Healthcare Leadership Teaching Dashboard
Healthcare ProfessionalCredo
Ten “I Will” commitments for healthcare leaders. Teach each one, rate it against behavioral anchors, track every learner’s growth, and design a Credo that lasts beyond its launch.
- 10 commitments
- 40 behavioral anchors
- Self and observer lenses
- Learner tracking
- 3 year sustainability plan
A Credo is a promise that can be observed
This dashboard turns the Healthcare Professional Credo into a complete leadership development system. Each “I Will” statement becomes a teachable module, a set of observable behaviors, a rating anchored in real conduct, and a measure a leader can be held to over time.
Healthcare Professional
Credo
- 01I Will be a patient advocate.
- 02I Will listen to patients, families, and staff before making decisions.
- 03I Will protect every patient's dignity, privacy, and right to be heard.
- 04I Will speak up when patient safety or quality of care is compromised.
- 05I Will support the people who care for our patients.
- 06I Will work to remove barriers that delay necessary care.
- 07I Will lead with integrity and compassion, especially when decisions are difficult.
- 08I Will use evidence, clinical judgment, and patient preferences to guide improvement.
- 09I Will take responsibility for my decisions and follow through on my commitments.
- 10I Will mentor future leaders to put patients at the center of healthcare.
Kelly Emrick
Every commitment returns to the patient
- Patient Voice
- Safety, Quality and Access
- People and Future
- Character
Select any commitment on the wheel to open its teaching module.
Four ways to use this dashboard
Teach
Ten ready to run modules, each with meaning, evidence, observable behaviors, a scenario, a 45 minute session plan, and a 60 second huddle script.
Open Ten CommitmentsGauge effectiveness
Rate a leader against 40 behavioral anchors from both the self and observer lens. The Credo Fidelity Index and a weakest link rule show where development should start.
Open AssessmentTrack learners
Keep a roster, record assessments over time, mark module progress from taught to observed, and see growth and blind spots for each learner and cohort.
Open Learner TrackerSustain the Credo
Score eight embedding mechanisms, generate a three year roadmap, run a Commitment of the Month rotation, and write a Credo charter with ownership and renewal.
Open SustainabilityHow the ten commitments fit together
Patient Voice
The patient is represented, heard, and protected before anything else happens.
01 Patient Advocate · 02 Listen First · 03 Dignity and Privacy
Safety, Quality and Access
Care is safe, timely, and improved on the strength of evidence and preference.
04 Speak Up for Safety · 06 Remove Barriers · 08 Evidence and Preference
People and Future
The people who deliver care are supported today and developed for tomorrow.
05 Support Caregivers · 10 Mentor Future Leaders
Character
Integrity, compassion, and ownership hold the other eight together under pressure.
07 Integrity and Compassion · 09 Ownership and Follow Through
The Credo integrity rule
A Credo is only as strong as its weakest commitment.
A leader who excels at nine commitments and routinely fails the tenth has not adopted the Credo. That is why this dashboard reports a weakest link alongside every average, and why any commitment rated Emerging caps the overall profile at Developing, no matter how high the other nine score.
The ten commitments, taught one at a time
Each module is built for a leader to teach their own team. Choose a commitment, work through its meaning and evidence, practice the scenario, and close with a personal micro practice.
Patient Voice · Patient Advocate
I Will be a patient advocate.
What it means for a leader
Advocacy means a leader actively represents the patient's interests in rooms the patient will never enter: budget meetings, scheduling decisions, staffing huddles, and contract negotiations. It is not a feeling of goodwill. It is the habit of asking, out loud, what a decision will mean for the person receiving care.
Why it matters
Patient-centeredness is one of the six aims for a quality health system named in Crossing the Quality Chasm, defined as care that is respectful of and responsive to individual patient preferences, needs, and values. Professional codes for nurses and healthcare executives place advocacy at the center of the role, which means it is an expectation of the job rather than an optional virtue.
Sources: Institute of Medicine 2001, American Nurses Association 2025, ACHE Code of Ethics, Barry and Edgman-Levitan 2012
It looks like
- Names the patient impact before the operational or financial impact when a decision is framed.
- Brings a real patient story or complaint into leadership meetings at least monthly.
- Escalates a patient concern past their own level when the answer at their level is inadequate.
- Asks "Who is not in this room who should be?" before approving a change that touches care.
It is not
- Treats advocacy as the patient experience department's job.
- Defends a process because it is policy, without asking whether it serves the patient.
- Advocates only when a patient or family complains loudly.
Leader micro practice
Open every operational meeting you chair with one question: "What will the patient notice if we get this right, and what will they notice if we get it wrong?"
60 second huddle moment
“Today, when a decision is made on this unit, someone should ask what the patient will experience because of it. If no one asks, you ask.”
Practice scenario
To relieve a backlog, your director proposes double booking the first two outpatient MRI slots each morning. Throughput would rise, but the patients booked into those slots would routinely wait 45 minutes or more, and several are elderly patients arriving by paratransit.
What would you do?
Rubric for this commitment
1 Emerging
Can describe what advocacy means but raises patient impact mainly when asked or after a complaint.
2 Developing
Raises patient impact in some decisions, but drops it when schedules, budgets, or senior leaders push back.
3 Proficient
Consistently names the patient impact in decisions, escalates concerns past their own level, and follows them to closure.
