12 Best Practices for Making Hospitals Great Places to Work

It is time to re-engage hospital staff. According to a 2010 report by Press Ganey Associates, 45 percent of hospital employees consider themselves "distanced from or discontent with their current work." Here are 12 best practices to turn that sad statistic around and nurture a fully engaged workforce.

1. Culture eats strategy. Vincent McCorkle, president and CEO of Akron (Ohio) General Health System, is fond of saying that "culture eats strategy." He means that while strategy is key for a successful organization, it can only produce short-term compliance if there is no strong employee culture. All the strategic planning, launching of new initiatives and use of sophisticated metrics in the world won't be successful without a fully engaged workforce.  

2. Draw from a 'well of credibility.' Any effort to engage employees should be treated as a valuable investment, says Kevin Haeberle, senior vice president and senior advisor at Integrated Healthcare Strategies in Kansas City, Mo. "Whenever you are engaging in mutual trust, you are putting water into the well," he says. "How deep that well is begins to matter when you need to take water out." For example, you have to postpone annual pay increases, cut back on benefits or make some other unusual demand that is going to be trying on your staff. "If you hit hard times and your well is shallow," he says, "you'll be in for a major negative reaction."

3. Be available. "When the hospital starts losing money, do all the top executives hide in their offices, no longer to be seen by anyone?" asks Brad Federman, president of Performancepoint in Memphis, Tenn. This is poisonous for employee morale, he says. Left without any information, employees start getting fearful, invent scenarios and are distracted from their work. To keep in touch, Mr. McCorkle holds regular "town hall meetings" for all shifts at his hospital. "We talk about aspirations and achievement in there," he says.

Availability is crucial up and down the chain of command, says Vicki Hess, RN, an employee engagement expert in Owings Mills, Md., and author of "The Nurse Manager’s Guide to Hiring, Firing & Inspiring." A common complaint from employees is, "My boss is in meetings all the time," Ms. Hess says. She advises managers to maintain an open-door policy and spend time with the staff. When the manager cannot always be personally available, there should be other ways to keep in touch with the staff, such as calling in or stopping by between meetings, she says.

4. Provide achievable goals. "People respond to goals," Mr. McCorkle says. For example, orthopedic surgeons are famous for ignoring requests to consider less expensive implants, but if they were told, "Saving x-amount of money on implants means we would be able to fund these specific projects," they would more likely respond. Having something to work toward "narrows the gap between itch and scratch," Mr. McCorkle says. He wants all goals to be ambitious, adding: "If we don't set high goals we will never achieve them." For example, the proper policy for dealing with patient falls is to set a goal of absolutely no falls with injuries.

5. Be transparent. Mr. Haeberle says the traditional approach is for management to be secretive. "If you were going to lay off people, you would announce it just before it happened," he says. The reasoning was people would stop working hard if they knew, but in fact, most people will continue to do their jobs well, he says. Indeed, Mr. Federman found that hospitals in financial straits during the recession fared better if they were very open about it.

When Mr. McCorkle meets with employees at Akron General, he gives them "total amnesty" to talk about anything they want, even if they don't like his policies. "Transparency is essential," Ms. Hess says, adding that when staff know and understand management's objectives, they will be more likely to share them. For example, a nurse who is tempted to give away medical supplies to patients when they go home might not do so if she knew her department was struggling to balance its budget. "Shared knowledge can be a powerful tool," Ms. Hess says.  

6. Nurture mutual respect. Under an older management style, the CEO says, "I expect you to respect me," Mr. Haeberle says. But if workers are treated as equals, they are more likely to be engaged, he says. "When I respect who you are, I try to understand why you think the way you do," he says. At Akron General, Mr. McCorkle insists that employees call him "Vince." He thinks they are more likely to be frank and open that way. "If someone can say, 'Hey, Vince,' they are going to tell you what's on their mind," he says.

7. Be supportive. A big part of nurturing respect is being supportive. Ms. Hess says managers should assume employees are doing the right thing until proven otherwise. For example, when a patient complains about an employee, assume the employee is innocent until proven otherwise, but all the while seriously check into what was going on. "You have got to ask questions and find out what happened," she says.   

8. Link employees to the mission. "Employees need to feel that what they do connects to the overall goals of the organization," Ms. Hess says. "If the manager tells me, 'You have to do this because it's our new rule,' that doesn't make me feel good about it," she says. She advises using the vision and values of the organization as a roadmap to guide employees.

Mr. McCorkle tells this story about the power of the mission: A janitor sweeping the floor at Cape Canaveral at night is asked what he is doing. "I'm helping to put a man on the moon," he says. "Healthcare is a calling. It means embracing something bigger than yourself," McCorkle says. "There needs to be a passion and an energy for all the things that the mission is about."

9. Create an effective team. Healthcare relies on relationships within a team, Ms. Hess says. The manager's guidance can make the team more productive. "Managing an effective team means promoting a high level of trust and comfort with conflict," she says. To be effective, team members need to speak up, identify their differences and work through them without hostility.

10. Let employees do their work. Ms. Hess says the hospital's goal should be helping each employee find his or her "professional paradise," where they are satisfied, energized and productive. Mr. Haeberle says managers who respect employees' opinions recognize there can be a variety of ways to accomplish a task. He advises management to get out of the way and let employees do their work. "When I ask you to do something, I'm going to assume it's going to get done," he says. If the employee doesn't do what he said he'd do, the pact is damaged. "The mutual trust has declined," he says.

11. Give employees choices. Employees who are given choices are going to be more invested in the work they do. It's not always possible to do this in a hospital environment where work is often based on prescribed protocols, but there are still many opportunities, Mr. Federman says. Rather than saying, "We can't do that," leaders should be saying, "How can we do this and still follow the regulations?"

"If there is a way to meet employees' pressing concerns, use it, even if it’s a little unconventional," Ms. Hess says. For example, employees may prefer to work extra hours rather use locum tenens nurses, but taking over one eight-hour shift may be too daunting for a full-time employee. One solution might be to cut the shift into two four-hour blocks, which full-timers would be more likely to accommodate.

12. Lead by example. Every two weeks, Mr. McCorkle has a meeting with his top-level managers. "We talk about barriers and roadblocks," he says. "People commit to a goal by signing a pledge." When his staff meets with more people down the organizational chain, they apply the same principles. He says top management's example is like a wave going through the whole organization.

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