Last week we looked at a company that encapsulates the heart of transformation. In it we delved into what makes DaVita tick. I got a sense that from some of the feedback that I received that some readers, as impressed as they may be by the spirit of the DaVita workforce were a bit dubious about how the company works – its full throated appeals to community, even democracy, over tough-minded calls for efficiency and profitability. You skeptics are not alone. By virtue of his track record over the past decade, CEO Kent Thiry has been asked to address business schools and executive conferences about how DaVita has performed so well in such a grueling environment. How do leaders react to his company’s untraditional priorities and practices?

“My gut tells me that half the audience thinks it’s bullshit,”he says candidly: “A quarter thinks we’re naïve. The rest think we are on to something. Those are the people I try to reach. I ask them: How much time did you spend this month checking on your values and creating a greater sense of empathy among your leaders? CEO’s are happy to carve out time to check on productivity, R&D, sales. But unless you bring the same rigor to checking on how people treat each other, to refreshing and sustaining the behaviours you claim to value, you never get anywhere.”

Truth be told, I was skeptical when I heard about the story at a conference. After the story unfolded I became puzzled by the outsized emotions and larger than life rituals at the company. This is an organization whose affinity for call and response interaction rivals the level of audience participation at a Bruce Springsteen concert. When the CEO cries, “One for all!”his colleagues cry, “All for one!”.When he shouts, “We said!”they shout, “We did!”The graduation proclamation from the DaVita Academy, an intense, two-day program that has trained tens of thousands of frontline employees, will never be confused with HR boilerplate: “By the powers vested in me by generations of dialysis patients, past, present, and future, with serious respect, sincere gratitude, and warm affection, we hereby proclaim you graduates of the DaVita Academy…”This is a company that is not afraid to wear its heart on its sleeve or shout its enthusiasm to the rafters.

It’s also a company that’s not afraid to insist that its high-ranking executives invest themselves with the same degree of emotional commitment as the nurses and technicians on the front lines. Early on in the turnaround process, Thiry designed a program called ‘Adopt a Center” in which senior executives would be required to develop a personal connection to a specific dialysis treatment facility – to spend time there, get to know the staff and patients, even do some basic work. The goal was for caregivers to teach the executives why the business mattered. This was a company, after all, whose “customers” were literally fighting for their lives.

Later, as DaVita’s financial condition stabilized, Thiry raised his expectations for senior executives in a formal program called Reality 101. Every official with the title of Vice President or above spends a week on the front lines of a dialysis center, helping to set up and tear down equipment and simply experiencing in human terms the highs and lows, the laughter and tears, that everyone experiences in a typical week at one of these remarkable places. One of the great threats to the health of big organisations is when executives allow themselves to lose touch with what happens in the trenches, and when people in the trenches come to believe that the people in headquarters don’t understand their day-to-day struggles and problems. Reality 101 is one of many DaVita initiatives to maintain and strengthen a sense of empathy, not just between the company’s people and its patients, but also between the company’s high-ranking executives and the frontline staff.

Sustaining performance, building an organization that can “run the four-minute mile”and stay the course over the long haul – is as much about cultivating a spirit of grassroots energy, enthusiasm, and engagement as unleashing a set of game changing ideas.

In his inspiring and instructive book Rules of Thumb, Fast Company cofounder Alan Webber identifies two questions that demand the attention of leaders. The first is familiar: What keeps you up at night? What are the problems that nag at you? The second is less familiar, but even more important: What gets you up in the morning? What keeps you and your people more committed than ever, more engaged than ever, more excited than ever, particularly an environment around you gets tougher and more demanding than ever?

That’s a question every organization needs to ask and answer if it hopes to prosper in an era of hyper competition and non-stop dislocation. Even the most creative or disruptive leaders recognize that long-term success is not just about thinking differently from other companies. It is also, and perhaps more important, about caring more than other companies – about customers, about colleagues, about how the organization conducts itself in a world with endless temptations to cut corners and compromise on values. For leaders, the pressing question isn’t just what separates you from the competition in the marketplace. It’s also what holds you together in the workplace.