How to Shape Workplace Culture in 2027
How Endeavor Health Is Building One Culture Across Four Health Systems
In this episode of the HR Leaders Podcast, I sit down with Dianna Sparacino, MBA, SPHR, Chief People Officer at Endeavor Health, to explore how the organisation is bringing multiple healthcare institutions together as one system while continuing to protect what matters most to its people, patients and communities.
For HR leaders, the conversation raises a bigger question about the connection between employee experience and patient experience. From supporting frontline caregivers to experimenting with AI, knowledge transfer and new approaches to leadership development, Dianna shares what Endeavor is learning as it continues building one organisation from several distinct histories.
5 things you’ll learn from this episode:
The difficult balance Endeavor had to navigate when bringing four healthcare organisations into one system
Why frontline leaders may be the difference between employees understanding a transformation and simply experiencing more change
What prompted Endeavor to move from allowing culture to evolve naturally to shaping it much more intentionally
How the organisation is thinking about the relationship between employee experience and the quality of patient care
Where AI, simulation and new technology could help solve some of healthcare's toughest time, knowledge and capability challenges
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Diana, welcome to the show. How are you doing? I'm doing great, Chris. How are you? I'm good, I'm good. How's life? How's family?
[01:00:08:22 - 01:01:03:15]
Family is great. All out of the house, living their best lives, I would say. How old are they? They are 22, 24, 26, all girls. Oh, wow. All girls. All employed. All girls and all employed. All employed. What's the spectrum of jobs that they've jumped in? I love the early age first jobs. Like it's so, what they jumped into. Yeah, so interestingly, my 26 year old actually works for an out placement firm. Wow, okay. You can't make that up. They're kind of in just a little industry. Touch points. My middle daughter is a mental health therapist and yoga instructor. So interesting combination. And then my youngest just started a job at a IT staffing firm. Nice. So it's like, they're kind of all somewhat
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in the spaces in some way, you know, that's interesting. Yeah, they all have people connections, right? I mean, the youngest is doing sales, which is a little different, but still sales in the, how do you connect people with employment? Sales is unbelievable way to start. Like I think I mentioned my back, I started in sales at 17 and it's the, it changed my entire life. The skills that I built there, the people skills, the negotiation skills, the ability to be resilient when you get a nose. There's just so much that I at the time I was thinking, I really don't want to do this sales stuff. And I look back now and I think, wow, that jumping in there can fully change my entire life. Cause once you know that to sell, you're always going to be employed. Yeah, it doesn't matter about AI and change. You can sell yourself and sell something you're good.
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So congrats. So how's it feel now to be the empty nest?
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You know, it's a fine phase of life, you know?
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We enjoy our adult children. I'm someone who would say, you know, I think whether it's, excuse me, my career or my kids,
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you know, I've enjoyed all the different phases.
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And when it was ready to move on to the next phase, I was okay with it. Yeah. So. Love that for you. Talking about careers for yourself, tell everyone a bit about your journey. You know, did HR choose you? Did you choose it along the way?
[01:02:44:11 - 01:03:55:16]
You know, I would say I chose it, but very early on, you know, I have been in my career and in HR my entire life. Growing up, I always thought I'd go to law school and made a senior year pivot and said, no, I'm not gonna go to law school. So I really, people always are amazed that I did this, but I started going to the, I moved to Chicago, started going to the library, reading about different jobs, made a lot of connections and chose human resources because I felt like it was a really good combination of analytics, critical thinking, and people and relationships. And I think that has proven true throughout my entire career. Wow. It's incredible that you saw that so early on. Like the, because I know most people wouldn't have made that connection, right? Between, so especially the analytics side and other sides, right, that we see now, obviously, is very, it's one of the reasons I stayed in for 20 years, because I could see the progression of the industry. And I was like, I want to be part of that as well. But it's amazing that you saw that so early on.
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It is, so it's interesting that you say that. And I mean, I wonder, I knew the analytics and people side, whether I appreciated how much at 22 years old is debatable. Same for me, yeah.
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But it has proven very true. How do you think, if you look at your back at your career, like, and you think about it maybe as like chapters, how do you see that journey? And so it's the way we are now.
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Yeah, so you hear a lot of people talk about, HR has gone from personnel to, which was seen as very transactional.
