At San Diego-based Scripps Health, CEO Chris Van Gorder has stuck with a few leadership philosophies over the course of his 23-year tenure, including radical transparency with more than 2,500 physicians.
This spring, five-hospital Scripps clinched a spot on Fortune's annual list of the 100 Best Companies to Work For, one of only three U.S. health systems to earn the recognition in 2023 compared to eight systems a year prior.
"I am most proud of this last one," Mr. Van Gorder said about the distinction, which Scripps has earned for 15 years now. "Life has been really hard on hospital workers. There are so many external factors that we can't manage, but we made the list."
When asked what helped buoy Scripps as a strong workplace throughout a tumultuous time for hospitals, Mr. Van Gorder pointed to two big contributing factors: transparency and managers.
'I don't sugarcoat anything'
Transparency can oftentimes be discussed as a fixed state, in which the leaders and organizations that most powerfully champion transparent communications have a track record of doing so for years. Mr. Van Gorder's perspective on the topic is a little different, in that his first impression of Scripps was when it was relatively opaque. Answers were harder to find, communication was less forthcoming and the same information was not accessible to all.
"When I came here almost 24 years ago, we were not a transparent organization," Mr. Van Gorder says. "We did not share financial information with anyone aside from the board of trustees. I came in as COO, and within six months there were votes of no confidence against the CEO, who was a physician and a brilliant strategic thinker but not transparent."
Mr. Van Gorder was appointed CEO in 2000 and set out to build a more open culture, starting with Scripps' physicians. The first structure he created, as interim CEO, was the Physician Leadership Cabinet, which is an advisory body made up of medical staff and physicians elected by their peers. Mr. Van Gorder sees it as the second most powerful body at Scripps Health, with the board of trustees first.
The physicians set the agenda for the group's monthly meetings. Three things are off limits: anything protected by HIPAA, personnel issues as they relate to individual people, and anything protected by a nondisclosure agreement.
"Beyond that, everything is fair game," says Mr. Van Gorder. "You want to ask about my compensation? I'll talk about how that is decided by the board of trustees and an outside consultant. When you're answering questions candidly, it is what it is — I don't sugarcoat anything."
The Physician Leadership Cabinet was established 23 years ago and continues to deliver strong cultural benefits to Scripps, which has more than 100 physicians in leadership positions. For one, Mr. Van Gorder says the cabinet helps close a gap of information that can widen and fuel speculation if not managed. When people have the same information available to them, they can better understand how decisions are reached and made. This is key to overcoming the divisions that have historically plagued hospital administrators, physicians and front-line staff.
"If we can find a way to fill the gap of information, people with the same information would very likely make the same decision," Mr. Van Gorder says. "I learned that as the vice president of a hospital. The physicians on the board would campaign against administration to get on the board, and then they'd agree with the board 100 percent of the time."
Throughout Scripps, Mr. Van Gorder upholds the same expectation from the workforce at large. Got a question? Ask away. And he doesn't want softballs, either. At a recent open forum, he encouraged employees to come with at least two questions.
"And I'd like you to hit me with the hard ones," he said.
Employees typically start off cautiously, but then someone will raise a hand and get a bit bolder. Instead of reluctance or surprise, they are met with praise.
"I say, 'That's what I want to hear from you — the questions that are really on your mind,'" says Mr. Van Gorder. "There is nothing more powerful than a colleague asking a question."
Strong support for middle management
The past few years have brought a variety of professional challenges for all levels of the workforce, but middle managers were often in a uniquely difficult position and underappreciated.
Middle managers are charged to uphold and carry out the vision and values of their senior leadership team while also championing the needs of direct reports. This can feel like a tightrope act, especially throughout the Great Resignation and the more palpable period of quiet quitting. Since the pandemic, numerous surveys have illustrated the middle manager bench as burnt out and struggling with workloads and demands, with many eager to quit.
At Scripps, Mr. Van Gorder is quick and adamant in crediting middle managers for the health system once again earning recognition as a great place to work. He was once a middle manager, too, and found the job extremely demanding.
"I was administrative manager of a clinical laboratory after I had been promoted from being a security officer. I had 17 people reporting to me, and I never really had any management training," he says. "I lasted a year. I never realized how many problems people brought to work with them, and I wasn't prepared for it."
Lessons learned firsthand informed Mr. Van Gorder's approach to supporting middle management and ensuring they have the tools, development and access to do their jobs well. The system has a program for first-time managers, which involves a year-long orientation that covers information big and small, from values to payroll. Mr. Van Gorder joins the classes throughout.
"I meet with them in the very first session, and the first thing I tell them is that I will never miss coming to that class," he says. "You represent me. To this entire organization, you are me. We are such a large organization that an employee may be here for years before I get the chance to meet them. The company is represented by that front-line supervisor. I need you to be successful."
He also ensures each middle manager has his contact information should a problem, question or predicament ever reach a point where his guidance is needed immediately.
"Use your chain of command, but if you have to, come to me," Mr. Van Gorder tells them. "If I have to move resources around to have you be successful, I will do that. Your job is to take care of your people. You need to be an advocate for your people, and if you are, you won't just join them and complain — you'll teach or run it up the chain of command and effect a change to help them.
"That's your job and you can come to me anytime you want. If you can't get an answer from anyone else, email me. If I have the answer, I'll give you the answer. If I don't have the answer, I'll find out and get you the answer."