Goshen’s CEO and President Jim Dague contributes the hospital’s success to its unique mission-driven and participative management approach. According Mr. Dague, Goshen’s participative management approach keeps employees, or as Mr. Dague calls them, colleagues, satisfied, and this leads to success in quality of care and patient satisfaction. “Happy, mission-driven colleagues provide better care, which leads to happy patients, and that improves our bottom-line,” he says.
But 14 years ago, the hospital’s outlook was not as bright as it is today, and Goshen nearly went out of business. The health system was barely afloat with just three weeks cash left in the bank, and the employee turnover rate was at 27 percent. New management was brought in to turn around the ailing health system. To guide the turnaround, the new management team decided to implement the Uncommon Leader program, an organizational model developed by V. Clayton Sherman, EdD, author of Creating the New American Hospital.
At the heart of the management approach outlined by Dr. Sherman is an emphasis on the ability of all employees to lead. Goshen management, with the buy-in of employees, decided in 1998 to commit completely to these participative methods and to use them in all areas of management.
The effect of the program on the hospital system has been tremendous, according to Mr. Dague. “Today, we have sound financials and an award-winning destination cancer center that serves patients in a five-state area, and we are a Magnet hospital for nursing, receiving re-designation in March,” he says. “We have held a 1.25 percent turnover rate for the last three years and haven’t had a layoff in 14 years — all of this in a community with the largest percent of unemployed persons in the state,” he says.
Here, Mr. Dague discusses the participative management program in use at Goshen and describes five key practices for motivating and empowering employees.
1. Put employees first and stick to it. When Goshen committed to its new management approach, management decided that putting people first meant never using layoffs to improve financial conditions. The hospital has stuck to that policy for 14 years, despite challenging economic times.
“Layoffs are not an option here,” Mr. Dague says. “If a need for cost-cutting arises, colleagues have a major voice in determining where and how to make cuts or improve efficiencies. It’s not a top-down decision here.”
Another way that Goshen puts employees first is by making one of its core goals to help employees to live out their personal missions. “Our goal is to help our colleagues, all of our colleagues, live out their personal missions. We want them to consider the reasons why they got into healthcare in the first place, and we want to help them feel the satisfaction of carrying out that mission everyday,” says Mr. Dague.
2. Flatten your organizational structure. Goshen attempts to flatten its organizational hierarchy by doing away with terms such as “employee” and “supervisor.”
Mr. Dague says, “The term supervisor suggests that one person is subordinate to another, which just isn’t true here.” Instead, the terms “colleague” and “manager” are used.
Additionally, employees at Goshen participate in a gain-sharing program and are given information about all hospital financials. “Twice a year we hold a number of colleague meetings where we go over almost every detail of information about the system’s financials. Every colleague gets the same amount of information as any member of the board of directors,” says Mr. Dague.
3. Commit to gaining employee buy-in before making any organizational change. Goshen employees are actively engaged in the decision-making process. Any significant change that Goshen is considering is first presented to employees for feedback. If hospital leaders are considering a certain course of action, they always present that plan to focus groups of employees for input and alternatives before implementing a change.
For example, Goshen leaders considered raising employee contributions to the company’s health plan. The issue was discussed in employee focus groups, and the employees eventually agreed to the plan and helped structure the changes. On an employee satisfaction survey distributed shortly after the increased contributions kicked in, employees were so largely satisfied that Goshen set a new benchmark for employee satisfaction in the area of benefits. “We really commit to inviting our colleagues into the decision-making process,” says Mr. Dague.
4. Actively seek employee ideas for improving policies and processes. Goshen employees are encouraged — and in fact required — to bring forth suggestions for improvements to the health system. Employees must submit at least three suggestions each year to meet minimum requirements for their annual review.
When employees would like to make a suggestion, they simply complete a form and give it to their department director.
If the suggestion only involves the employee’s immediate group and the group agrees to the suggestion, the director will approve the idea on the spot and the colleague then has the authority to “just do it,” which is how Goshen describes the act of leading the change to improve work flow.
Suggestions that involve an entire department or several departments are submitted to what Goshen calls a “do-it group,” a group of 2-8 individuals who meet during four one-hour meetings to examine the old process and explore the suggested improvement, determining how to implement it successfully. Once the process is decided upon, the group must implement the change within 30 days.
For example, several years ago the emergency room department formed a do-it group to brainstorm ways to increase thrombotic therapy delivery to patients presenting to the department with symptoms of a heart attack. The group wanted to ensure that all applicable patients received the therapy within 30 minutes of arrival to the emergency room. At the time, the department only delivered the therapy to 30 percent of patients within the time frame. The do-it group created and implemented a new process to ensure more timely delivery of the therapy. Today, the department delivers the therapy to 100 percent of its patients within the 30-minute time frame, according to Mr. Dague.
The “just do it” and “do-it group” initiatives produce about 2,000 ideas per year, all of which are investigated, and many of which are implemented. According to Mr. Dague, ideas implemented by employees produced a cost savings of $3 million in 2008 alone and approximately $20 million since the program’s inception in 1998.
5. Hold employees accountable for participating. Goshen requires that employees submit three ideas per year to their directors, and the number of days it takes a director to respond to an employee suggestion is tracked. The number of ideas submitted by employees, along with their participation in focus groups and do-it groups, is taken into consideration during the employee’s annual review and therefore linked to compensation.
However, employees are usually more than eager to participate in these programs, says Mr. Dague. “Our colleagues understand that their opinion is valued and so they willingly participate. This is part of our culture. It’s not a burden to them,” he says.
“No one knows how to improve a process better than the person who does that job every day,” Mr. Dague says. “If you give every colleague the opportunity to make a change ─ no matter how small ─ that can add up to something big.”
About Goshen Health System
Goshen Health System is a not-for-profit provider of healthcare that includes Goshen General Hospital, The Goshen Center for Cancer Care, Park Home Medical Equipment, PrimeCare Physician Network, Team:Bariatrics, The Retreat Women’s Health Center and Indiana Lakes Managed Care Organization. The health system is an affiliate partner of Clarian Health. Learn more about Goshen at www.goshenhealth.org
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