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In the HR world, you hear a lot about, do I have a seat at the table? Meaning, are you really working with business leaders now to help make strategic decisions, right? And like have that seat at the table. And I do think that has evolved a lot. And I think when you think about healthcare and what we're doing right now, healthcare is, it's a people business, right?
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We work at Endeavor to deliver the best patient care and quality outcomes, great experience for our patients. And in order to do that, we really have to focus on our people, on our frontline workers, our frontline leaders, because that's how you get to excellent patient care. And so I think if I pull that back to, I think what's nice about healthcare is you do talk at a very senior level about what's the impact on people and your operations leaders are very focused on what's the impact on your people, which is nice. Which then of course, is there a ripple effect to your customers, right? Who you're serving. I'm sorry. Which is then the ripple effect to your patients, right? And customers who you serve, right? I'm sure there's a very strong why and purpose amongst the team.
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Yes, there is when you talk to frontline people, and I'm caregivers, let's just, let's call, they're caregivers, that's what they do and that's who they are. And I think a lot of what we try to focus on is trying to get things out of the way so our caregivers can do what they do best, right? So, if you take that to, I think it's really important for HR leaders to be in touch with caregivers and operations and for that strategic and people lens to be talked about at every level of the organization. Yeah, it's challenging in a not in office environment, but in the frontline environment, it's even more challenging. How do you ensure that you have a pulse and stay connected with those caregivers?
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So, I think that's the challenge in business.
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Everywhere, it's just even more important. So, what we talk about a lot is how do we support our frontline leaders? We often say frontline leaders have the hardest job in the organization. They are asked to convey so much information. They are asked to lead people who are caring for people at their most vulnerable moments. It's a very difficult job. So, we are spending a lot of time now with how do we help them more? How do we help them with communication? How do we help them understand why decisions are made so that they can convey that information to our caregivers and help our caregivers have confidence and support them? And we came out of COVID and I think that frontline leader job got very hard, right? Because during COVID, it wasn't just about how do we be a good leader, but we're driving the business, right? We wanna make sure we're performing well, we're caring well. I think many frontline leaders everywhere also became in some way counselors, right? And they became very, they became ears to their employees. And everybody was dealing with so much that I think frontline, a lot of leaders had to
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really be listening to more personal or helping people navigate the unknown. And I think now that we're coming out of,
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we're what, six years out from COVID, now we're trying to reposition in a difficult economy. How do we now drive performance and be that supportive organization, right? And so I think there's a lot we need to do to position our leaders to manage both of those things differently than maybe they did pre-COVID during COVID. Yeah, it was tough, right? Because we speak now a lot about leading with empathy. Right, that wasn't something that, when I was a manager, it wasn't a thing that came up, right? And I feel like many of our leaders and managers were not really prepared or supported in many organizations or have to really necessarily skills or even clear communication of like, where do you signpost people, right? Because you don't have all the answers and that's okay, you're not supposed to have all the answers. But at the same time, to your point, we saw a lot of, especially amongst our community, a lot of managers burning out during that time. So not only now am I here to support my team, but I'm trying to take care of me as well, and the business and deliver on my day to day is a lot to ask, but they are crucial to your point of delivering and conveying that message for the organization as well. One of the things that I'm interested to talk about is that you've helped bring four, if I'm correct, health systems together into Endeavor Health, if I remember that correctly,
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what would you say is the hardest part of getting people to feel like one team, but also at the same time respecting the organizations that they came from? Does that make sense? Yeah, it does make sense. And yes, we have over the past six years brought four different institutions, healthcare institutions together. I think there's a couple things that I would highlight. First of all,
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the health systems that we brought together,
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there were some very important similarities, very community focused. So when we brought our systems together, the North Star for all of the systems care of the patient and care for the community. Now, I wouldn't say that means that all four of the institutions were the same because they were very different, but there was a similar North Star, which I think helped as a core unification.
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But when we bring folks together, what you said is really important. And one of the things I always say is we have to help honor the past while we move forward into a different future.
