Donato-picDonato Tramuto is the author of a new book The Double Bottom Line and the CEO of different healthcare companies. In this episode, you will learn how compassionate leadership can lead to an organization that collaborates, cooperates, and trusts each other.

A global health activist, former CEO of Tivity Health, and founder of the Tramuto Foundation and Health eVillages.

Donato has nearly four decades of business leadership experience and is most notable for his ability to balance transactional and transformational leadership within organizations.

In his new book, The Double Bottom Line, Donato Tramuto ― recognized CEO, business leader, innovator, and philanthropist, ― makes the case that compassion is a key leadership principle.


Narrator:        Welcome to Cracking the Cash Flow Code where you'll learn what it takes to create enough cash to fill the four buckets of profit. You'll learn what it takes to have enough cash for a great lifestyle, have enough cash for when emergency strikes, fully fund a growth program, and fund your retirement program. When you do this, you will have a sale‑ready company that will allow you to keep or sell your business. This allows you to do what you want with your business, when you want, in the way you want.

In Cracking the Cash Flow Code, we focus on the four areas of business that let you take your successful business and make it economically and personally sustainable. Your host, Josh Patrick, is going to help us through finding great thought leaders as well as providing insights he's learned through his 40 years of owning, running, planning, and thinking about what it takes to make a successful business sustainable and allow you to be free of cash flow worries.

Josh Patrick:   Hey, how are you today? This is Josh Patrick and you're at Cracking the Cash Flow Code. And, today, my guest is Donato Tramuto. I think I got that right. I hope I did. And he is the author of a new book, The Double Bottom Line. And that's what we're going to talk about today. But besides being the author of this really nice book, he also was the CEO of a zillion different healthcare companies. And he is now on the board, he told me, of - I don't know, six boards or nine boards and four other things. He's got a deal going with Boston University. A busy guy so we're glad to have him today. So, let's bring him on.

Hey, Donato. How are you today?

Donato Tramuto:       I'm doing great, Josh. And thank you for that wonderful introduction.

Josh:                Oh, you're welcome. You're a very impressive guy. Well, luckily, we had a chance to talk a little bit a couple of, you know, weeks ago. And, unfortunately, there were some technical glitches so we're starting all over again.

So, tell me. What is The Double Bottom Line?

Donato:          Well, it's a very interesting question. You know, I think that, for years, we've talked about doing good and being profitable. What this book really does and I think that what I have really enjoyed about the book, it's not, you know, the double bottom line according to my opinions. We interviewed 41 world leaders. And I think many of those leaders, people will know, the readers will know those individuals. But then, we also surveyed 1500 individuals in the United States - workers, to try to compare their viewpoint in terms of how organizations are being led today and compare it to the control group of the 41.

And what we really learned, in this really tough environment, you know, you've heard the term the great resignation. People are leaving their jobs. They're redefining what they want to do with their lives. But in many respects, what they really want is a sense of belonging. They want a sense of compassionate leadership that focuses on being profitable and also focuses on inclusion and doing good. And that's what the book is about. You know, there's rich data that will help the reader and leaders understand what are the ingredients behind the double bottom line.

Josh:                So, Donato, I have a question for you.

Donato:          Please.

Josh:                I know that what you just said resonates with millennials and Gen X. It doesn't really resonate with-- I mean, not Gen X but millennials and Gen Z. It doesn't resonate with Gen X and baby boomers.

Donato:          Absolutely. But it's a very interesting, you know, kind of question you ask.

What really was concerning to me in the data was the gap. There is an enormous-- let me give you one great example. The survey revealed that the majority of those surveyed felt that compassionate leadership leads to a organization that collaborates and that there's cooperation. However, the interesting variable is, when you interview the leaders-- by the way, what they also indicated is that it becomes less competitive. But when we went back to really measure what happens in those organizations, we found the organization to be very competitive. So, there is this gap that there's agreement that compassionate leadership leads to more collaboration as opposed to competition, but the organizations are actually competitive. The other thing that we found in our control group is that there was no question that the leaders felt that compassionate leadership as part of a double bottom line was absolutely critical but in all actuality their focus was on the one aspect of the bottom line - how to be profitable. So just with that information, there is an enormous disconnect.