4 Exemplary
Builds patient impact into how the team decides (agendas, templates, checklists) and coaches others to advocate without being prompted.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Today, when a decision is made on this unit, someone should ask what the patient will experience because of it. If no one asks, you ask.” |
| 5 to 15 | Meaning | Advocacy means a leader actively represents the patient's interests in rooms the patient will never enter: budget meetings, scheduling decisions, staffing huddles, and contract negotiations. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- Describe a decision in the last month where the patient's interest was not represented. What would advocacy have looked like?
- Where does advocacy create tension with productivity or cost targets on your team, and how do you hold both?
- Which patients on your service are least able to advocate for themselves?
Measures to watch
- Share of leadership meeting agendas that open with a patient impact item
- Patient concerns escalated and resolved, with time to resolution
- Patient experience comments that mention being represented or looked out for
Patient Voice · Listen First
I Will listen to patients, families, and staff before making decisions.
What it means for a leader
Listening before deciding means the leader gathers the perspectives of those closest to the work and the care before the decision is made, not after it is announced. The order matters. Listening after a decision is consultation theater; listening before it is leadership.
Why it matters
A classic study of primary care visits found physicians redirected patients' opening statements after a mean of 23.1 seconds, and patients completed their opening statement of concerns in fewer than a third of visits. In care teams, leader inclusiveness (inviting and appreciating input) is associated with psychological safety and engagement in improvement work, and it narrows the gap in psychological safety between higher and lower status professions.
Sources: Marvel et al. 1999, Nembhard and Edmondson 2006, Beach et al. 2006, Edmondson 1999
It looks like
- Asks open questions and waits through silence before offering a view.
- Seeks out the quietest voices on the team, including night shift and support staff.
- Summarizes what was heard and checks it for accuracy before acting.
- Tells people afterward how their input changed, or did not change, the decision and why.
It is not
- Announces a decision and calls the Q and A that follows "listening."
- Hears only from the people who attend the meeting or speak the loudest.
- Interrupts to solve the problem before the speaker has finished describing it.
Leader micro practice
Before any decision that changes how staff or patients experience care, speak with at least one patient or family member and one frontline person who will live with it. Close the loop with them afterward.
60 second huddle moment
“Before we change anything today, who has not been asked yet? Name one person and go ask them.”
Practice scenario
You plan to move the unit's supply room to free space for a new workstation. The layout makes sense on paper. You have one week before facilities begins work.
What would you do?
Rubric for this commitment
1 Emerging
Listens when approached but usually decides first and explains afterward.
2 Developing
Seeks input before some decisions, mostly from familiar or senior voices, and rarely closes the loop.
3 Proficient
Routinely gathers patient, family, and frontline input before deciding, including quiet voices, and reports back what changed.
4 Exemplary
Designs listening into the team's operating rhythm (rounding, huddles, patient advisors) and teaches others to listen before deciding.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Before we change anything today, who has not been asked yet? Name one person and go ask them.” |
| 5 to 15 | Meaning | Listening before deciding means the leader gathers the perspectives of those closest to the work and the care before the decision is made, not after it is announced. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- When did you last change a decision because of something a frontline staff member or family told you?
- Who on your team is least likely to speak up, and how would you know what they think?
- What does your team see you do after they give you input?
Measures to watch
- Decisions with documented frontline or patient input before approval
- Staff survey items on being heard and on seeing input acted on
- Loop closure rate: input givers told the outcome within two weeks
Patient Voice · Dignity and Privacy
I Will protect every patient's dignity, privacy, and right to be heard.
What it means for a leader
This commitment protects three things at once: how a patient is regarded (dignity), what is known and shared about them (privacy), and whether their own account counts (the right to be heard). Leaders protect all three through the environments, workflows, and norms they design, not only through individual courtesy.
Why it matters
Dignity conserving care, as described by Chochinov, rests on the attitudes, behaviors, compassion, and dialogue that shape how patients perceive themselves. The HIPAA Privacy Rule sets the legal floor for protecting health information, but dignity and voice are ethical obligations that go beyond compliance. Communication behavior has also been linked to malpractice claims history among primary care physicians.
Sources: Chochinov 2007, HHS HIPAA Privacy Rule, Levinson et al. 1997, American Nurses Association 2025
It looks like
- Notices and fixes environmental threats to dignity: gowns, hallway conversations, exposed screens, curtains left open.
- Uses the patient's preferred name and asks about what matters to them.
- Treats a patient's own account of symptoms or events as data, not noise.
- Addresses disrespectful talk about patients immediately, including in staff areas.
It is not
- Treats privacy as a training module rather than a daily practice.
- Tolerates jokes or labels about "difficult" patients in break rooms.
- Allows a patient's report to be dismissed because it conflicts with the chart.
Leader micro practice
Do a weekly dignity walk: spend ten minutes seeing your area as a patient would, looking for exposure, overheard information, and moments where a patient's voice could be lost. Fix one thing each week.
60 second huddle moment
“Every patient here today will be seen, covered, and heard. If you notice a moment where that is not true, fix it or call it out.”
Practice scenario
During a busy afternoon you overhear two staff members at the nursing station discussing a patient's diagnosis by name. The hallway is full of visitors. One staff member is a high performer you rely on.
What would you do?
Rubric for this commitment
1 Emerging
Follows privacy rules and treats patients courteously but does not look for system threats to dignity.
2 Developing
Corrects obvious dignity or privacy lapses when seen, but inconsistently, and seldom addresses the environment that caused them.
3 Proficient
Consistently protects dignity, privacy, and patient voice, addresses lapses promptly and respectfully, and fixes environmental causes.
