that really counted.  Patients were not the only ones who suffered from this deterioration.  Everyone suffered, including the organization's capacity to sustain its dominant competitive position.


SBE changed cost-consciousness from a survival tactic to a value that was vital to patient caring.  SBE co-opted the nursing staff and others into imagining a hospital committed to cost efficiency, not as a business imperative but as a moral one, to extend quality medical care to people at the lowest possible cost.  The nursing staff began to seek their own ways to cut costs as part of their patient caring.  Staff reductions initiated by the nursing staff themselves did not cause resentment and did not impact negatively on the quality of patient caring.  We translated these and other supporting values (beliefs) into an ethic (conduct) that management began to live by. No longer was "rainmaking" seen to be more important than quality in interpersonal conduct.  Very soon, this work began to show astonishing results in employee commitment to both cost efficiency and excellence of care.