If executive coach and consultant Quint Studer had his way, all business leaders would stop focusing on policies, procedure manuals and endless meetings and would instead become Fire Starters.

According to Studer-a former hospital president and 20-year healthcare veteran-Fire Starters were those invaluable individuals in ancient civilizations responsible for keeping the community fires burning and who taught others how to keep the flames alive. If they were successful, the tribe survived. If not, the flames would burn out and the tribe would slowly die off. Modern-day Fire Starters, Studer explains, must guarantee an organization's survival by conceiving great ideas and then making sure they're implemented by sparking everyone's enthusiasm.

"Once you become a Fire Starter, you spark the flame in others," Studer says. "The flame is passed from you to someone else and from that someone to another someone. Everyone in your organization gets drawn in. And in the end, you create a culture of excellence for everyone, which in turn creates better service for your customers and clients. It doesn't matter what field you're in or what problems your organization has. The sparks you light will make a difference, and it's amazing how good that feels."

Studer, founder and CEO of Gulf Breeze, Fla.-based executive coaching firm Studer Group, has authored two books on the subject of achieving meaningful corporate change: the best-selling Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference and 101 Answers to Questions Leaders Ask. He counts among his clients some of the nation's best-known healthcare institutions, including Shands Medical Center at the University of Florida, University of Chicago Hospitals and the Health Systems of Chicago. And Studer has sparked the interest of several local executives, including at Sarasota Memorial Hospital and the Sarasota County School District. (Pam Beitlich, Sarasota Memorial's director of patient services, in fact, credits Studer's philosophy with creating a "cultural shift" that has resulted in the hospital's turnaround in employee morale and patient satisfaction and, to a certain extent, a spike in revenues.)

So how does one implement real organizational change? Studer encourages companies to "hardwire excellence" by combining service excellence, leadership development and accountability systems. He insists that change can happen quickly once the corporate culture embraces his Five Pillars of Excellence (Service, People, Quality, Finance and Growth) and the following Nine Principles:

Principle 1:

Commit to Excellence

Unless you're willing to embrace change and make tough decisions, you will not be able to hardwire excellence throughout your organization. By committing to excellence, you are saying you will do what it takes to make your organization world-class. You want your employees to feel valued and your customers to feel that the service and quality they receive are extraordinary.

Principle 2:

Measure the Important Things

Define specific targets, align the necessary resources to hit those targets, and then measure progress and results. For example, when a hospital measured patient satisfaction and looked at the results for each doctor, one doctor with a particularly low satisfaction rating wanted to know why his scores were so low when clinical outcomes were high. It turned out that the doctor was perceived poorly by patients in the category of "listening." By looking at the data and adjusting his behavior, this physician markedly improved results.

Principle 3:

Build a Culture Around Service

Keep your organization's goals in front of you and then script behaviors to accomplish them. For example, organizations might develop a protocol of "key words at key times." In a hospital setting, this could mean taking an extra few seconds to explain to a patient why you are pulling the curtain shut between beds. The patient might think you are being rude or trying to hide something. A simple explanation, such as, "We want to make sure you have some privacy. Let me close the curtains for you," can go a long way to boost that patient's perception that you have his or her best interest in mind.

Principle 4:

Create and Develop Leaders

Invest in leaders by continuous training. Take them off-site every 90 days to participate in a Leadership Development Institute that focuses on a specific learning objective, such as maximizing staff scheduling, running an effective meeting, or addressing specific challenges the company faces.

Principle 5:

Focus on Employee Satisfaction

"Satisfied employees do a better job," says Studer. Employees want three things: to believe that the organization has the right purpose, to know that their job is worthwhile and to make a difference. Studer advocates "rounding for outcomes." Leaders and executives should go to the employees' work area and communicate with them on a regular basis. Ask what is going well and whether there is anyone in particular in the unit or division who deserves particular recognition, thereby giving fellow employees a chance to praise each other. Ask employees about improvements they'd like and whether they have the tools and equipment to do their jobs.

Principle 6:

Build Individual Accountability

Get your employees to act like owners instead of renters. "It's amazing what your staff will do when they feel ownership with an organization," Studer says. Encourage peer interviewing (existing employees take a personal interest in the new hire's success), and pay close attention to how a new employee is faring in the first 90 days.

"A lot of employees get discouraged in the first 90 days," Studer explains. "A new job can be overwhelming, so we encourage supervisors to sit down with employees and ask the following: How do we compare to what we said we were going to be like? Tell me what is going well and who has been helpful to you? What can we do better? Is there any reason why you would think about leaving?" These questions acknowledge that the new employee has certain expectations, helps to focus the new employee on the positive while opening up an opportunity for the new employee's peers to be recognized, and lets the employee know you value his or her input.

