Chuck Lauer: 10 Factors in Creating a Positive Work Environment
Over the past few years a new phenomenon has burst upon the healthcare world: the call for a positive work environment for employees. This is a great trend and I hope it will continue forever, but one warning: it is not so easy to accomplish. It takes a lot of hard work and total dedication. Here are 10 basic factors that I believe are essential to create a positive workplace. I believe each and every one of them is tremendously important to the overall health of the hospital and to the morale of the people who work in it.
1. The CEO must be involved. The work environment is not going to improve without total involvement of the CEO. You, the CEO, set the tone and create the culture. If you are enlightened, your employees will be enlightened, too. If you don't care, everyone else will pick up on that, too. The CEO is the face of the institution. You must exude confidence and energy and be willing to listen attentively to your employees, so that they feel respected.
To free up the time to devote to the staff, the CEO must delegate a great deal of management functions to others, such as a talented COO. Leave the paperwork and meetings to other executive staff so that you can connect with your staff and your patients. Bring all employees together regularly in meetings, so that they feel part of the overall operation of the hospital. Use these meetings to hand out awards to deserving employees. Awards not only boost morale but also help people feel they're part of a team.
2. Tear down all the silos. One undeniable way to improve morale is to get rid of all the silos that exist in every healthcare organization –– yours included. "Silo" is just a new word for "clique," but I like "silo" because it points to the barriers that cliques create. Silos are endemic in any large organization. When people from the same department spend a lot of time together, they begin to distrust everyone else. In healthcare, there are also a lot of professionals with degrees, who may conclude they are not subject to the same objectives and goals as the rest of us.
Tear down these silos! Everyone in the hospital should have the same objective –– to deliver quality healthcare to patients in a timely and efficient manner. From the housekeeper to the top surgeon, they all need to strive for the same goals. And no one should be made to feel they don't count. Everyone is an essential part of the master plan of the organization. You as CEO can discourage silos by using the bully pulpit. You can also chip away at silo-based thinking by inviting people from different departments to work together on key projects.
3. Understand patients are customers. Every employee in the hospital, no matter what their job is, needs to put the patient first. Too often patients are ignored as we tackle the paperwork and the bureaucracy, but keep in mind: patients are our customers. Now, many people in healthcare are uncomfortable with the term "customer," but it's absolutely the right word. The customer deserves everyone's undivided attention and respect. No business, including a hospital, can exist without a continued flow of customers. Remember that in the future, reimbursements will recognize the way patients are treated –– not just in your hospital, but across the continuum of care.
Every single person in the organization should be on board with the customer concept. But all too often, they aren't trained to think in these terms. In just about any other field, people are routinely taught how to treat customers with dignity and respect and to make sure they get exceptional service. Erie Chapman, the former president and CEO of OhioHealth, has written a book about how to treat the patient, "Radical Loving Care." He points out that in the traditional hospital, patients are made to feel like prisoners. They are stripped down, put into a gown and given a number, and visits are regulated. This affects employee morale, because when patients are the prisoners, employees take on the role of prison guards.
4. Include physicians in all decision-making. At a small meeting of hospital CEOs that I attended not so long ago, the subject of appointing physicians to the board came up. One of the CEOs said, "I will never have any one of those guys on my board. They just screw things up." I couldn't believe what I heard. I thought he was joking, but he was dead serious. This kind of thinking is all too prevalent. It ignores the fact that without physicians, the hospital couldn't exist. There would be no patients to admit. Physicians' goodwill is essential to a positive work environment in any hospital or system. And I do believe physicians deserve at least one seat on the board, and probably more.
A lot of hospital executives pay lip service to the importance of physicians, but they still keep them at bay. They don't want them to know about the financials or what is really going on. They fear that if the physicians really knew how much the CEO makes, they would be upset. But it is a far greater danger to keep your physicians in the dark. When physicians think they are powerless, which is all too common these days, they will constantly resist you, and this will affect efficiency and morale.
At Naples Hospital in Florida, part of NCH Healthcare System, the doctors were so upset they were going to the media. Then one of these physicians was made CEO and turned the whole place around. Allen Weiss, MD, has done everything possible to open the lines of communication. Now the hospital has won award after award, not only for being a great place to work but for clinical excellence as well. Ed Eckenhoff, the former head of head of National Rehabilitation Hospital in Washington, D.C., recently was hospitalized at Naples Hospital, and told me, "I have never been treated so well in a hospital in my life. The hospital just saved my life."
5. Empower each employee. Every single person who works in a hospital should be empowered to do what he or she feels is necessary to improve care for the patients. There are all kinds of wonderful stories about people stepping up to help patients cope with their insecurities and fear. Recognize there can be a variety of ways to accomplish a task. As a rule, management should get out of the way and let employees do their work.
6. Train personnel on a regular basis. Empowering employees involves giving them the tools to do their jobs and making sure they don't develop bad habits. In a busy hospital, the staff has to cope with a great deal of stress and still be patient-friendly. This has to be learned. Someone has to teach them the skills, but most hospitals do not give employees much assistance.
Training is an ongoing effort. Being a great employee takes constant attention. It's not something you do just once or twice a year. It should occur on a monthly or even a weekly basis. It might simply involve several employees meeting during a lunch break to discuss the challenges of the job. Training sessions should include talking about the mission and vision of the management team and why everyone –– no matter how menial their job –– is part of the overall effort to deliver quality care to patients.
7. Reach out to staff. To create a positive culture, CEOs have to make themselves visible. This means walking around all departments and talking with employees. Great CEOs always make sure that they are known throughout their organization and not hiding in their offices, away from the daily activities that occur in any hospital. Tim Stack, the president and CEO of Piedmont Healthcare in Atlanta, is a walk-around guy, even though his organization has five different hospitals. And Alan Channing, the CEO of Sinai Health System in Chicago, makes sure everyone knows he cares deeply about his people. The physicians call him by his first name.
When leadership does not reach out, it can be very corrosive. Look at the old Soviet Empire. No one had basic information about what was going on, so people started inventing their own scenarios. When people are cut off, rumors abound, and they get distracted from their work. Being open and transparent means constantly meeting with staff and sizing up their needs. Employees need to feel that what they have to say is important. And no one should feel they cannot criticize and voice their opinions relative to the operation of the hospital.
8. Take risks to make your organization stronger. All hospitals and health systems will have to do more with less. This means they have to continually explore new ways of delivering quality care to patients. Hospitals have to take risks and try out new systems, new viewpoints and new relationships. Leaders who are not willing to do this are jeopardizing the future of their organizations. Healthcare reform is here to stay, with or without the Affordable Care Act. Executives are going to have to step forward quickly, with innovative and creative ideas. If they don't, the whole organization will suffer the consequences, and some will even close.
9. Make sure nurses are treated with respect. Nurses often get mistreated in a hospital, which is not just bad for them, but affects the efficiency and morale of the entire organization. Many nurses feel exploited and treated indifferently, and stories of sexual harassment abound. When they are treated well, they are more likely to be engaged with their work. Nurses deserve to be treated with respect and dignity. When we truly respect someone else, we have to figure out why they think the way they do.
10. Encourage staff to be active in the community. The management team should always encourage employees to be active in their communities, whether it is the local Rotary Club or coaching kids in sports. After all, most hospitals are community-oriented, so the more people in the community are familiar with the people there, the more supportive they will be when it is time for fundraising.
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