4 Exemplary
Builds dignity and voice into space design, workflows, and team norms, and develops others who protect them without being asked.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Every patient here today will be seen, covered, and heard. If you notice a moment where that is not true, fix it or call it out.” |
| 5 to 15 | Meaning | This commitment protects three things at once: how a patient is regarded (dignity), what is known and shared about them (privacy), and whether their own account counts (the right to be heard). Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- Where in your area could a patient overhear information about another patient?
- How does your team respond when a patient's account conflicts with what the record says?
- What language do staff use about patients when patients are not present?
Measures to watch
- Privacy incidents and near misses reported (reporting up is healthy)
- Patient experience items on respect and on being listened to
- Environmental dignity audit findings closed per quarter
Safety, Quality and Access · Speak Up for Safety
I Will speak up when patient safety or quality of care is compromised.
What it means for a leader
A leader speaks up personally and makes it safe for everyone else to do the same. The leader's own voice matters, but the larger obligation is the climate: whether a new graduate or a transporter will stop the line when something looks wrong.
Why it matters
The Joint Commission has identified leadership's role in safety culture as essential and has warned that intimidating and disruptive behaviors undermine a culture of safety. Research on speaking up shows staff weigh perceived risk and expected response before raising concerns, and psychological safety makes voice more likely.
Sources: Joint Commission 2017, Joint Commission 2008, Okuyama et al. 2014, Edmondson 1999, Frankel et al. 2017
It looks like
- Raises safety or quality concerns directly, with specifics, regardless of the rank of the person involved.
- Thanks people publicly for speaking up, including when the concern turns out to be unfounded.
- Responds to reported concerns with visible follow through.
- Uses a shared language (for example, a stop the line phrase) that anyone can use.
It is not
- Waits for someone else to raise the concern first.
- Reacts to bad news with irritation or blame.
- Treats speaking up as disloyalty to a physician, a peer, or the organization.
Leader micro practice
End each huddle by asking "What worries you about safety today?" and thank the first person who answers, every time.
60 second huddle moment
“If something looks unsafe today, say it. You will be thanked for it, even if it turns out fine.”
Practice scenario
A technologist tells you a physician ordered a contrast study without reviewing a documented prior reaction. The physician is known to react badly to being questioned, and the patient is already on the table.
What would you do?
Rubric for this commitment
1 Emerging
Speaks up when a concern is clear cut and low risk, but hesitates when rank or relationships are involved.
2 Developing
Raises safety concerns in most situations but responds inconsistently when others speak up to them.
3 Proficient
Speaks up reliably regardless of hierarchy and responds to others' concerns with thanks and follow through.
4 Exemplary
Has built a climate where staff at every level stop the line, and teaches other leaders how to respond to voice.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “If something looks unsafe today, say it. You will be thanked for it, even if it turns out fine.” |
| 5 to 15 | Meaning | A leader speaks up personally and makes it safe for everyone else to do the same. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- When did you last stay silent about a concern? What made silence feel safer?
- How do people on your team know it is safe to challenge a senior clinician?
- What happens, visibly, after someone on your team speaks up?
Measures to watch
- Safety event and near miss reporting rate (higher is often healthier)
- Staff survey items on comfort speaking up and on response to concerns
- Time from concern raised to feedback given to the reporter
People and Future · Support Caregivers
I Will support the people who care for our patients.
What it means for a leader
The people who deliver care are the care system. Supporting them means removing friction from their work, protecting their capacity, recognizing their contributions, and treating their well-being as an operational responsibility rather than a personal problem.
Why it matters
The Quadruple Aim adds improving the work life of clinicians and staff to the goals of better care, better health, and lower cost, on the premise that care of the patient requires care of the provider. The National Academies report on clinician burnout frames it as a systems problem, and organizational strategies led by executives are associated with lower burnout and higher engagement.
Sources: Bodenheimer and Sinsky 2014, National Academies 2019, Shanafelt and Noseworthy 2017, Greenleaf 1977
It looks like
- Asks staff what gets in the way of their work and fixes at least one thing visibly.
- Protects breaks, reasonable schedules, and time for development.
- Recognizes specific contributions, not just general effort.
- Checks in after difficult events and connects people to support.
It is not
- Responds to burnout with resilience training alone.
- Praises heroics that mask a broken process.
- Is visible only when something has gone wrong.
Leader micro practice
Each week, ask three staff members "What got in your way this week?" Log the answers and close one barrier before the next week.
60 second huddle moment
“Who on this team needs help today? Ask, and if you are the one who needs it, say so.”
Practice scenario
After a difficult code that ended in a patient's death, the team is quiet and the next shift is short staffed. Your manager asks for a staffing plan by end of day.
What would you do?
Rubric for this commitment
1 Emerging
Recognizes the importance of staff support but acts mainly on formal requests or crises.
2 Developing
Offers support and recognition in some situations, often generic, and rarely removes structural barriers.
3 Proficient
Regularly removes barriers, recognizes specific contributions, protects capacity, and checks in after hard events.
4 Exemplary
Treats workforce well-being as an operational system with measures and accountability, and coaches other leaders to do the same.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Who on this team needs help today? Ask, and if you are the one who needs it, say so.” |
| 5 to 15 | Meaning | The people who deliver care are the care system. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- What is the most frustrating part of your team's work that has nothing to do with patients?
- How do you know when a team member is struggling?
- Which of your team's burdens could you remove this month?
Measures to watch
- Staff engagement and burnout indicators by unit
- Barriers reported and resolved per month
- Voluntary turnover and first year turnover
Safety, Quality and Access · Remove Barriers
I Will work to remove barriers that delay necessary care.
