Executive Summary
Evolving the culture is difficult in any organization, but it’s a particular challenge in health care where change comes slowly, if at all. Novant Health, a North Carolina-based network of 15 medical centers, uses a shared reading program to shape the culture. The system-wide free-book program invites staff at all levels and in every role to read a book together and explore themes related to patient care or personal and professional development.
Evolving the culture is difficult in any organization, but it’s a particular challenge in health care where change comes slowly, if at all. At Novant Health, a North Carolina-based network of 15 medical centers, we have found a powerful and perhaps unexpected tool for influencing our culture: a shared reading program.
For the past five years we have offered a voluntary, system-wide free-book program for our more than 28,000 team members called Novant Health Reads, in which we invite staff at all levels and in every role to read a book together and explore themes related to patient care or personal and professional development. We carefully review books to find ones that will resonate for a health care readership, speaking to the unique challenges they face. We have invited the authors of the selected books to come in person for a culminating keynote address that is live-streamed and recorded so that all team members have an opportunity to watch. In addition, we offer complementary content around the chosen theme.
Many companies have book clubs, providing copies of books for employees or leadership and using them as supplementary training tools. Several even have larger corporate discussion programs. But it is our careful selection and integration process that makes this program more than a book club, and more than book discussion. While those programs typically focus on a honing a specific strategic capability – say leading teams or improving sales skills – our initiative is designed to engage staff with change initiatives by exposing them to points of view from renowned authors that align with the organizational vision. We choose books not only for their value in supporting the organization’s work, but for their ability to resonate at a personal level for team members regardless of their role.
Insight Center
We kicked off Novant Health Reads in 2015 with 8,500 copies of Being Mortal by Atul Gawande. As with all books in the program, we arranged with the publisher for a special edition with our logo on the cover and a letter from our CEO inside. We chose Being Mortal to help team members understand the importance of Choices and Champions, a new initiative to transform how we deliver end-of-life care that focuses on knowing and honoring patient wishes. Although we had used many tactics to improve care at the end of life we struggled to get busy clinicians to have conversations with seriously ill patients. Discussing Being Mortal and engaging with the related educational resources and tools we had created helped our team members understand the purpose behind our expanded, long-term focus on end-of-life care. Dr. Gawande’s sharing of his own journey around his father’s death also helped team members see these issues as personally relevant and begin having conversations with their own families. The inaugural program culminated in a live event with Dr. Gawande that was broadcast to 180 locations throughout Novant Health. All of this generated rich discussion around end-of-life issues and helped encourage a more open and empathetic culture around death and dying.
Following Being Mortal, in 2016 we turned to Shawn Achor’s book The Happiness Advantage, distributed to 15,000 readers, which flipped from the clinical focus to personal development. With its focus on developing a positive mindset to improve energy, creativity, and productivity, the reading and discussion program supported an array of initiatives around team-member engagement, satisfaction and reducing burn-out. Tenets from The Happiness Advantage have also been used in new-physician orientation programs and have been incorporated into a revised employee handbook.
Year three returned the focus to a clinical topic, the need to eliminate stigma and improve access to care for people with chronic brain diseases such as mental illness or addiction. We handed out more than 17,000 copies of A Common Struggle, written by former congressman Patrick Kennedy, and through this book and related programming generated an outpouring of personal stories. Melissa Perrell Parker, VP of patient services and patient advocacy officer, spoke about and wrote a series of articles for our internal newsletter sharing her personal journey as a parent of a child with bipolar disorder and drug addiction; this inspired hundreds of team members to offer up their own accounts of dealing with mental illness and addiction. These efforts helped to accelerate Novant Health’s work in tackling the opioid epidemic and was the driver in creating a committee focused on reducing the stigma surrounding addiction. During his visit, physicians, administrative leaders and government relations team members met with Kennedy to discuss national and local efforts to address the epidemic and what further work is needed. The program around this reading ultimately led us to substantially reduce the co-pay for mental health and addiction services and make access to care simpler and more affordable for our own staff. As a result of these efforts, we received an Outstanding Recovery Ally Award from the North Carolina Addiction Professionals Association.
In 2018, we selected Type R: Transformative Resilience for Thriving in a Turbulent World, by Ama Marston and Stephanie Marston, a book about a certain type of resilience — turning challenges into opportunities, and “springing forward rather than merely bouncing back.” In a healthcare system, as with parenting or leadership or any service occupation, personal resilience is essential, and it is vital to regularly refuel in order to maintain it and serve others well. The Type R reading and related programs – including writing groups and a webinar — emphasized the importance of resilience for clinicians and leaders on an individual level and as members of the broader community, and reinforced our existing resiliency program. More importantly, the discussions around the 16,000 copies we distributed of this book led to the formation of a formal organizational resiliency model that is now being used at Novant Health. The program also included a video on resilience and system-wide discussion groups that focused on increasing awareness of ACEs (adverse childhood experiences) that can lead to life-long social and health challenges – and how clinicians can help connect patients who experienced childhood trauma to supports that can draw on, and enhance, their resilience.
This year, we are reading In Shock by Rana Awdish, a critical care doctor’s account of suddenly becoming a dying patient and her perceptions about the shortcomings of the current system, and ways to improve it. We handed out 17,000 copies of this one. Leaders held virtual book discussions using Zoom remote conferencing and staff at all levels shared their own experiences as patients. We are now developing a program to help clinicians deal with the often unexpressed grief they feel when they lose patients.
The enthusiasm readers across the organization have shown for Novant’s Health Reads and the positive changes that have flowed from it suggest that any health care organization could benefit from embarking on a similar initiative. One of our physicians, Steve Stinson, described the initiative as “a program that nourishes our soul.” If you’d like to learn more about it, email us at NovantHealthReads@NovantHealth.org.