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So when we brought the four institutions together, we always thought about that. We always talked about that. We did a lot of listening. And we came into this as we, and we were very focused on being one system. We were not a federation of different groups. We came together as one system. So we did drive significant amounts of change for everybody. But what we talked a lot about at Endeavor was no one group, no one team,
[01:12:58:11 - 01:14:00:06]
no one hospital system is doing everything right. And our goal is to learn from each other and really focus on the best of what each organization can do. That was a core principle. And that took time, right? That absolutely took time. It took a lot of patience, a lot of collaboration, and a lot of listening. But we did that, and then we took some very big steps to operate as one system. I mean, we aligned our benefit programs. We aligned a lot of the things that touch employees, which was hard in doing it, but then there was, we did it transparently. We did it with the sense of, we wanna be fair across all of our team members. And so, and everybody felt some change. And so it was a little bit of different pain, but shared pain.
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But they were shared experiences. And I think we spell out, once we did some of those big things,
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I think we all had to live a little bit in the discomfort.
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And maybe it felt a little bit of ambiguity. We all had to live in that a little bit in order to get to the other side. And once we got to know each other, that's when we got very intentional about how we build our shared culture, how we built our shared culture. And that's the journey that we've been on as we come together over the last couple of years.
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And so with a couple of premises, honor the past, while together we move forward towards the future to make things better for our patients, for our communities and our team members,
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that became our focus. We developed our shared mission and our shared vision. And I think our shared vision is really, really important because it's safe, seamless, and personal, every person, every time. And we were intentional about every person, every time, because that applies to our patients and the experience we wanna create for our patients, but it also applies to our team members and the experience that we want to create for our team members. And the parallels become very important. And the actions that we take are aspirational. I mean, healthcare is not easy, right? But we are working towards making it seamless. Sometimes employment, staffing shortages, changes that you're gonna make, that's not easy either, but we're gonna aspire to make it more seamless. We're gonna always work on safety and make sure we are keeping our people safe. And we want to think about the experience in a personal way for our employees. So those parallels really helped us in honoring the past. Oh, I love that. When you think about, and it is a journey, of course, so it never really ends, it's ongoing. But having gone through that the last couple of years, what are some of the lessons that you learned
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that you know now that you wish you knew,
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coming into this?
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Yeah, so a couple of things. So let me think about what I would say. There are some things that I think
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we need to move a little faster on, right?
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Sometimes, so it's that balance of collaborating, listening, hearing, and moving at pace. And I think sometimes, even with integrating teams, we may have over-indexed on the collaboration side sometimes. And that made us maybe not move as fast as we probably would in the future. Yeah, that's understandable. So that's always balanced. Yeah, it's hard to find that balance because if you go too far, she'll leave people behind. And then obviously they're disengaged, et cetera. If you go too slow, then obviously, you're not having the impact and the transformation that you need. It makes sense to be on the journey.
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What did this mean for, from the lens of employee experience, patient experience, in my mind, those things are inseparable. Can you share an example of like, that really brings that connection to life for the new lens, the new why, the purpose, the mission, and how you're making sure that that isn't just the words on the wall, but it actually shows up, does that make sense? Yeah, yeah, so absolutely. So we started with our mission and vision. And then when we really got into what I would say is our intentional culture journey, the first thing that we started talking about is we'd been together long enough that you could say culture is going to form.
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And so let's intentionally shape what that looks like. So we did, and we did this internally, and we started through really using a lot of AI to take all the different listening forms that we have done over the past few years with all of our different teams, and really understanding through a lot of, I guess, concatenation of data to say,
[01:18:48:21 - 01:19:57:23]
what are we hearing from our people what's really good about our culture, and where can, as we have come together, where can we improve? So we did a lot of that, and then we brought our top 500 leaders together, clinical leaders, as well as administrative leaders, to intentionally build this together. And we started with a revamp of our values, right? So when we think about culture, what we really talked to people about, and there's a Harvard Business Review article on this that links culture, strategy, and purpose as a triangle, right, and that those three things need to be in balance, and really, culture is the one that glues purpose and strategy. To think about those three things together. And we use that as a backdrop for how we intentionally build our culture journey with our leaders.
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And then we started with a revamp of really thinking about our values and what was important.
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And we talked about our culture journey that we need to live with our values at the center. Everything we should do is with our values at the center, and that the reason we're bringing 500 leaders together is because the most important thing in shaping culture is leadership, right? And culture is not something, to your point, that you say it's how we do things around here, how we do things around here consistently. So I think I'm gonna get to kind of answering your question. So then what we think about is our values are how we behave. When we think about ourselves as a health system, what do we really wanna be doing? We wanna be highly reliable, right? For our patients, for our communities, and for our team members.
