Author: David Schillinger, MD, FACEP, Chief Medical Officer

Building a successful emergency medicine (EM) or hospital medicine (HM) program requires leadership—someone who can steer the ship in a predetermined, goal-oriented path.

For an organization to excel, it requires leaders who can motivate others. Most of us are not taught leadership, yet not uncommonly, we find ourselves in a leadership role. Being successful in this role requires direction and mentoring. SCP believes in investing in those in a leadership role. I like to say, “If we do not invest in the success of our leaders, we should not expect to have success as a company.”

Who can become a leader? While the answer is not everyone, many can develop the skills with proper mentorship and dedication. Let’s use Shamoo as an example:

When Sea World wants to find the next Orca for its show, it does not look for a whale that is cresting and slapping the water and say, “There is our whale.” Of course not. A whale is brought to Sea World and placed in a tank. Each time the whale swims over the rope, he gets a fish; under the rope, no fish. Gradually the rope is moved to the surface whereby the only way the orca gets his fish is to jump out of the water. That whale was rewarded at each step along the way. Rewarding people for getting things “almost right” gradually leads to getting it right.

Foundation of an Organization

Every entity is built on some foundation—a base upon which the organization’s values sit. Analogous to the foundation of a home, the foundation must be tried and true all the time. Without a solid core, no organization can excel. That foundation is truth.

As we work our way through this blog post, understand that you are powerless without truth. Truth is where it must all begin. With truth and honesty, you can begin to develop trust.

Many organizations muddle through their existence because of a lack of trust. Team members must trust each other and you as the architect of the team. Without trust, there is skepticism, which undermines the goals of the team.  When team members are distrustful, they question each other’s integrity, agenda, and capabilities. 

There is no trust meter. Trust is not one of those items that can be measured; however, the impact is real. When there is a lack of trust, the motives and goals of the leader become questionable.

Gandhi said, “The moment there is suspicion about a person’s motives, everything he does becomes tainted.” As a result, projects begin to move at an imperceptible rate, more check stops are put into place, and the result suffers in quality; hence, distrust costs money. Conversely, when trust is high, teams move efficiently through projects, decreasing the cost of execution.

Your word is the currency of trust. No one can teach trust. No one can demand trust. Trust is earned by truth, honesty, and a commitment to your word.


Creating a Culture

Before you can create a culture, you have to decide what it is you want to create. This will again require leadership (we will revisit this shortly). Any good healthcare organization will want to build that culture around the patient, providing quality care. Similarly, at SCP we want our culture to be focused on our providers. We don’t practice medicine as a company, but we can take care of those taking care of our patients.

Culture is the thread that runs through an organization and keeps it together. It is both tactile and visual, apparent to everyone that encounters the organization. Culture is modeled, starting at the C-suite and permeating through the entire company.

Guiding the culture are core values, boundaries in which we work. Achieving a goal, by all means, is not a culture. There are rules. These are a belief and an operating system guiding the company’s behavior all of the time. Core values are not just evident in good times but must endure during the rough patches. SCP has adopted a set of values to guide our success:

  • Agility: the ability to adapt on time to real-time change
  • Collaboration: working with all team players and realizing that no one of us will be as smart as all of us.
  • Courage: to address obstacles to success honestly and openly at all times.
  • Respect: for others and their ideas, every time, all the time.

Leading by Intention

Creating a culture can occur by design or by default. The leaders of an organization choose the path of culture development. Leading by intent is the ability to see a vision, create a path and work the entire organization toward success of the mission. The execution of a plan is the phase where most visions die. Execution occurs by making conscious decisions. Decide in advance how you want an organization to react when it encounters a situation, every time. Similar to muscle memory, we most often react to events when we don’t have a plan.

Leading with Intention

Building that culture requires a well thought out plan—the culture wheel. There is no starting point or end. It continually develops and evolves building on previous successes.

  • Leadership: modeling the culture; walking the walk. People are more likely to follow what you do than what you say.
    • Are you doing what you say?
    • Do your actions demonstrate your intention?
    • Do you generate distraction or are you focused and generating attention?
    • Are you the embodiment of the culture you are trying to create?
    • Who are you being when you are being you?!?
  • Education: you have to invest in the success of the team members; without proper tools, no one can succeed. 
  • Reinforce: feedback is important for promoting success; catch people doing something “almost right.”
  • Communicate: verbalize your goals, values, and culture.


Everything we do as an organization must focus on our patients and providers. Doing this requires creating a vision, building a team based on trust, and focusing on executing the plan. The culture we create while executing the plan is developed by leaders. True leadership occurs by intent with careful planning and behavior. And, at the center of execution are our core values:


Visit our culture page for more information about SCP’s culture of excellence.
Click here to view a video about our commitment to leadership development.