Founder or CEO: Who Sets the Culture?

Much of my career has been spent in organisations shaped by their founders and founding families. That is the norm in Gulf healthcare: many of the region's leading hospital groups began with a single physician or family, and their values still carry the founder's mark. A professional chief executive who joins such a group faces a delicate task. The organisation usually does not need to be rebuilt. It needs to be renewed.

What the book describes

When Nadella became Microsoft's third chief executive in 2014, the company founded by Bill Gates had lost momentum. His job was not to reinvent Microsoft but to rediscover what it was for. He simplified the strategy, changed the culture from one of internal competition to one of learning, and formed partnerships with companies that had been seen as rivals.

He reframed the company's purpose around helping people and organisations achieve more, including in education and healthcare. Much of his thinking about empathy and technology came from his own family's experience of disability, which convinced him that innovation should help people overcome obstacles.

What it means for healthcare leaders

Respect the DNA, refresh the culture. A founder's values, such as a commitment to patients or to the community, are often the organisation's greatest asset. The chief executive's job is to keep them while changing the habits that no longer serve them.

Purpose before strategy. Staff will accept a great deal of change if they understand what it is for, and very little if they do not.

Partner with competitors where it serves patients. Nadella's willingness to work with rivals applies directly to healthcare, where shared services, referral networks and data exchange often benefit everyone.

Lead with empathy. In a hospital, empathy is not a leadership style. It is the business.

Questions for leadership teams

1. Which of our founder's values are we protecting, and which habits are we keeping only out of habit?
2. Does every member of staff understand the purpose behind our current changes?
3. Which competitor could we partner with to improve care for patients we both serve?

A new chief executive's task is rarely to rebuild. It is to help an organisation remember what it was for, and then move faster towards it.