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Because that drives excellent quality care. It drives a personal and great experience for everyone. So what we actually started to do was think about our culture is really made up of our behaviors and with our values at the center. So that's how we behave. High reliability becomes how we perform, right? How we perform for our patients every day and for our people. And high reliability is something that's been part of healthcare for a very, very, very long time.
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But linking it so intentionally to our behaviors
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and making it a true part of our culture so that we get great patient care is part of our journey. And then I think the last thing that we link and say, this is our definition of how we do things around here, our culture, is really some of our protocols for execution. Because you've gotta execute well, that's how we perform. So when we think of it, so what we try to do in doing this is really be very intentional as we talk to everybody on how we link these things and how it becomes really important in our day-to-day work. So it's not just values on a wall. It's embedded throughout our work. And I'm not, I would, we are, are we there? No, I don't think you're ever fully there. Like what you said, culture is a journey.
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We are working towards continuously improving and living this every day. Yeah, I mean, I think one of the key things, right, to your point, though, is like looking, whenever you're thinking about a strategy, a change, even a technology, is looking it through that lens. They're talking about that kind of creates sort of the foundational decision-making. I even find it here, whenever we're going through a lot of change, like so much going on, okay, we have our foundation of our culture, our values, our mission, our purpose, like let's just start here again and say, is this serving that? And if the answer is no, we move on. So sometimes it makes things really easy, actually, when you are really living through that, right? And you look at that, look at every, our decision-making through those lenses, and then it's like, oh, okay, that's very clear, we move on.
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That's the direction we're going now because it's not serving where we want to go, if that makes sense.
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It absolutely does. And I think as we built this, we did a little bit of a parallel work, and you heard me talk about our North Star as always, of all organizations has been our patients in our communities at the center. We actually start, separate from our mission, vision, those are always there, we actually thought about where do we want to go in the future? And we, whether you're familiar, we thought about the John F. Kennedy story when he goes to NASA and asks a,
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the man who is sweeping the floors, oh, so what do you do here? President Kennedy asks him, and the man says, I'm helping put a man on the moon, right? Which is like a beautiful unification of what everybody's doing. So we articulated a North Star as building world-class care in the communities we call home, right? And so, and what we really started thinking about is with all of this, how can we have every person think about, what am I doing to build world-class care? How am I contributing? Because everybody does. Yeah.
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And so that became part of how we talk about things. That's really powerful, because that can get lost a lot of times, even me and my career after 10 years in the same company, I remember watching, I always say this, like I always remember the moment I saw the TED Talk to Simon Sinek start with why, and to your point, and I was like, what is my why? And I didn't have an answer, and that really stuck with me. You know, that Janet is sweeping the floor, had a very strong why.
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This is why I'm sweeping these floors every day. And so I think it's important that every employee needs to understand what does it mean for Chris? Like, what is my contribution to this mission, where we're going? And you can't over communicate that.
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It is to be constantly be showing up, right? In the way we work, in the conversations, and to your point of behaviors as well. Because once you do that, and everyone's clear on what that shared mission is, it's very powerful. You can, that's where you get a lot of momentum.
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And that, you know, that's why, I mean, to what I said earlier, that's why the role of the leader is, it's paramount to this success, and we have to support the leaders all along. Because it's not just cascading messages, it's translating messages into what does that mean, to every person. It's giving that context, it's creating clarity. And it's helping each person understand these things with a degree of conviction, that makes them believe. So we got lots of work to do, but that's what we believe. So does everyone. When you speak to your carers, your nurses, if you ask them, what would you love to spend less time doing? What would, do you think they would say?
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So if we looked at our nurses,
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they would like, they would, let me twist that for a second, what they would like to spend more time doing. Yeah, okay, let's do a positive lens. (Laughs) Let's switch to a positive. What do you want to spend more time doing, yes. They want to spend more time actually talking with their patients, you know, caregiving. And there's a lot of, as you know, there's staffing shortages, there's lots of different things going on, that make it harder to do that. Nurses are amazing, they're just, they're amazing people and what they do is remarkable. And they would like to spend more time really caring for patients. And there's a lot of other things they have to do, right? Which I mean, they'd probably like to do less documentation. They'd probably like to do less, some of the administrative stuff.
