10 Questions Every Hospital Should Ask its Employees

Paul Spiegelman's new book, co-written with president of Texas Health Presbyterian Hospital Dallas Britt Berrett, starts with an intriguing premise: Patients come second.

Without downplaying the importance of patient care, Mr. Spiegelman posits that the root of a hospital's success lies with how it treats its employees – an aspect of hospital management he says is too often overlooked. In writing the book, Mr. Spiegelman and Mr. Berrett developed a "quiz" for hospital employees called the CultureIQ™, a 10-question test that allows hospitals to gauge how their employees see the company, as well as how they measure up to their competitors.

"The purpose is to look at the perception of the individuals in that organization – anything from the C-suite to a front line worker, and use that data to compare the organization to other organizations with the same type or size or geography," Mr. Spiegelman says. "It also allows the organization to compare levels and departments in the same organization." He says this tool is important for hospitals because improving the employee experience improves the patient experience, which in turn improves case volume and hospital revenue. Even if a hospital's main priority has to be financial stability, improving employee satisfaction is a means to an end.

He says the CultureIQ test has yielded some interesting results so far. Each question on the test is scored on a 1-10 scale, with 1 being the worst perception of the hospital's culture and 10 being the best. The overall score gives hospitals an idea of how they're doing – an 89, for example, would be good, while a 50 would show some problems with staff satisfaction. In many hospitals, the discrepancy between scores in the C-suite, middle management and the front lines have been significant, Mr. Spiegelman says. "If the C-suite fills it out and scores at 89, but the middle managers score a 62, you're wondering if the hospital has a communication problem," he says.

Overall, he says the data shows hospitals have a long way to go in developing the kind of internal cultures necessary to improve the patient experience. Physicians and front-line workers are most likely to score the organization low, while upper management is most likely to score the organization high.  

Here, Mr. Spiegelman and several top hospital CEOs discuss the ten questions in the CultureIQ test, as well as what hospitals can do to reach "10" in every category.

1. Are our core values are deeply ingrained into our decision-making process? The first question relates to the hospital's "mission, vision and values." In many hospitals, Mr. Spiegelman says the core values are simply words in a handbook that aren't instilled in the everyday life of the employees.

He says in the best organizations, the mission, vision and values will be a constant part of life in the hospital – so much so that employees bring them up at meetings, discuss them in the halls, and joke about them over lunch. In his company, he says it's not unusual for an employee to raise their hand and ask, "Are we going to sacrifice quality in order to do something non-standard for a client?" This shows that employees understand the company's core values, one of which is "never sacrifice quality."

Gary Newsome, CEO of Health Management Associates in Naples, Fla., agrees with Mr. Spiegelman that the mission of the hospital has to be spread by the senior executives. "The culture of an individual hospital relies heavily on the leadership team of that hospital," he says. "The tone has to be set at the top. Everyone needs to understand: What is the goal? How are we going to get there? Every individual, from nursing to dietary to business ops, has to have a common understanding."

2. Do we have fun at work? Even in a serious business like a hospital, Mr. Spiegelman says there's room for fun. This question determines whether your employees like the atmosphere at their workplace and feel comfortable joking (appropriately, of course) with their coworkers. A hospital should hold regular events that make employees feel part of the organization's family, such as potlucks, barbecues and field days.

Dane Peterson, CEO of Emory University Hospital Midtown, says "laughter in the workplace is critical. Even in life-or-death institutions, it is important to enjoy the work. If we cannot laugh and enjoy the good times, it is hard to handle the inevitable difficult times." In a hospital, this is even more important than in a regular office, since those ‘difficult times' are all the more likely in a place where the customers are ill.

3. Do we have a system in place to show that we care about the personal lives about our employees? "You have to genuinely care, and that's not something to take for granted," Mr. Spiegelman says. In the healthcare industry, many CEOs have thousands of employees, meaning they need an institutionalized system to support individual team members. Otherwise, people will get lost in the shuffle, and employees will assume that the hospital is only focused on meeting financial goals rather than caring for its staff.

Andy Leeka, CEO of Good Samaritan Hospital, explains that caring for employees has a positive effect on the organization's success. He gives the example of Bea, an environmental services worker who brings in homemade tamales for hospital associates from time to time. "I know about Bea's family," he says. "I know about her tragedy in her family. I've helped her out financially because I'm going to take care of her. I'm going to take care of Bea, and Bea is going to take care of me, because she's going to take care of the patients and the room and the lobby and everything else."

At his company, Mr. Spiegelman says the managers have an intranet site where they can find out about employee birthdays, family deaths and personal accomplishments. When something happens, the managers immediately step up and send a card, talk to the employee, or notify the office. "Often, people say they care, but they don't do a good job of actually finding out what happens and doing something about it," he says.

4. Do we hire for fit in addition to skill? Your employees will notice if the people around them are dissatisfied, Mr. Spiegelman says. Nothing kills job satisfaction like listening to your coworkers complain, day in and day out, about the culture of the company, their supervisors and their daily work.

