Want to build better healthcare? Wipe ‘or’ from your vocabulary, says Houston Methodist CEO Dr. Marc Boom.

Ask Dr. Marc Boom for three words that best describe Houston Methodist as a high performer — he'll give you nine.

Anyone who knows the esteemed CEO won't be surprised that behind every one of his words is action. After all, leading an institution that's surmounted everything from brutal hurricanes to a world-altering pandemic takes a lot more than superficial sentiments.

It takes years of system building that can withstand even the most unprecedented adversity.

Which brings us back to those nine words.

"Culture, culture, culture — there's your first three," said Dr. Boom, who's served as president and CEO of Houston Methodist since 2012. "You gotta get the culture right before you can get everything else."

He'll come back to that.

First, he wants to discuss the six words that outline Houston Methodist's vision for the second century: unparalleled safety, quality, service and innovation.

You might be thinking — does the and really count? Absolutely, Dr. Boom believes. In fact, it might count most of all. None of these are tradeoffs: There's no place for or in top-notch healthcare.

"These aren't choices," he explained. "You don't sacrifice service for safety or vice versa."

Again, these aren't just words. They're a cultural norm foundational to Houston Methodist's sterling reputation, one further cemented by all seven of its hospitals landing in the top decile of the 2023 Vizient Quality and Accountability rankings.

So, what does better look like when you're one of the best?

"It's never about the awards — but we are unapologetically competitive," Dr. Boom said, citing a laundry list of the impressive rival healthcare institutions that line the Houston landscape. "When hospitals and academic medical centers compete on the fundamentals, patients win."

The 'and' vs. 'or' approach

When Dr. Boom took the stage at the 2024 Vizient Healthcare Executive Forum (VHEF) it was with a knowing nod to the fact that he was the conference's closing speaker.

"I'm very aware that I am the last thing between you and flying home or whatever else you have planned," he quipped.

But even in the final throes of a three-day event, every attendee was all ears. In 2022, Dr. Boom delivered a widely lauded opening keynote at Vizient Connections Summit that focused on building an organizational culture that can survive — and even thrive — in the toughest of times. Now, the question he fields most often is: How do you sustain it?

Don't be seduced by an or mindset, he said.

"It's irresistible to think we can't possibly tackle quality, access and cost all at the same time. You want better quality? Well, something has to give, it's going to cost you more. You want to focus on reducing costs? That's fine, but it'll hurt your quality and it'll hurt your access. And that is absolute …"

I'll give you the nice term, he told the audience.

"It's baloney."

He's speaking from experience. In 2005 — just three years after persevering through the torrential flooding and subsequent damage wrought by Tropical Storm Allison — Houston Methodist began its journey toward fully embracing an and mentality. That year, the system took part in a Vizient study that highlighted what distinguishes top performers from the rest: a shared sense of purpose, leadership style, accountability, a focus on results (not awards), and a collaborative work environment.

The study ultimately showed that Houston Methodist ranked 49th out of 79 institutions. Those middle-of-the-road results catalyzed the system's improvement efforts, which included using Vizient performance ranking methodologies and databases to achieve its end goal of becoming the top-ranked institution in the country.

That meant striving to be the best in all areas – picking and choosing wasn't an option.

"You always have to look in the mirror and say, 'We can do better,'" Dr. Boom said. "Our patients don't want us to choose unparalleled safety, quality, service or innovation. They want, demand and deserve every single bit of that. And that to me is our sacred responsibility."

In 2016, Houston Methodist Hospital and Houston Methodist West ranked as top performers; by 2023, all seven system locations landed in the top decile, including a meteoric rise for Houston Methodist Baytown from No. 104 to No. 2 among complex care medical centers.

To achieve this, the system focused on creating a culture of inclusivity and accountability among staff. To attract and retain top talent, the system instills a shared sense of connectedness, purpose, mission and joy that helps the team deal with just about anything that comes their way. During the pandemic, for example, Houston Methodist didn't cut a single employee or any staff wages.

"Never waste a watershed moment," Dr. Boom said. "If appropriately managed, every crisis can strengthen a culture."

Now, back to culture

Dr. Boom loves to say "culture, culture, culture" — the reality is, he can't repeat it enough.

"If you get the culture right, 80% of the battle is won," he told the VHEF crowd. "If you get it wrong — frankly, you're sunk."

But how do you get it right?

Storytelling, for one. Dr. Boom is a big fan of that method, as evidenced by the fact that nearly every point he makes about boosting internal culture is encased in a sports, literature or pop culture reference.

There's the story of Erling Haaland and Kevin De Bruyne, two polar opposite Manchester City premier league players who together made magic: "Our teams will be comprised of people with very different backgrounds, viewpoints, characteristics and goals. We as leaders have to embrace that. We have to figure out what makes each person tick."

There's the chocolate-covered banana from the TV show "The Bear": "I'm not going to spoil it for those who haven't seen it, but it's about surprise and delight. Each year, if we're doing well, we'll give our staff an unexpected bonus. It creates connection and trust."

There's Odysseus convincing his crew to resist the allure of the siren's song: "The irresistible call we deal with in this country today is conflict and disagreement. The best decisions happen when well-intentioned people work together — when they see all sides of an issue, respect one another, listen to one another."

But the most important tale he shares is one that showcases the stories his employees tell each other. Yes, he's CEO, but Dr. Boom sees his role more as Chief Culture Officer. As such, every year he and his team organize "Pathway to Unparalleled," a 90-minute series in which employees from across the institution discuss what it means to be unparalleled. Each series has a specific focus, from service to innovation to strengths to action. Last year was safety, this year was quality.

No matter the theme, the outcome is the same.

"You have no idea how heartwarming it is to watch your staff share what it means to do their work and why they have purpose," he said.

Dr. Boom also looks for stories that reinforce the type of leadership behaviors integral to the system's success. Senior executives set the tone, he believes, and must mold institutional consensus to enable their teams to row in the right direction. That means setting clear expectations through organization-wide goals, identifying areas for growth and relentlessly working to bolster them.

And look, he says, he knows none of this is easy — but central to success is a willingness to tackle the hard stuff.

"To make the tough calls for our institutions, we need to be wise leaders," Dr. Boom said. "We need to focus on our culture and our communities to improve the world we live in."

Most importantly, he added, "We must embrace the and."

Learn more about how culture can lead to high performance.