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Yeah. So those are things that we constantly work on and think about with care model designs, there's lots of ways to attack that. You hear about virtual nursing, I think we've done some pilots there that have been pretty positive in how we can do some of that. So, you know, I think everybody in healthcare is managing this and there is no one solution to all the things I think industry and certainly the healthcare industry is managing through. It is really thinking through things as a toolbox and what might work here, trying things, if they don't work, failing fast and moving to the next. Yeah. I only asked that because I've seen like the big contrast recently with my own like, visit to my doctor or nurse and even a private practice that I went to recently. And, you know, the NHS in the UK, I went to, I had my doctor's appointment and then I could see them writing it all down. And then when I was leaving, I was like, oh, like just walk me through your process because I'm really nosy and want to understand what it looks like. And they're like, then they have to write it down manually. So not only are they writing in computer, they're also writing on paper, which is crazy, right? So I was thinking about the amount of time that they're not spending because rather than engaging with me in the conversation, they're writing stuff down, right? And then I went to another appointment a few months later and I realized that the doctor had a note taker on the table and I felt heard, seen and really engaged in the conversation. And then I was like, well, he's like, yeah, he's like, he's changed my entire, like the way I work with patients and the care I can give because it's just automatically updated on my computer and added to my notes and stuff. So I'm really excited about the opportunity of AI to help, to your point, your carers like spend more time with patients and be truly present as well. So that's the only reason I mentioned that. I think it's exciting. It's an exciting time. What you just said about your experience with your provider, we too, I'm sure many health organizations have done this. The AI note taker for our physicians has been a game changer for that.
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And like any technology, originally, initially maybe a little wary of what this is, but it is so well done. It has done exactly what you said, allowed physicians to look their patients in the eye, have a conversation and not have to spend as many night typing notes. So we want to keep looking for innovations like that to make the care experience better for patients and for our caregivers. Amazing. When you think about knowledge, right? Because you've got many employees that have been, one of the most thing about health care,
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there's employees that have been there 10, 20 years, like, there's really great retention. How do you think about retaining that knowledge? When someone's retiring and they've got this wealth of experience, right? That they have, that they've captured, you want to bottle up and pass on. How do you think about that?
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It is, I will tell you, I think it's one of the hardest things we are confronting right now. When you look at the workforce overall,
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I think I looked at data yesterday that said close to half of our workforce has been hired in the last three years. Yeah, yeah, yeah, it's crazy. Yeah. And I tell this to my kids all the time, you know, when you talked about resilience and these things, but I tell this to my kids, like, there is nothing that replaces experience. Nothing.
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And the only way you get that is by making some mistakes and having people help you learn.
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And so what you're saying about how do you retain that,
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it is hard, but we work hard with, let's just take nurses again to keep our nurses at all levels very engaged. And I do think that caregivers, they want to impart that knowledge because they care about the patient and they care about the profession, right? And they want to keep doing that. It's just tiring. And so there's lots of different things that you need to do and there's partnering with different community colleges or colleges to help further train. It's finding more people to precept, but it is hard to keep that knowledge. Yeah, it's huge. One of the ways I'm looking at that now is being able to, again, leverage AI to capture that. Yeah. Information, because if you, I mean, of course it needs to be consent and make sure you're being compliant about how you capture that information, but it's incredible now that just in our AI tool, I can see all the activity anonymized from my entire team across our business. I can see what are the challenges they keep asking our agents. What are the information that they're giving to the system? So all of that knowledge, they're putting that in every day, right? As well, on the backend, I can start to see themes and emerge and I can actually ask, you know, hey, like how do I do this? And because my entire production teams put all of that information in there, it will give me, this is the process. This is our standard operating system, like procedures, this is, and it's because they're supposed to be able to capture all of that. And it's been unbelievable. Like someone could come in tomorrow and ask our agent, how do I produce a podcast? And it will literally run you through the entire process of how to do that. Because I've been asking the team to train the tool on how they're doing it. So that's something, that's one way that this really, really exciting. And imagine if you have the employee numbers of yourself and it's training constantly and you may be asking nurses, you know, when they got some time, some questions or to give some feedback now and again, like to impart that experience. I think that's gonna be something really fascinating. Yeah, well, and I think that's a lot of what we, so, you know, we do have a dedicated innovation team and a simulation lab, right? So that's another way that we do some of this. And our innovation team spends time understanding the,
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the difficult aspects of our, of the care model, right? And goes out and really looks for different solutions. And, you know, we pilot lots of different things. And that's what I mean about, you know, we try to understand what it can do and fail fast if it doesn't work or expand as quickly as we can when it does.
