Top Brass Try Life in the Trenches

Top Brass Try Life in the Trenches

To Promote Understanding, Firms Require Executives To Perform Entry-Level Jobs

By JOANN S. LUBLIN
June 25, 2007; Page B1

ATLANTA -- By 11:30 a.m. one recent day, Carolyn Kibler had been on her feet for nearly six hours, shuttling among 16 dialysis patients at a DaVita Inc. clinic here. Her lower back ached from the unaccustomed strain.

Ms. Kibler is a vice president of the nation's No. 2 dialysis-treatment operator, earning a comfortable six-figure salary while overseeing 48 other clinics. For three days this spring, however, she helped treat seriously ill patients alongside technicians working up to 13-hour days for an average of $14.30 an hour. "The job is definitely more physically demanding than I had imagined," the 48-year-old executive admits.

That's precisely the point, according to DaVita Chief Executive Kent J. Thiry, who created the immersion program for his senior managers in 2002. "The experience changes their view of the world," he says. "They are better leaders as a result."

DaVita is among a growing number of big businesses -- including Walt Disney Co., Continental Airlines Inc., Sysco Corp. and Amazon.com Inc. -- that require some of the top brass to walk in front-line workers' shoes. The notion is not new, but "is gaining in popularity," thanks to a new breed of hands-on CEOs keen to stay closely in touch with their troops and customers, says Edward Lawler, head of the Center for Effective Organizations at the University of Southern California. An empathetic leader "gets better information about what's going on," he adds.

About 150 officials of Loews Hotels must spend a day every year in an entry-level job at one of its 18 U.S. and Canadian hotels. They share impressions with employees in their temporary departments and solicit ideas for making those jobs easier. One result: installation of handle bars on room-service carts so they are easier for waiters to push.

"It's smart management" when bosses gain a ground-level perspective on improving customer service, observes Jonathan Tisch, chief executive of the Loews Corp. unit. The program grew out of his 2004 appearance on the TV reality show "Now Who's Boss?" Assuming roles such as bellman, pool attendant and housekeeper at a Florida hotel, Mr. Tisch sweat so much in his polyester uniform that he ordered the style and material altered.

But such programs can increase cynicism among the rank and file, Mr. Lawler cautions. Executives' rare appearances in the trenches may suggest "these people really are out of touch," he says.

A close look at DaVita's Reality 101 immersion program shows how one company tries to ensure that newly sensitized managers retain leadership insights gleaned from the front line. The El Segundo, Calif., concern requires managers to attend two days of classroom training before working in a clinic and surveys participants after their visits. DaVita plans to expand the program to middle management this summer, and is mulling an annual refresher program for executives like Ms. Kibler.

The outgoing and talkative former nurse knew little about dialysis clinics before she joined DaVita last October. Dialysis takes the place of nonfunctioning or poorly functioning kidneys in flushing wastes from the body. Treatments typically last four hours; many patients require three or more treatments per week.

Ms. Kibler arrives at Buckhead Dialysis Center for her first day of Reality 101 clinic experience just before 6:00 a.m. Outside, it is still dark. Inside the brightly lit facility, however, technicians Laila Tanferno and Daniel Mainer have already been at work for an hour or more setting up 16 dialysis machines. Each beige metal machine is the size of a three-drawer file cabinet on wheels, with flashing lights and blaring alarms.

Two gray-haired men have been waiting almost 30 minutes. The cheerful Ms. Tanferno greets each with a hug. Before beginning dialysis for an elderly woman with an amputated leg, she carefully arranges a blanket and TV set the way the patient likes. "I see these patients more than I see my real family," Ms. Tanferno says.

Ms. Kibler quickly feels the stress of the job. She must don a close-fitting surgical gown and plastic face visor. "It's real hot," she says. While wearing the protective gear, she helps Ms. Tanferno monitor patients' blood pressure, check other vital signs, watch the machines' water purity and complete paperwork.

Technicians absorb occasional patient complaints. Lindsey Pryor, a 60-year-old retired teacher undergoing dialysis, recently raised a fuss because staff meetings delayed completion of treatments. Clinic officials adjusted the meeting times. "None of us wants to be here, but it [dialysis] is keeping us alive," he says to Ms. Kibler.

Death, too, is part of the job. Dialysis patients typically suffer from multiple ailments, and roughly 20% die annually. Ten patients of the Buckhead facility have died since January 2006, some during treatment. In March, a 42-year-old man whom Ms. Tanferno treated on a Friday unexpectedly died over the weekend from an inflamed pancreas. "I cried for a whole week," she tells Ms. Kibler.

After her hectic three-day stint, Ms. Kibler describes the technicians as "some of the most empathetic caregivers I have ever seen." DaVita's prosperity depends on front-line troops aiding patients "Band-Aid by Band-Aid, piece of tape by piece of tape and alarm by alarm," she continues.

Back in her office in another part of Atlanta, Ms. Kibler tries to integrate the lessons from her clinic experience into her leadership of a roughly 750-employee division. "I am more conscious of the power of my words and my actions and the impact they have down in the organization," she says.

So, Ms. Kibler is more lenient when clinics fall behind on paperwork due to staffing shortages. She praises a nurse who skipped a conference call to discuss a clinic's quality report so she could fill in for an absent employee caring for patients. "When something like that comes up, I have a picture of the [treatment] floor, everyone scurrying around and patients waiting in their chairs," Ms. Kibler says. "Patient care comes first." At an evening staff meeting in another clinic on June 13, she thanked workers for "the gift of life they had given to each patient they had touched that day."

She also is trying to plan better, so last-minute deadlines don't distract clinic administrators and technicians. On Aug. 1, DaVita will change its procedures for drawing patients' blood. To prepare for the switch, Ms. Kibler set intermediate goals for her lieutenants. "I'm forcing them to do it in small bites," she remarks.

The immersion experience prompts changes far from the clinic floor. Harlan Cleaver, DaVita's chief information officer, felt terrified when dialysis-machine alarms sounded during his clinic work -- even though a technician was nearby. "I didn't have a clue what I was doing but I had [the patient's] life in my hands," Mr. Cleaver recollects.

After the program, Mr. Cleaver accelerated plans to extend the training period for new analysts on the company's computer help desk, and lowered his expectations of productivity from such new hires. Before Reality 101, he notes, "I never really realized how incompetent entry-level people are when they start their jobs."

Write to Joann S. Lublin at joann.lublin@wsj.com1
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