• Crafting Better Vision Statements

    J. Stuart Showalter Mar 18, 2015

    A recent study reveals two common dysfunctional practices among healthcare leaders: They tend to develop blurry organizational visions, and they overuse value-laden rhetoric.

    A recent study of hundreds of hospitals’ vision and values statements revealed that they often do not result in a shared sense of purpose among employees. People share a common understanding of an ultimate goal only when a vision statement has vivid imagery coupled with a limited number of core values, according to a recent study “A (Blurry) Vision of the Future: How Leader Rhetoric About Ultimate Goals Influences Performance,” a recent study published in the Academy of Management Journal.

    For example, the study’s authors cite Martin Luther King, Jr.’s famous words: “I have a dream that one day, on the red hills of Georgia, the sons of former slaves and the sons of former slave owners will be able to sit down together ….”

    The imagery found in King’s speech allows the audience to develop a clear picture of the vision statement, which was an important factor in energizing the civil rights movement and changing the course of history, say the study’s authors Drew Carton of the Wharton School at the University of Pennsylvania, Chad Murphy of Oregon State University, and Jonathan Clark of Pennsylvania State University.

    Comparing Blurry Versus Effective Statements

    In contrast to King’s clear mental picture, the authors found that healthcare leaders tend to craft blurry visions like this one:

    We will be the leading healthcare delivery system in the community.

    The vision is then often further obscured by the addition of too many values. The study’s authors illustrate this point with the following example. A health system might state that the organization is motivated by these core values:

    • Quality—excellence in patient care and other work performed
    • Safety—for patients, employees and visitors
    • Caring—valuing differences and respecting the well-being and dignity of each person
    • Integrity—honesty and trustworthiness in all our affairs
    • Creativity—enhancing knowledge and discovering and sharing new ways to do things
    • Teamwork—commitment to working together to achieve goals
    • Patient, physician, and employee satisfaction—an environment in which all caregivers, employees, and patients are pleased with the outcomes provided

    Value statements like these, although well-intentioned, are likely to result in different interpretations among employees say the researchers. For example, “quality health care” can mean different things to different people, but the mental image of a smiling patient is likely to be shared by almost everyone.

    A more vivid mission statement might read:

    Our mission is to hear patients say we provide ideal patient care, see employees and volunteers smile because they’re happy to be at work, and have donors tell people that gifts to the hospital are among the best decisions they have ever made.

    A focused values statement might say that a hospital considers the following principles important:

    • Quality—care that puts patients first
    • Respect—regard for the dignity of all persons
    • Responsibility—stewardship over our human, financial, and environmental resources

    One of the more intriguing findings was that only a handful of the hospitals studied had vision statements with a significant number of image-based words in them, said Clark. “Most didn’t have any at all,” he said. “This means that the types of messages employees respond to best are the ones hospital leaders are least likely to craft.”

    The researchers speculate that most healthcare leaders aren’t using image-based vision statements because vivid images are more difficult to communicate and because leaders may believe they are “selling” the vision by presenting as many reasons for it (values) as possible.

    Linking Vision Statements to Results

    The researchers conclude that there is a strong relationship between image-based words and hospital performance and quality and that this relationship is stronger as the number of values decreases.

    The Connection Between Vision and Values
    The Connection Between Vision and Values

    To determine the link between vision statements and quality, the researchers gathered hospital data on profitability and cardiac patients’ readmission rates. Readmission rates were used as proxies for quality, and both readmission rates and profitability were compared to the vision and values statements of the respective organizations. The statements were scored based on the number of image-based words used.

    The researchers found that a large number of image-based words result in two fewer heart attack patient readmissions per hospital per year and a 2 percent improvement in return on assets (ROA). However, the link between image-based words, readmission prevention, and ROA improvement became weaker when the number of values expressed to staff increased. These findings were confirmed by subsequent controlled experiments, in which visions and values were randomly assigned to full-time employees working in teams.

    “In probing the data further, we found that the effect of imagery on performance was most positive when leaders expressed fewer values,” Clark says. This relationship reflects meaningful practical differences: for example, fewer heart attack patients requiring readmission.

    Developing Better Vision Statements

    Noting that it costs virtually nothing to change one’s rhetoric, the authors emphasize these key points:

    Consider removing a value from a statement. One way to winnow down the list of values is to submit each one to this test: “If we no longer communicated this value, would we retain—or perhaps even enhance—our distinctive identity?”

    Use image-based words. Especially useful as image-based words are nouns with physical features (e.g., “children” or “patients” rather than “people”), verbs that indicate observable actions (e.g., “smile” rather than “enjoy”), and words that refer to things that are familiar (e.g., “friends” or “parents”).

    Incorporate mental images. Tell stories with mental images everyone can relate to—for example, the smile on a patient’s face or the joy of a father seeing his newborn child for the first time.

    Consider various media. In some cases, leaders may be able to communicate visions effectively without using rhetoric at all. For example, videos or still images can be used to depict a desired future. For example, Cleveland Clinic’s video “Empathy: The Human Connection to Patient Care” video emphasizes the health system’s concern for the mental, physical, and spiritual well being of its patients.

    Communicating a Shared Purpose

    Rhetoric about organizational goals cannot merely establish a sense of purpose; rather, it should be aimed at establishing a shared sense of purpose. By adding image-based words and mental images to vision and value statements, healthcare leaders can establish a shared sense of purpose and succeed in the rapidly changing healthcare environment.

    J. Stuart Showalter, JD, MFS, is a contributing editor for HFMA.

    Interviewed for this article: Jonathan R. Clark is an assistant professor, Department of Health Policy and Administration, Pennsylvania State University, University Park, Penn.