The other disconnect that really came out of the survey, the average age of the CEOs in America is 59 years old. By the way, that's the same average age for those who are serving in Washington. But 50% of our employee population are 40 years and less. And so, are we really listening to the millennials and the gen Z-er’s? The answer is very, very quick - no. And so, there is this disconnect. And this is what I think the book will help leaders, current leaders and future leaders, understand.

Josh:                So, you know, I've been listening to stuff about Gen Z and millennials, and how they're slugs, and they don't like to work, and all that kind of stuff. And I don't think it's any different than what I heard from when I was a kid and when the Gen X‑er’s were kids. It seems like every rising generation gets dumped on by the people in their 50’s and 60’s.

Donato:          There's no question. But there is a commonality that we found in our research. Like generations before them, Gen Z‑er’s have a need for belonging. And there is a less of an importance placed on prestige and titles which is a little bit different because, when you look at the 50 year old’s, there's a lot of emphasis placed on titles and prestige. That is not the case with the Gen Z‑er’s.

This is an important takeaway given to what I just said, a few minutes ago, that the average C‑suite executive is 59 years old. And guess what? They hire according to that same age bracket. What we found in our research is that, if you're 59 years old and a CEO, you will tend to hire in that 50‑year age bracket. Now, why not bring some of the young people in who, in many respects, have a totally different perspective about services, and brands, and products? So, there is a very, very significant perspective.

The other one that I think is important is that very, very interesting, you know, we kind of look at the Gen Z-er’s as being this kind of, you know, very savvy on the technology side because they really grew up in this digital age. What they know about technology is with social media. And so, sometimes a, you know, older executive is thinking, “Gosh! They know a lot about technology. Why are they not stepping up?” That's a bias. What they know about technology is the social media.

The last point that we found in our, you know, incredible research is the sense of isolation - why they don't feel like they belong. Look what they have grown up with. The, you know, fear they have in schools because of the school shootings. They've lived through the pandemic. They've lived through a lot of venues that have created this isolation. And so, if I, as a CEO, am not aware of that, I'm assuming, “Hey, you're part of the employment, you know, business venue here. You know, step up and feel like you belong.”

Leaders are going to have to work harder now to really embrace what the Gen Z-er’s and millennials have gone through and to be able to address it in a way. And let me give you one example. I don't believe in the open‑door policy anymore. That doesn't work. Waiting for somebody to come to your office, that's an age‑old practice. You’ve got to get your behind off your chair. You have to now approach that employee. And that's what we talk about in this Double Bottom Line book.

Josh:                Although Tom Peters talked about that in the late ‘70s, in Search of Excellence, within MBWA (management by walking around).

Donato:          And what I propose is not only walk around, because a lot of managers have done that and they go back in their office, Josh, and they say, “Hey, I did my job.” You have to walk around and ask the question to which you're not afraid to receive the answer. For example, “Josh, tell me about what's going on right now in your life and your work.” And that's the piece that's missing is that many leaders feel like, “Hey, wait a second. I'm doing my job. I walk around and I show my face.” Then, they go back into their office. And what we're proposing, you're going to have to take that up now another notch.

Josh:                Yeah, I would say-- and I think Tom Peters would say MBWA is not walking around. It’s walking around and engaging.

Donato:          Exactly right. Yep.

Josh:                And if you don't engage--

The other thing, I think, which is really kind of-- I'm going to bet you're a fan of, is the thing I call servant leadership. And I'm not talking about the religious type of servant leadership although there are some interesting things. I'm talking about the fact is a leader’s job is to serve the people they work with. And their job is to serve the people they work with. Turn that org chart upside down and you've got a better model.

Donato:          Well, let me add to that. And that's exactly what we address in the book is that it's the, you know, adding value question. And that's what compassionate leaders do. “What can I do today to add value to other people?”