Principle 7:

Align Behaviors with Goals and Values

Create and implement objective, measurable evaluation systems such as monthly report cards and 90-day action plans. "Leader evaluation tools are not always easy to implement," Studer says. "They force senior leaders to ask soul-searching questions like, what are the top priorities? How do we weigh them? Which things should we stop doing or do less of? What do we do with leaders who are not hitting the targets?"

These tools quickly separate the high, middle and low performers. The result is that low performers become evident and visible, and if their behavior is not addressed by senior leadership, then senior leadership loses credibility. Studer says most leaders and staff know who the low performers are. This tool makes it impossible to avoid taking action.

Principle 8:

Communicate at All Levels

Change occurs when everyone understands what is important and how to accomplish organizational goals. "An organization can't be confident that it is doing a good job at communicating," says Studer, "until the cashiers in the cafeteria have the same information about the organization's goals, direction and progress that the vice presidents have." He recommends "managing up" tactics: Send your bosses a thank-you note for something specific they may have done for you; or provide them with information so they can connect personally with staff, spotlight performers to the higher-ups, and let clients know about your skill sets.

Principle 9:

Recognize and Reward Success

Hardwire rewards and recognition. Hand out employee recognition cards and thank-you notes, even for leaders like physicians and senior managers. Be generous with compliments. "If you give a staff member one compliment and one criticism, it equals a negative relationship," Studer says. "But if you give them three compliments to one criticism, it will equal a positive relationship."

A HOSPITAL'S TALE

Sarasota Memorial tries the Studer approach.

Pam Beitlich, Sarasota Memorial Hospital's director of patient services, keeps on her desk a dog-eared copy of Hardwiring Excellence by Quint Studer. She lovingly refers to it as "the bible" and to Studer as Sarasota Memorial's guru, and credits both with the hospital's turnaround in employee morale and patient satisfaction and, to a certain extent, a spike in revenues.

"Back in 1998, when I was working as the administrative director for women and children's services, there was a real disconnect at Sarasota Memorial between the leadership and the staff," Beitlich says. "We were doing things like measuring patient satisfaction, but we weren't doing anything with the information. Employee morale was low and the hospital was losing money."

Beitlich, with several hospital colleagues, decided to see if they could do something about that. The team benchmarked several hospitals including Baptist Hospital in Pensacola. That's where they first encountered Quint Studer, the CEO at Baptist, and learned about his Five Pillars of Excellence.

Today, if you walk through the lobby of SMH you'll see a wall representation of the Five Pillars-Service, People, Quality/Safety, Finance and Growth. Beitlich stands proudly by the display. "The pillars all relate to one another. What we learned from benchmarking with Baptist and talking to Quint was that if you're not providing great service and quality and employing the best people, you're not going to have the volume you need to keep solvent."

The hospital now consistently rates high in its patient and employee satisfaction surveys and in 2003 received Magnet designation, the highest honor a healthcare facility can receive from the American Nurses Credentialing Center. Less than 3 percent of the nation's hospitals have received the designation.

SMH instituted several steps to improve overall service. If you pass a hospital staff member in the corridors, expect a warm "hello" and a smile. Can't find a particular office, patient room or department? A hospital employee will be glad to escort you. And if you ever find yourself a patient being transported on a stretcher onto one of the hospital's elevators, your attendant will do his or her best to secure your privacy by politely asking people to wait for the next elevator.

These customer-friendly acts aren't just suggestions for how hospital employees should behave; they are, to use a favorite Studer term, "hardwired" into the hospital's system. Each employee is required to read a 30-page Standards of Behavior handbook and sign a pledge to adhere to its principles.

Beitlich says they've also improved standards for hiring and retention of staff. Each prospective employee is subjected to peer review during the hiring process. And Beitlich makes no bones about firing people who are not meeting the hospital's high standards. "If someone is interfering with our mission or imposing a negative impact on staff, we will not hesitate to free up their careers by asking them to leave," she says. "Our goal is to create a great environment so people want to work here."

Service is also a key aspect of SMH's new culture. "In our patients' minds, if you answer the call light quickly, that says you care about them. So they feel that they are getting good service. But this also translates into quality. If an attendant answers the call-light quickly, they avoid a situation where a patient tries to get up themselves to get to the bathroom and gets hurt."

Much of the success of Studer's methods comes from his top-down approach. Leadership buy-in is an absolute necessity. The hospital also invests in training its managers, and executives participate in Leadership Institutes to review progress and set goals every 90 days.

"If you take a charge nurse who is good clinically and make her a director without giving her direction and training, you are setting her up for failure. Great organizations develop their leaders. We take the time to make sure that leaders are given the skills they need to lead effectively," Beitlich explains.

The Studer approach, Beitlich insists, shouldn't be referred to as a "program." "What we have really done here at Sarasota Memorial is create a culture shift. We are focused on running a better hospital-for our patients and for our staff."