What it means for a leader
Barriers include scheduling bottlenecks, authorization delays, transportation gaps, language access, cost, and handoffs that stall. A leader treats every unnecessary delay as a design problem to be solved, not as an unfortunate fact of healthcare.
Why it matters
The Institute of Medicine's Getting to Now report called for health systems to match supply and demand continuously and to offer care promptly, framing delay as a quality and safety problem. Transportation is a well documented barrier: a systematic review found that transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use.
Sources: Institute of Medicine 2015, Syed et al. 2013, Institute of Medicine 2001
It looks like
- Measures time to care, not just volume, and knows where the waits are.
- Walks a patient's path from order to result to find the delays.
- Partners across departments to fix handoffs no single department owns.
- Considers transportation, language, cost, and health literacy when designing access.
It is not
- Accepts "that is just how long it takes" as an answer.
- Fixes delays inside their own department while pushing them onto another.
- Assumes a patient who missed an appointment was simply noncompliant.
Leader micro practice
Each month, trace one patient's journey from first contact to completed care and map every wait. Pick the longest avoidable wait and assign an owner.
60 second huddle moment
“Which patient is waiting today who does not need to be? What would it take to move them?”
Practice scenario
Your department's no show rate is climbing. A supervisor proposes a policy to discharge patients from the schedule after two no shows.
What would you do?
Rubric for this commitment
1 Emerging
Acknowledges delays but treats most of them as outside their control.
2 Developing
Fixes delays within their own area when they are raised, but rarely looks upstream or across departments.
3 Proficient
Measures time to care, maps patient journeys, and removes barriers across department lines.
4 Exemplary
Builds access into the system: equity stratified access data, cross department ownership, and leaders who remove barriers by habit.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Which patient is waiting today who does not need to be? What would it take to move them?” |
| 5 to 15 | Meaning | Barriers include scheduling bottlenecks, authorization delays, transportation gaps, language access, cost, and handoffs that stall. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- What is the longest avoidable wait a patient experiences in your area?
- Which barriers fall between departments, so that no one owns them?
- How do you distinguish a no show from an access barrier?
Measures to watch
- Time from order to completed care (median and 90th percentile)
- No show rate stratified by transportation, language, and payer
- Avoidable delays identified and eliminated per quarter
Character · Integrity and Compassion
I Will lead with integrity and compassion, especially when decisions are difficult.
What it means for a leader
Integrity is the alignment between what a leader says and what the leader does. Compassion is recognizing the suffering a decision will cause and acting to reduce it. The Credo asks for both together and specifically when decisions are hard: layoffs, service closures, disciplinary action, disclosure of errors.
Why it matters
Behavioral integrity, the perceived alignment between a manager's words and deeds, is a foundation of trust, and ethical leadership research ties leaders who model and communicate ethical standards to followers' trust and willingness to report problems. In a national survey, only about half of patients and physicians said the health care system generally provides compassionate care.
Sources: Simons 2002, Brown and Treviño 2006, Lown et al. 2011, Mayer et al. 1995
It looks like
- Tells the truth about hard decisions, including what is not yet known.
- Delivers difficult news personally rather than by email or through others.
- Considers the human impact and takes concrete steps to reduce harm.
- Admits when their own words and actions have not matched.
It is not
- Softens a hard decision until it is no longer accurate.
- Makes a decision based on convenience or self protection and presents it as principle.
- Treats compassion as weakness or integrity as rigidity.
Leader micro practice
Before any difficult decision, write two sentences: what you will say that is true even if it is uncomfortable, and one concrete action you will take to reduce the harm it causes.
60 second huddle moment
“Hard decisions are coming this quarter. You will hear about them from me, directly and honestly.”
Practice scenario
Budget cuts require eliminating two positions on your team. You have been asked to keep it confidential until HR finalizes details next week. A team member asks you directly whether jobs are at risk.
What would you do?
Rubric for this commitment
1 Emerging
Values integrity and compassion but retreats to vagueness or avoidance when decisions are difficult.
2 Developing
Is honest and caring in most situations, but under pressure either softens the truth or loses sight of the human impact.
3 Proficient
Communicates hard decisions truthfully and personally, acts to reduce harm, and keeps word and deed aligned.
4 Exemplary
Is known across the organization as a leader whose word holds under pressure, and mentors others through difficult decisions.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Hard decisions are coming this quarter. You will hear about them from me, directly and honestly.” |
| 5 to 15 | Meaning | Integrity is the alignment between what a leader says and what the leader does. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- Describe a time your words and actions did not match as a leader. How did your team notice?
- What makes compassion harder when a decision is difficult?
- How do you deliver bad news in a way that is both honest and humane?
Measures to watch
- Staff survey items on trust in leadership and on honest communication
- Proportion of difficult decisions communicated in person by the accountable leader
- Upward feedback on consistency between words and actions
Safety, Quality and Access · Evidence and Preference
I Will use evidence, clinical judgment, and patient preferences to guide improvement.
What it means for a leader
This commitment brings the three parts of evidence based practice into leadership: the best available evidence, the expertise of the people doing the work, and what patients value. Improvement guided by only one of the three tends to fail: evidence without judgment ignores context, judgment without evidence repeats habit, and neither without patient preference misses the point.
Why it matters
Sackett and colleagues defined evidence based medicine as integrating individual clinical expertise with the best available external evidence, applied with regard to the patient's values and preferences. Shared decision making has been called the pinnacle of patient centered care because it brings evidence and preference together at the point of decision.
Sources: Sackett et al. 1996, Barry and Edgman-Levitan 2012, Frankel et al. 2017, Institute of Medicine 2001
It looks like
- Asks "What is the evidence?" and "What do patients want?" before approving an improvement.