And your perspective of servant leaders is almost, you know, identical to the compassionate leadership model. And that is, you define others’ success as their own success. You focus on helping others succeed. I used to label myself as a COO as the chief obstacle officer. My job was to remove the obstacles. And the only way you can remove the obstacles is you’ve got to take time to understand and listen to the other person. And that is one of the most important ingredients of the compassionate leadership model.

Josh:                Yeah, I think that makes a lot of sense. I still have this belief is that my belief is a leader’s job is to make the job easier for the people who report to them.

Donato:          Well, what did Tom Peters say? Organizations exist to serve, period. Leaders live to serve, period.

Josh:                Yes.

Donato:          You know, and I think the COVID-19, I'm going to share with you a very interesting example. In one of the interviews and contexts that we were, you know, involved with, during COVID. There was a manager - this has been told to me by another person. There was a manager who was disappointed that he didn't get the purchase order from one of his customers. And this is the way it went. He got onto the, you know, Zoom call with the customer. And the customer had indicated that he and his wife had COVID. And what do you think the manager did? The manager said, “Oh, you know, I feel bad. By the way, when is that purchase order coming in?” Guess what? He never got the purchase order. And if he would have taken the time to really say, “You know what? I'll address the purchase order maybe on another call. Let me get really involved in understanding what this individual and his wife went through.”

And so, I don't think--

Yogi Berra once said, “You don't want to make the wrong mistake.” We are going to make mistakes in our career. How do we avoid the wrong mistakes? And there is a great example that I don't think this manager intended to approach it the way that he did. However, he not only, you know, lost the purchase order, he lost the trust. And that's the one thing we talk about in this book is a lot about trust.

Josh:                Yeah, I think that-- I mean, you know, there's a great book by Steven Covey’s son called business is The Speed of Trust. And the main premise of the book is the higher the trust level is in your organization, the faster your organization is going to move because you're not playing CYA all the time.

Donato:          Music to my hearing aids.

And, by the way, Josh, this is going to shock your-- you know, you and your viewers, and that's okay. For years, I've been taught that culture eats strategy for lunch. Get the culture right and everything else will follow. Throw that playbook out the window. What comes first is the trust. Then, you can address the mission, the values, the culture.

And we give examples of the 41 leaders that we interviewed, how they did. And, in one instance, you know, there was a, you know, pressure from the outside market to get the strategy in place. And the leader kept on saying, “No. I am taking my time,” and meeting with the employees, and understanding what the situation and what the challenges are in the org-- what was happening, he was building trust.

And then, once you get that trust, you can begin to address the culture. And you can begin to address the values and mission and vision. So, it's a little bit, you know, turning it upside down. But I think what you do is you avoid having to walk around with a pooper scooper. There's too many mistakes. And once you lose the trust, it is extraordinarily difficult to get it back.

Josh:                Actually, I would disagree with that. And I also want to disagree, just a little bit, with culture being after trust. In my world, or my experience anyhow, if I'm clear on my values and I'm clear on a clarifying statement around my values, I can build trust on that. But the challenge with values is too many businesses stick ‘em on a wall and never make ‘em part of the organization.

Donato:          Well, but, even more than that is they develop them in a vacuum. You know, you used the word my. It's okay to have your values. But what we've seen is that leaders tend to get five or six people together and then these values. And that's what I'm saying how the trust is lost. But if you can really take the time to engage the organization, one by one or in small groups, for a month or two, then you have a better sense of a more of a buy‑in. So, we're not saying culture doesn't matter. We're saying take the time to really understand that other side of the equation and then you can begin together to develop the trust, the mission, and the vision.

Josh:                Yeah, I think that probably makes more sense in big organizations than little organizations. Not the trust part. I think the trust part is crucial in any organization. But, in a small company, I often will ask the owner, I'll say, “Okay. Let's develop values. Let's live these values. Let's identify the values as core values versus aspirational values.” And then, when we bring people into our company, we're bringing them in based on the values that we have so they buy‑in or they don't buy‑in before they even walk in the door for the first day of work.

Now, maybe in a big organization, that won't work so well because I know in a small organization that works exceptionally well. And small I mean a hundred employees.

Donato:          Yeah, you know, I had the advantage, Josh, and you may be correct. Though, I have the advantage of running small organizations and, you know, large organizations. I was a public company CEO. I have used the same model with each organization.