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And, you know, it's really, it's really interesting because we've talked a lot, we talked a little bit about leadership and, you know, in the clinical world, the simulation lab is, it's invaluable, right? You're doing clinical simulations all the time. And our simulation lab is very, it's very impressive.
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And I recently sat down with, you know, our head of innovation and said, okay, how can we really think about training our leaders and helping? How can we use concepts like the sim lab, like virtual reality, like all of these different things that we may use to even train clinicians? How can we learn from that to help our, our trainer leaders faster and at scale, right? So that's something we're talking about right now. But when it's, you know, transferring that clinical knowledge, those are two additional ways that we focus and do some of that work. Yeah, exciting times ahead. When you think about the journey you've been on so far,
[01:37:21:21 - 01:37:23:06]
what would you say you're most proud of?
[01:37:28:23 - 01:37:42:15]
Yeah, so, you know, look, I spent, I spent the majority of my career in manufacturing and distribution, right? I came to healthcare about eight years ago.
[01:37:44:07 - 01:38:05:06]
And for me, first of all, I'm so happy that I came to healthcare, right? To be able to use some of my skillset to help people who, you know, who are caring with such incredible amounts of purpose.
[01:38:06:12 - 01:39:14:05]
You know, so personally, I'm proud of that. I think when I think about all the work we've done, you know, I think what I'm most proud of is just how we've done some of this work. It is hard to unify a system and we have stuck with it and we have learned along the way and we have corrected from a continuous improvement standpoint all the time along the way. We built a culture that we strive to focus on transparency, to live with our values at the center and we are continuing to grow that. And I think that would be really the culture that we're building and how we are linking things together to help everybody feel that sense of appreciation.
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That makes me proud. Yeah, I mean, that's an amazing, at the end of the day, you're literally changing people's lives.
[01:39:25:09 - 01:39:30:10]
Well, it's nice of you to say that. I don't really, I think about
[01:39:32:14 - 01:39:58:23]
our caregivers are changing people's lives. Yeah, that's what I mean. You wanna help. And you know, it's funny, as we've continued to evolve, one of the things we say is, you know, how do we help you build a career that changes lives starting with your own, right? That's what we wanna do. We are not there yet, that's kind of what we wanna do from a value proposition for our team members
[01:40:00:10 - 01:40:25:13]
because they change lives and they do it when people are at their most vulnerable. And that's amazing. Yeah, well, listen, congratulations to you and the team so far. Like you said, I mean, that's the right mindset to have. It's an ongoing journey. You're never there. It is never a we've solved this. That's not part of it as well. But I appreciate you taking the time out to join me in the show and share your journey experience. Before I let you go,
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where can people connect with you or if they wanna say hi or learn more about the organization, like where's the best place to go? Yeah, you can connect with me on LinkedIn.
[01:40:37:12 - 01:40:41:11]
You know, that's probably the best place. Yeah, and the website?
[01:40:43:16 - 01:41:12:03]
My work, just-- Endeavor. Diane. I mean, if someone-- Oh, through our Endeavor website, yes, you can find me through our website. Yeah, I mean, I'm saying, people listening may wanna pursue a career. Yeah, I know. So if you guys-- So I would love, you know, we always love for people to visit EndeavorHealth.org. Yeah, amazing. And learn more about, you know, our journey, learn more about Endeavor Health and the care that we provide, so.
[01:41:13:21 - 01:41:21:14]
Amazing. I love that. For everyone listening, you already know what I'm gonna say. Those links will already be in the description. So wherever you're watching, listening right now, click the link below.
[01:41:22:15 - 01:41:29:01]
There'll be links below as well. But thank you so much again. I appreciate you taking the time out to join us. And I wish you and the team all the best until we next speak.
[01:41:30:03 - 01:41:32:04]
Thanks, Chris, really appreciate it. It was fun.
Dianna Sparacino, Chief People Officer at Endeavor Health