- Uses data over time, not single data points, to judge whether a change worked.
- Invites frontline clinical judgment about whether evidence fits local conditions.
- Includes patient advisors or patient reported measures in improvement work.
It is not
- Adopts a practice because a competitor or vendor did.
- Uses data selectively to support a decision already made.
- Treats patient preference as a satisfaction score rather than an input to design.
Leader micro practice
Use a three part check on every improvement proposal: What does the evidence say? What do the people doing the work think? What do the patients affected want?
60 second huddle moment
“Before we change a process, we ask three questions: what does the evidence say, what do you see, and what do patients want?”
Practice scenario
A vendor presents an AI scheduling tool with impressive results from another system. Your CFO is enthusiastic. Your schedulers are skeptical, and no one has asked patients.
What would you do?
Rubric for this commitment
1 Emerging
Values evidence but often decides on experience, anecdote, or the most recent example.
2 Developing
Uses evidence or data in formal projects but inconsistently integrates frontline judgment and patient preference.
3 Proficient
Routinely integrates evidence, clinical judgment, and patient preferences, and tests changes over time before scaling.
4 Exemplary
Builds an improvement system that requires all three sources and teaches others to use evidence without dismissing experience or patients.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Before we change a process, we ask three questions: what does the evidence say, what do you see, and what do patients want?” |
| 5 to 15 | Meaning | This commitment brings the three parts of evidence based practice into leadership: the best available evidence, the expertise of the people doing the work, and what patients value. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- Which recent change on your team was based on habit rather than evidence?
- How are patient preferences captured in your improvement projects?
- When evidence and frontline judgment disagree, how do you decide?
Measures to watch
- Improvement projects with a documented evidence review
- Projects with patient partner or patient reported outcome input
- Changes sustained at 6 and 12 months on run or control charts
Character · Ownership and Follow Through
I Will take responsibility for my decisions and follow through on my commitments.
What it means for a leader
Ownership means a leader stands behind decisions, especially ones that turn out badly, and does what they said they would do. Follow through is how teams learn whether a leader's commitments are real. Every unkept promise teaches people to stop bringing problems forward.
Why it matters
Just culture distinguishes human error, at risk behavior, and reckless behavior, and holds leaders accountable for the systems they design as well as for their own choices. Behavioral integrity research shows that perceived word and deed alignment shapes trust and performance. Leaders who acknowledge their own mistakes also make it safer for others to report theirs.
Sources: Marx 2001, Simons 2002, Brown and Treviño 2006, Kouzes and Posner 2017
It looks like
- Says "That was my decision" when outcomes are poor.
- Keeps a visible list of commitments and reports progress on them.
- Tells people promptly when a commitment cannot be kept and why.
- Holds others accountable fairly, distinguishing system failures from choices.
It is not
- Attributes poor results to others, the system, or bad luck.
- Makes commitments in meetings that quietly disappear.
- Punishes honest errors while excusing their own.
Leader micro practice
Keep a public commitment log for your team: every promise you make, who it was made to, the due date, and the status. Review it at every staff meeting.
60 second huddle moment
“Here is what I committed to last week and where it stands. Hold me to it.”
Practice scenario
A scheduling template you designed and implemented is causing patient delays and staff overtime. Your supervisor asks what went wrong in front of the leadership group.
What would you do?
Rubric for this commitment
1 Emerging
Accepts responsibility when outcomes are good or when accountability is unavoidable; commitments slip without notice.
2 Developing
Owns most decisions and keeps most commitments, but communicates poorly when commitments slip.
3 Proficient
Owns decisions and their consequences, keeps commitments reliably, and renegotiates openly when plans change.
4 Exemplary
Creates a culture of fair accountability, with visible commitment tracking and just culture responses, and develops leaders who own outcomes.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Here is what I committed to last week and where it stands. Hold me to it.” |
| 5 to 15 | Meaning | Ownership means a leader stands behind decisions, especially ones that turn out badly, and does what they said they would do. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- What commitment have you let slip recently, and who noticed?
- How do you respond when a decision you made turns out to be wrong?
- How does your team tell the difference between a system failure and a personal choice?
Measures to watch
- Commitments made versus kept on time (commitment log)
- Upward feedback on accountability and reliability
- Just culture consistency in responses to events
People and Future · Mentor Future Leaders
I Will mentor future leaders to put patients at the center of healthcare.
What it means for a leader
The Credo is only sustainable if it outlives the leader who wrote it. Mentoring is the mechanism: deliberately developing the next generation of leaders, formal and informal, so that putting patients at the center becomes how they lead by habit.
Why it matters
Kram's research established that mentoring serves two functions, career support and psychosocial support, and a systematic review in academic medicine found mentorship associated with personal development, career guidance, and research productivity. Deliberate practice with feedback is how complex skills develop, which is why leadership is learned through guided experience rather than instruction alone.
Sources: Kram 1985, Sambunjak et al. 2006, Ericsson et al. 1993, Kouzes and Posner 2017
It looks like
- Identifies emerging leaders early, including those who do not fit the usual profile.
- Gives mentees stretch assignments with support and honest feedback.
- Teaches the Credo through real decisions, explaining the reasoning as well as the result.
- Measures their success partly by the success of the people they develop.
It is not
- Mentors only people who remind them of themselves.
- Offers advice without creating opportunities.
- Treats mentoring as something to do when there is spare time.
Leader micro practice
Name two people you are deliberately developing. Meet each monthly, and in every meeting discuss one real decision through the lens of the Credo.