Funny, when I did become a public company CEO, people would challenge me and say, “You know, what you did in the smaller company won't apply here.” Nonsense. And it's a matter of what degree of sustainability do you want? And I think that that's the difference that we saw in the leaders that took the time to really define what trust meant for them, what trust was going to be in the organization versus what I call just a rapid, you know, feeling that you have to get, you know, the values done this week or the mission done next week. And so, I think it's just taking a little bit, you know, of a respite and saying, “Can we do this in a very calculated way that helps the organization to feel that they're part of it?” And that's the compassionate leadership, you know, model.

Josh:                You know, there was a wonderful book written called The Trusted Advisor. And in there, they have a thing called the trust formula. And I use that thing every single day when I work with somebody. And the trust formula is very simple. It's intimacy which means how much do I care about you, plus competence, plus reliability, divided by self‑interest will tell you how much trust you have or how little trust you have. And when trust falls out, it's one of those four things that’s going out of whack.

Donato:          Well, think about a marriage, if you want to just put it in simplistic terms. On the first date, do the couple talk about their mission and vision and, you know, what they hope to do in their lives? No. They get to know one another. They get to understand the other person's story.

And that's what we've found. Trust is about understanding the other person's story to the point that you feel now that you have a relationship. We have to move away from a versation to a conversation. And that's what we're finding in the organizations and why we have this great resignation is that employees are saying, “I don't feel like I belong.”

And so, I think this new model is taking a little bit of a pause and, in many respects, developing the kind of relationships that can allow you to put a strong culture, a strong vision, and a strong mission statement together. And I truly believe it begins with trust, first, before it starts with the culture.

Josh:                Well, you can't have a real conversation without trust.

Donato:          Yep.

Josh:                I mean, that's really--

I mean, the truth is, if I don't trust you, I'm not going to tell you what I'm really thinking. If I don't feel safe, I'm not going to tell you what I'm really thinking. If I think I'm going to be punished, I'm not going to tell you what I'm really thinking. And none of us come to work in a company without baggage from our lifetime of growing up to that point.

Donato:          We all have a story. I remember when I became the CEO of Healthways which was a publicly traded company. And the first day they had an inauguration with the CEO and there were 2000 people in the audience, maybe, you know, a thousand were on the virtual platform. And I said to them, “I do not expect you to trust me today. Why? Why would you trust me? You don't know me.” I didn't get up there and say, “Here are my values. And here are my--" I said, “I am going to meet with as many of you as I can.”

It took me six months, Josh, but I met with more than 90% of that organization. And then, I started to learn about their dissatisfaction with the bonus plan, their dissatisfaction with investments. It went all over the place. And then, when I had put the strategy out there, and the vision/mission that we brought them all together and the values. You know, they had nine values and nobody could remember them. And I could have just said, “Keep the nine values there.” But I listened to them when they said, “We can't remember the nine values.”

And so, my point is, if you take the time to really listen, and it's going to take a time investment. You can get to a point where the other aspects of your role, as a leader, making tough decisions will begin to fall into place. And one of the tough decisions I had to make was to get rid of a division that was losing money that they had put nearly a billion dollars into. But I listened to the employees who informed me we can't be competitive. And that's how I gained the trust.

Josh:                Yeah, that makes-- you know, that makes sense. I mean, the truth is, if you're not listening and if you have nine values and nobody can remember what they are, you might as well have zero values.

I mean, the truth is-- and I've been-- and this is a hard thing to coach into people. I tell leaders, “If you're not talking about values and you're not talking about how that value relates to the day‑to‑day life of the person you're talking with, at least five times a week, nobody's going to ever pay attention to your values.”

Donato:          Well, you've raised something very, very good. And, you know, once you have gained the trust and then you start to drive forward in the culture, and the vision, and the mission, you’ve got to communicate. You can't just, you know, announce, to your earlier point, these are the values and put it up on, you know, the wall. It's got to be constant and consistent.