In this economy, there are a lot of people looking for work, meaning hospitals have their pick of the litter when looking for a staff member to fill a position. Because of this luxury, Mr. Spiegelman cautions hospital hiring departments to hire for fit with the organization as well as skill. The interview should involve a lengthy conversation about the employee's values, expectations, past behavior and interpersonal skills.

5. Do we quickly and appropriately move the wrong people out of the organization? Mr. Spiegelman says this question consistently scores the lowest on the test, both in the C-suite and on the front lines. "Senior executives are fairly honest that we don't do a good job of getting rid of the wrong people," he says. "They'll tend to blame everything from HR to legal issues to unions, but the reality is that they've set the problem up themselves."

Tom Royer, former CEO of CHRISTUS Health in Irving, Texas, says, "The biggest barrier is tolerance of mediocrity [in our people]. There's nothing worse than good people becoming mediocre." He says a hospital cannot depend on the 99 percent of employees who do their jobs well and treat patients kindly, because patients will remember the 1 percent who were rude or careless.

Mr. Spiegelman says every hospital needs a clear process for removing "bad apples" from the organization, and the process should be fast enough to eliminate bad fits while still giving struggling employees the chance to improve. "Hospitals tend to procrastinate and hold onto people who aren't meant to be part of the organization," he says.

6. Do our employees get personally involved in our community service activities? Every hospital should be involved in the community, and with a large staff that interacts with the public on a daily basis, it shouldn't be difficult to engage with local residents. Mr. Spiegelman recommends letting employees get involved with the process of choosing a charity or community service activity, so that the activity doesn't seem passed down from the C-suite.

He says the activities should also let employees get their hands dirty, rather than simply raise money for an organization or bring in canned food. "It's not about collecting money; it's about the time people spend painting firehouses, or putting packages together for people who don't have as much," he says.

In a hospital, you're hopefully hiring people who want to benefit their community through their job, so it should be relatively easy to get people excited about community service activities. "It's a great pride-building activity for employees, to get your hands dirty and serve others in the community," he says.

7. Do we regularly measure employee engagement, create action plans and communicate results?
"You'd be surprised by how many organizations don't even measure employee engagement," Mr. Spiegelman says. He says while many hospitals have picked up on employee satisfaction surveys, the traditional annual survey is not enough to ensure engagement on a perpetual basis. The hospital should set up a system to let employees give feedback whenever they want, whether it's through informal lunches, chats with the CEO, or a website to let people give feedback anonymously.

He says once those results have been collected, the hospital should create an action plan to improve satisfaction and share it with the employees, incorporating suggestions given during the survey process. And don't present the results dishonestly: "Employees will always sniff out the ‘spin' on … satisfaction results," says John Hill, former CEO of Medical Center of Aurora. "Celebrate improving and great results, and talk frankly about poor or negatively trending results."

Mr. Spiegelman says he happened to visit Mr. Berrett's hospital on a day when the hospital had raised employee satisfaction from the 50th to the 92nd percentile, and were celebrating with pizza for the whole staff. Employees will appreciate hospital leaders taking their suggestions, improving the hospital's culture and then thanking them for their feedback.

8. Do we have a robust reward and recognition program? Hospitals should have a system to reward and recognize employees, and it should be standardized throughout the organization to avoid claims of favoritism from staff. He says this doesn't necessarily mean doling out bonuses; in fact, non-monetary rewards can go a lot farther in showing employees they are valued.

He recommends implementing a program where employees can recognize each other and be recognized by their colleagues and superiors for even minor successes, such as recognizing a patient safety issue or helping a patient's family during a hard time. If you recognize these small victories, you motivate employees to behave well in the hopes that they'll be rewarded.

9. Do we regularly demonstrate our commitment to growing and training our employees? A certain percent of employees love their jobs and are perfectly happy to stay where they are in the organization, Mr. Spiegelman says. But most need growth and development opportunities, and you need to provide them. Great hospitals recognize that future leaders can come from any level in the organization and implement programs to help management, nurses, techs, physicians, and office managers pursue advanced degrees and certification.

10. Do our employees feel like they are here for a purpose beyond just their job? "We're all in healthcare, and generally we're driven by a higher purpose," Mr. Spiegelman says. You want to make your employees feel that they're tied to something more than just a job – that through their work, lives are changed and the world is improved. He says this starts with the leadership team. The CEO should be constantly driving the mission, values and purpose of the organization, as well as emphasizing how every role in the hospital fits into the overall mission.

The "higher purpose" ties into the mission, vision and values of the organization, Mr. Spiegelman says. The values of the organization should be easy to recite, so that employees can remember them and are forced to ask: Why am I here? What are my personal values? Do I agree with the hospital's mission? Mr. Peterson says, "Everyone wants to be part of something bigger than themselves, so even those employees who work in roles that are not found only in healthcare, and even those of us who came to healthcare later in life, can get excited about making a real difference in the lives of others."

He emphasizes that leadership should walk the talk, making decisions that pair up with the stated mission and values of the organization. "Actions speak more forcibly than words, and when actions and words are aligned, engagement will follow," he says.

Paul Spiegelman and Britt Berrett have written a book, Patients Come Second: Leading Change by Changing the Way You Lead, due out March 13. Visit the book's website here and take the CultureIQ test here.

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