60 second huddle moment
“Who is learning from you this month? Teach one thing today that puts the patient first.”
Practice scenario
A charge nurse with strong clinical skills, who is quiet in meetings, asks you how to become a manager. You have a heavy workload this quarter.
What would you do?
Rubric for this commitment
1 Emerging
Supports development when asked but has no deliberate mentoring relationships.
2 Developing
Mentors informally and occasionally, mostly through advice rather than structured experience.
3 Proficient
Maintains deliberate mentoring relationships with stretch assignments, feedback, and explicit teaching of patient centered leadership.
4 Exemplary
Builds a mentoring system, develops mentors as well as mentees, and has a track record of leaders who carry the Credo forward.
45 minute teaching plan
| Minutes | Segment | Facilitator guide |
|---|---|---|
| 0 to 5 | Open | Read the commitment aloud together, then use the huddle moment: “Who is learning from you this month? Teach one thing today that puts the patient first.” |
| 5 to 15 | Meaning | The Credo is only sustainable if it outlives the leader who wrote it. Ask for one real example from the group of the commitment kept and one of it missed. |
| 15 to 25 | Evidence | Share why it matters, then walk through the four “looks like” behaviors and the three “it is not” patterns. |
| 25 to 40 | Practice | Run the scenario in pairs. Each pair chooses an option and defends it before the feedback is revealed. Close with the discussion questions. |
| 40 to 45 | Commit | Each participant writes the micro practice in their own words, names the date they will start, and names who will observe it. |
Discussion questions
- Who mentored you to put patients first, and what did they do that mattered?
- Who on your team has leadership potential that others may be overlooking?
- How would your team know the Credo if you left tomorrow?
Measures to watch
- Leaders with named mentees and a development plan
- Internal promotion rate into leadership roles
- Mentee retention and progression at two years
The leader rubric: 40 behavioral anchors
Each commitment is rated on four levels that describe what a leader actually does, not how they feel about the commitment. Rate from direct observation over the last 90 days. If a commitment has not been observed, record it as not observed rather than guessing.
1 Emerging Knows it
Understands the commitment and applies it when prompted or when conditions are easy.
2 Developing Tries it
Applies the commitment on their own, but inconsistently, and it weakens under time or conflict pressure.
3 Proficient Lives it
Practices the commitment consistently and visibly, including when it is inconvenient.
4 Exemplary Builds it
Models and teaches the commitment and builds systems that make it reliable for others.
| Commitment | 1 Emerging | 2 Developing | 3 Proficient | 4 Exemplary |
|---|---|---|---|---|
| 01I Will be a patient advocate. | Can describe what advocacy means but raises patient impact mainly when asked or after a complaint. | Raises patient impact in some decisions, but drops it when schedules, budgets, or senior leaders push back. | Consistently names the patient impact in decisions, escalates concerns past their own level, and follows them to closure. | Builds patient impact into how the team decides (agendas, templates, checklists) and coaches others to advocate without being prompted. |
| 02I Will listen to patients, families, and staff before making decisions. | Listens when approached but usually decides first and explains afterward. | Seeks input before some decisions, mostly from familiar or senior voices, and rarely closes the loop. | Routinely gathers patient, family, and frontline input before deciding, including quiet voices, and reports back what changed. | Designs listening into the team's operating rhythm (rounding, huddles, patient advisors) and teaches others to listen before deciding. |
| 03I Will protect every patient's dignity, privacy, and right to be heard. | Follows privacy rules and treats patients courteously but does not look for system threats to dignity. | Corrects obvious dignity or privacy lapses when seen, but inconsistently, and seldom addresses the environment that caused them. | Consistently protects dignity, privacy, and patient voice, addresses lapses promptly and respectfully, and fixes environmental causes. | Builds dignity and voice into space design, workflows, and team norms, and develops others who protect them without being asked. |
| 04I Will speak up when patient safety or quality of care is compromised. | Speaks up when a concern is clear cut and low risk, but hesitates when rank or relationships are involved. | Raises safety concerns in most situations but responds inconsistently when others speak up to them. | Speaks up reliably regardless of hierarchy and responds to others' concerns with thanks and follow through. | Has built a climate where staff at every level stop the line, and teaches other leaders how to respond to voice. |
| 05I Will support the people who care for our patients. | Recognizes the importance of staff support but acts mainly on formal requests or crises. | Offers support and recognition in some situations, often generic, and rarely removes structural barriers. | Regularly removes barriers, recognizes specific contributions, protects capacity, and checks in after hard events. | Treats workforce well-being as an operational system with measures and accountability, and coaches other leaders to do the same. |
| 06I Will work to remove barriers that delay necessary care. | Acknowledges delays but treats most of them as outside their control. | Fixes delays within their own area when they are raised, but rarely looks upstream or across departments. | Measures time to care, maps patient journeys, and removes barriers across department lines. | Builds access into the system: equity stratified access data, cross department ownership, and leaders who remove barriers by habit. |
| 07I Will lead with integrity and compassion, especially when decisions are difficult. | Values integrity and compassion but retreats to vagueness or avoidance when decisions are difficult. | Is honest and caring in most situations, but under pressure either softens the truth or loses sight of the human impact. | Communicates hard decisions truthfully and personally, acts to reduce harm, and keeps word and deed aligned. | Is known across the organization as a leader whose word holds under pressure, and mentors others through difficult decisions. |
| 08I Will use evidence, clinical judgment, and patient preferences to guide improvement. | Values evidence but often decides on experience, anecdote, or the most recent example. | Uses evidence or data in formal projects but inconsistently integrates frontline judgment and patient preference. | Routinely integrates evidence, clinical judgment, and patient preferences, and tests changes over time before scaling. | Builds an improvement system that requires all three sources and teaches others to use evidence without dismissing experience or patients. |
| 09I Will take responsibility for my decisions and follow through on my commitments. | Accepts responsibility when outcomes are good or when accountability is unavoidable; commitments slip without notice. | Owns most decisions and keeps most commitments, but communicates poorly when commitments slip. | Owns decisions and their consequences, keeps commitments reliably, and renegotiates openly when plans change. | Creates a culture of fair accountability, with visible commitment tracking and just culture responses, and develops leaders who own outcomes. |
| 10I Will mentor future leaders to put patients at the center of healthcare. | Supports development when asked but has no deliberate mentoring relationships. | Mentors informally and occasionally, mostly through advice rather than structured experience. | Maintains deliberate mentoring relationships with stretch assignments, feedback, and explicit teaching of patient centered leadership. | Builds a mentoring system, develops mentors as well as mentees, and has a track record of leaders who carry the Credo forward. |
Rate behavior, not intent
Behaviorally anchored scales tie each level to observable conduct, which reduces the ambiguity that makes ratings drift. Ask “What did I see this leader do?” before choosing a level.