I had introduced something that was called the ask‑me‑anything call. The day before, I would record a voice email and send it out to all the employees. And then, the next day, every Friday, I had an ask‑me‑anything call. You could get on and ask me anything.

I once proposed that we do it once a month and you would have thought that I had, you know-- you know-- you know, damaged, you know, the company. The employees enjoyed that we were now following it up with communication. So, we had a value that we would be open and we would be high with integrity. What does that mean? Well, it meant that we're going to share with you information that we have.

And so, you're absolutely correct. You have to bring it to life then in a way that really does reinforce that trust that you were establishing.

Josh:                Yeah. That speaks to what we call core values versus aspirational values which I stole from Patrick Lencioni, from his book The Advantage. And, in there-- and what I've discovered is that, when I'm talking about values, I have to be very clear about what's a core value, and what's not a core value, and what I want to have become a core value. And the reason is, if you don't, the people who work with you see you as a big fat liar.

Donato:          Well, and after that, you have to hire-- I always hired and fired according to those core values.

Josh:                Oh, yeah, absolutely. I mean, I can train other stuff. I can't train values.

Donato:          You remind me of a story one time. And this was the son of a very well‑known healthcare CEO who wanted me to hire the son. And one of our values was continued learning. And during the interview, Josh, I had asked him, “What was the last book that you read?” You know, business leadership book. And he said to me, “Well, I honestly don't read leadership books--" he was like 41 years old. “--because I feel like I know enough about leadership.” I almost fell off my chair.

Guess what? I said to him-- I said, “You know what? We're not going to do well here. This is a core value in the organization and that is continual learning.” So, you have to be willing to hire and fire according to those core values.

Josh:                Absolutely.

Donato, you're a pleasure to speak with. And, unfortunately, we're out of time.

So, I'm sure The Double Bottom Line is a great book. I hope people take a chance to pick it up. Where would they find it?

Donato:          Right now they can pre‑order it.

Interesting. Josh, there is a paper shortage. And so, the book has been delayed. It was supposed to be introduced in January. It's now March 1.

But they can get onto Amazon, put The Double Bottom Line, and the book will come up, and they can preorder it there.

Josh:                Sounds good.

Would you like to have a conversation with-- if somebody wants to talk to you, would you be willing to do that?

Donato:          Oh my gosh, absolutely. In fact, one of the things--

Josh:                So, how would they find you? How would they find you?

Donato:          Simply go to our website,

Josh:                Cool.

And I've got two things I would like you to do. I'd like you to go to wherever you're listening to this podcast. First, subscribe. And then, please rate and review us. It's really important. The more ratings and reviews we get, the higher we go up on the list, the more Apple, or Spotify, or Amazon, or wherever you're listening gets reviews, the more they’ll love us, and the higher they rank us. So, that's something I hope you really do. I've been asking this every single podcast episode so it's not anything new to our people who have been around for a while.

The second thing is, about six weeks ago, we published my second book, The Sale Ready Company. It's a parable. It’s a continuation of the story with John Aardvark and his family. And you're going to find out that, you know, getting ready to have a sale ready company, although it sounds like it's a lot of fun, can be a lot of challenges. And there's a lot of major decisions that need to be made along the way. So, I hope you pick up the book.

It's really easy to get, just go to And you can buy the book there for half price and I have a bunch of bonuses. And if you're really feeling brave and want to have some fun, you can sign up to have a 20‑minute conversation with me.

So, this is Josh Patrick. We're with Donato Tramuto. You're at Cracking the Cash Flow Code. Thanks a lot for stopping by. I hope to see you back here really soon.


Narrator:        You've been listening to Cracking the Cash Flow Code where we ask the question, “What would it take for your business to still be around a hundred years from now?”

If you've liked what you've heard and want more information, please contact Josh Patrick at 802-846-1264 extension 102, or visit us on our website at, or you can send Josh an email at

Thanks for listening and we hope to see you at Cracking the Cash Flow Code in the near future.

Topics: key to profitability, good leadership, Compassionate Leadership, The Double Bottom Line, Donato Tramuto

Posts by Tag

See all

Subscribe to receive notifications about our most recent podcasts, videos, and blogs