Chris Van Gorder, CEO of Scripps Health in San Diego, began his career on the front-line, first as a policeman, and then — after a career-ending injury — as a hospital security guard. His new book, out today, "The Front-Line Leader: Building a High-Performance Organization from the Ground Up" (Jossey-Bass, 2014), shares leadership lessons from his decades in the healthcare industry. Mr. Van Gorder, who led Scripps' remarkable $150 million turnaround after being named chief executive in 2000, will donate all sales from the book back to the health system he leads.
Here, Mr. Van Gorder discusses with Becker's Hospital Review the book's release, his leadership philosophy and the most important lessons he's learned during his career. 
Q: Your book is titled "The Front-Line Leader: Building an Organization from the Ground Up," but the book is clearly directed at high-level leaders. Aren't they, by definition, not front-line leaders?
Chris Van Gorder: Well it's interesting, to be very honest with you, the title wasn't my first choice for the book, but the publisher liked the concept. The theme for the entire book is about leaders not sitting in the C-suite and issuing orders, but really working side-by-side with others and getting deeply involved in the organization.
Q: You seem to put a lot of effort into getting yourself on the front-lines and working side-by-side with others. Why is that so critical in your opinion?
CV: Just yesterday, I spent nearly the entire day at one of our hospitals, Scripps Mercy San Diego, after getting a call from the Sheriff's office about a deputy who was badly injured and was being taken to the hospital. I spent most of the day with the sheriff and the deputy's family, and I had a chance to watch the staff and doctors. I oversaw a nurse talking to his family; she told them he was talking when he arrived and was never alone. You could see the family start to relax at that point. I never would have seen that if I'd stayed in my building, nor would I have had the opportunity to tell the staff how much I appreciated what they did. I sent them all a note last night to let them know how much I appreciated their work.
Q: How does that exposure to the front-line help you as a leader?
CV: I manage a $2 billion company; it's pretty easy to get distant from what you actually do if you don't work to observe the front-lines of your organization. That's front-line leadership. I feel a real connection with the staff at Scripps and the doctors at Scripps; I've been to plenty of organizations where the CEO didn't have that connection. When you don't have that connection, you don't make good decisions.
If I make decision that either helps or hurts our people, I realize I'm affecting real people. I'm affecting their lives, and that makes you much more conscientious about decisions you make involving your people. And, from the other end, interacting with the front-lines helps employees realize you're a regular person with kids, a life and a dog. All of a sudden, that takes this sense of inapproachability away and makes you more relatable to them.
Q: In the book you write, "Psychological distance can by extremely dangerous for leaders" and emphasize the importance of conveying the idea of working "together" with employees, not them working for you. Did you know there's actual research suggesting that just using the word 'together' leads to more engaged employees?
CV: It's interesting; I did see that research. I think psychological distance is dangerous in two ways. If you're too far away and too distant from the impact of your decisions on people, you could be hardened. You don't really think about impact on front-line. But I also think it's dangerous to get too close as well.
Q: I love the anecdote you mention in the book about your days as a hospital security guard. You tell the story of running into the hospital CEO in the basement in the middle of the night; you were excited for the encounter, but then he passed you like you weren't even there. That happened some 30-40 years ago, and you still remember it! It must have really influenced you.
CV: It had a profound impact on me. I'd never seen him. I didn't think it was going to be a long conversation, but I thought at least he'd acknowledge me or shake my hand. Instead, he walked right by. He was a good CEO; he did a good job running that hospital, but I don't think he had a connection with the front-line. He managed managers, and he let them manage the front-line staff.
I aspired someday to be a manager — of course I had no idea I'd be a CEO — and I promised myself I would acknowledge everybody and their work. If you're getting a paycheck from the organization, you're doing something of value, and that's worth being acknowledged. Today I go to nearly every new employee orientation so that I can meet as many employees as possible.
Q: In the book you mention that Scripps' VPs perform an exercise where they simply sit in the lobby for an hour and observe what's going on. Almost all come away with ideas for improvement. Have you ever done this? What did you learn?
CV: Just yesterday I was doing that, though not in the lobby but in the Mercy Scripps hallway. I was just standing in the hallway, watching staff go in and out, watching the facility. Mercy is getting a bit older, and we're going to have to replace it at a cost of $1.2 billion. That's a big number, but when I saw it, when I observed, I saw that we really do need to rebuild this hospital. You see things differently sometimes when you stop with the intent to observe.
Q: Reading the book, it's very clear you to me you are a humble leader. In one section you write, "I didn't do anything, the people around me have made me successful." I found that comment really telling, given that some recent research suggests that humble managers are more likely to have engaged and autonomous employees than less humble leaders. Why do you think having humility is so impactful?
CV: I am not my title. Believe me, I'm not so sure I'm always as humble as I ought to be, but when you go to the front-line and see a very skilled surgeon saving a life, that will make you humble. That's not something I can do. If you watch a nurse holding a mom's hand, well, that's something I could do, but I'm not so sure I could do it like an experienced clinician could. When I see that sort of thing, I feel incredibly humble. Yesterday at Mercy, I was the least important person there to the family of the injured deputy. If leaders go to where the work is being done, it's almost impossible not to be humble.
Q: If you had to take all the advice in your book and boil it down into a single sentence, what would it be? What is the most important thing leaders can do to improve their organizations?
CV: Leadership is about three things: responsibility, authority and accountability. What I have found from a management standpoint is, if you move up in an organization, you're going to be given more responsibility and authority. But, you need to embrace accountability too. You can't focus on making a profit at the expense of other pieces of the organization that are important. What frustrates me today is when people in leadership roles make excuses or blame others for problems or challenges. When you do that, the message you're sending is I don't want to be accountable. Leaders must hold themselves and others accountable.