Use two lenses
Self ratings and observer ratings of leaders often disagree. The gap is itself development data: a self rating well above observers signals a blind spot, and one well below signals an unrecognized strength.
Level 4 is about others
Exemplary is not “perfect.” It describes a leader whose practice of the commitment has become a system: others do it reliably because this leader taught it and built it into how work gets done.
Assess a leader against the Credo
Choose a learner and a lens, then rate each commitment. Results update as you go. Select a level to see its behavioral anchor, and save the assessment to build the learner’s record over time.
I Will be a patient advocate.
Not yet rated.
I Will listen to patients, families, and staff before making decisions.
Not yet rated.
I Will protect every patient's dignity, privacy, and right to be heard.
Not yet rated.
I Will speak up when patient safety or quality of care is compromised.
Not yet rated.
I Will support the people who care for our patients.
Not yet rated.
I Will work to remove barriers that delay necessary care.
Not yet rated.
I Will lead with integrity and compassion, especially when decisions are difficult.
Not yet rated.
I Will use evidence, clinical judgment, and patient preferences to guide improvement.
Not yet rated.
I Will take responsibility for my decisions and follow through on my commitments.
Not yet rated.
I Will mentor future leaders to put patients at the center of healthcare.
Not yet rated.
Track every learner’s progress
Keep a roster of the leaders you are developing. Each learner carries a history of assessments from both lenses and a module record that moves from taught, to practicing, to observed in daily work.
Add a learner
Record leaders and staff only. Never enter patient names or patient details anywhere in this tool.
Roster
No learners yet. Add a learner above or load the demonstration cohort to explore the tracker.
See the cohort at a glance
Cohort analytics show where a group of leaders is strong, where it is weak, who is growing, and who needs attention. The weakest commitments across the cohort become the next teaching focus.
Cohort analytics appear once learners have at least one assessment. Load the demonstration cohort in the Learner Tracker to preview them.
Plan the teaching sequence
Schedule the ten modules with spaced reinforcement. Distributed practice produces more durable learning than massed sessions, so every module is followed by a huddle reminder, a practice check, and an observation.
Design a Credo that lasts
Most value statements fade within a year of launch because nothing in the organization depends on them. Score the eight mechanisms that embed a Credo into culture, then build the roadmap, rotation, and charter that keep it alive.
Credo Sustainability Assessment
Rate how established each mechanism is today. 0 Absent, 1 Initiated, 2 Established, 3 Embedded.
Leadership Modeling Binding
Schein: deliberate role modeling, teaching, and coaching
Not yet rated.
Attention and Measurement
Schein: what leaders pay attention to, measure, and control
Not yet rated.
Selection and Onboarding
Schein: how leaders recruit, select, promote, and excommunicate
Not yet rated.
Recognition and Reward
Schein: how leaders allocate rewards and status
Not yet rated.
Critical Incident Response
Schein: how leaders react to critical incidents and crises
Not yet rated.
Capacity and Resources
Schein: how leaders allocate resources; PSAT: organizational capacity and funding stability
Not yet rated.
Communication and Story
PSAT: communications
Not yet rated.
Governance and Renewal Binding
PSAT: strategic planning, program evaluation, and program adaptation
Not yet rated.
Three year roadmap
Rate the eight mechanisms to generate a roadmap that starts with the weakest and binding mechanisms.
Commitment of the Month rotation
Credo charter builder
A charter answers the questions that decide whether a Credo survives: who owns it, how it is measured, when it is reviewed, and what may change.
Choose one organizational measure per commitment.
Charter preview
Facilitator toolkit
Printable tools for putting the Credo into daily practice: a pledge card for each participant, an observation checklist for leader rounding, and a 60 second huddle script for every commitment.
Personal pledge card
Healthcare Professional
Credo
- 01I Will be a patient advocate.
- 02I Will listen to patients, families, and staff before making decisions.
- 03I Will protect every patient's dignity, privacy, and right to be heard.
- 04I Will speak up when patient safety or quality of care is compromised.
- 05I Will support the people who care for our patients.
- 06I Will work to remove barriers that delay necessary care.
- 07I Will lead with integrity and compassion, especially when decisions are difficult.
- 08I Will use evidence, clinical judgment, and patient preferences to guide improvement.
- 09I Will take responsibility for my decisions and follow through on my commitments.
- 10I Will mentor future leaders to put patients at the center of healthcare.
I will practice first: 01 Patient Advocate. My micro practice: Open every operational meeting you chair with one question: "What will the patient notice if we get this right, and what will they notice if we get it wrong?"
Kelly Emrick
Leader rounding observation checklist
Credo Rounding Observation
| Commitment | Look for | Seen | Level |
|---|---|---|---|
| 01 Patient Advocate | Names the patient impact before the operational or financial impact when a decision is framed. | ☐ | 1 2 3 4 |
| 02 Listen First | Asks open questions and waits through silence before offering a view. | ☐ | 1 2 3 4 |
| 03 Dignity and Privacy | Notices and fixes environmental threats to dignity: gowns, hallway conversations, exposed screens, curtains left open. | ☐ | 1 2 3 4 |
| 04 Speak Up for Safety | Raises safety or quality concerns directly, with specifics, regardless of the rank of the person involved. | ☐ | 1 2 3 4 |
| 05 Support Caregivers | Asks staff what gets in the way of their work and fixes at least one thing visibly. | ☐ | 1 2 3 4 |
| 06 Remove Barriers | Measures time to care, not just volume, and knows where the waits are. | ☐ | 1 2 3 4 |
| 07 Integrity and Compassion | Tells the truth about hard decisions, including what is not yet known. | ☐ | 1 2 3 4 |
| 08 Evidence and Preference | Asks "What is the evidence?" and "What do patients want?" before approving an improvement. | ☐ | 1 2 3 4 |
| 09 Ownership and Follow Through | Says "That was my decision" when outcomes are poor. | ☐ | 1 2 3 4 |
| 10 Mentor Future Leaders | Identifies emerging leaders early, including those who do not fit the usual profile. | ☐ | 1 2 3 4 |
Record only what you directly observed. Leave the level blank if the commitment was not observed.
60 second huddle scripts
01 Patient Advocate
“Today, when a decision is made on this unit, someone should ask what the patient will experience because of it. If no one asks, you ask.”
Ask: Describe a decision in the last month where the patient's interest was not represented. What would advocacy have looked like?
02 Listen First
“Before we change anything today, who has not been asked yet? Name one person and go ask them.”
Ask: When did you last change a decision because of something a frontline staff member or family told you?
03 Dignity and Privacy
“Every patient here today will be seen, covered, and heard. If you notice a moment where that is not true, fix it or call it out.”
Ask: Where in your area could a patient overhear information about another patient?
04 Speak Up for Safety
“If something looks unsafe today, say it. You will be thanked for it, even if it turns out fine.”
Ask: When did you last stay silent about a concern? What made silence feel safer?
05 Support Caregivers
“Who on this team needs help today? Ask, and if you are the one who needs it, say so.”
Ask: What is the most frustrating part of your team's work that has nothing to do with patients?
06 Remove Barriers
“Which patient is waiting today who does not need to be? What would it take to move them?”
Ask: What is the longest avoidable wait a patient experiences in your area?
07 Integrity and Compassion
“Hard decisions are coming this quarter. You will hear about them from me, directly and honestly.”
Ask: Describe a time your words and actions did not match as a leader. How did your team notice?
08 Evidence and Preference
“Before we change a process, we ask three questions: what does the evidence say, what do you see, and what do patients want?”
Ask: Which recent change on your team was based on habit rather than evidence?
09 Ownership and Follow Through
“Here is what I committed to last week and where it stands. Hold me to it.”
Ask: What commitment have you let slip recently, and who noticed?
10 Mentor Future Leaders
“Who is learning from you this month? Teach one thing today that puts the patient first.”
Ask: Who mentored you to put patients first, and what did they do that mattered?
Evidence and methods
The teaching content draws on the sources below. The scoring rules are design choices for this teaching tool and are documented here so every number on the dashboard can be traced and challenged.
Credo Fidelity Index (CFI)
CFI = (mean rated level − 1) ÷ 3 × 100
Commitments rated Not observed are excluded from the mean. At least 7 of 10 commitments must be rated for an index to be reported, so a score never rests on a thin sample.
Bands: 0 to 24 Awareness, 25 to 49 Developing, 50 to 74 Practicing, 75 to 100 Modeling.
Weakest link rule: any commitment rated 1 (Emerging) caps the band at Developing regardless of the index.
These bands divide the scale into equal quarters. They are developmental guides for coaching conversations, not validated cut scores, and should not be used for employment decisions on their own.
Perception gap and sustainability
Perception gap = self level − observer level for each commitment. A gap of +1 or more is flagged as a possible blind spot; −1 or less as an unrecognized strength. Self and other ratings of leaders commonly diverge, which is why both lenses are recorded.
CSI = sum of eight mechanism ratings ÷ 24 × 100
Bands: 0 to 24 Fragile, 25 to 49 Emerging, 50 to 74 Durable, 75 to 100 Self sustaining. Leadership Modeling and Governance and Renewal are binding: if either is rated 0, the band is capped at Fragile.
The eight mechanisms adapt Schein’s primary culture embedding mechanisms and domains of the Program Sustainability Assessment Tool. They are an adaptation for this Credo, not the validated PSAT instrument.
Learning design
The tracker follows the logic of Kirkpatrick’s four levels: a module moves from taught (reaction and learning), to practicing (a committed micro practice), to observed (behavior seen in daily work), and cohort results connect to the organizational measures chosen in the charter. The curriculum planner spaces sessions and reinforcement because meta analytic evidence favors distributed practice and leadership training that uses practice, feedback, and spaced sessions.
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