6 Issues That Damage Employee Satisfaction in Hospitals

Hospital employee satisfaction is coming under the spotlight, as healthcare leaders start to realize that organizational culture is directly tied to patient satisfaction, financial results and clinical quality. Here three hospital CEOs discuss the issues that hurt employee satisfaction in a hospital, as well as the approaches they take to fulfill and retain their associates.

Special thanks to Paul Spiegelman, CEO of The Beryl Companies, for facilitating these interviews. These CEO quotes are excerpts from an upcoming book titled Patients Come Second by Paul Spiegelman and Britt Berrett.

1. Educating providers in "silos." According to Wayne Lerner, DPH, FACHE, president and CEO of Holy Cross Hospital in Chicago, healthcare is organizing its education system in the wrong way. Today, physicians, nurses and healthcare administrators are all educated in entirely separate systems — "silos" that teach very specific, job-related skills without touching on the roles of other employees in the hospital. "Then we graduate and they throw us together in a patient care environment and ask us to go work together," Dr. Lerner says. "There is no common language amongst healthcare practitioners other than clinicians."

Dr. Lerner believes that if healthcare professionals could start their careers with a common "orientation" course, they would be able to communicate much more easily about problems. Doing something as simple as creating a common language — for example, a universal term for a negative personnel issue at your organization — can break down boundaries and allow people to express their opinions without feeling misunderstood. Dr. Lerner also believes staff and physicians should have a common understanding about their community. He says the "best course" to get providers on the same page would be a course on epidemiology, which studies the health events, characteristics and patterns of a specific population.

2. Expecting staff and management to work with minimal breaks.
Many hospitals are struggling to improve employee satisfaction and hospital culture because of financial pressures. Dr. Lerner's hospital has not distributed raises in two years because of the high percentage of Medicaid patients it accepts. "It's hard to get people to focus on the good things that they do with those types of pressures," he says. However, even if your hospital is forced to freeze or even lower salaries because of the current healthcare climate, you should not expect employees to work for days, months and years with limited time off. Vacation or breaks during the workday can be just as powerful as a raise or bonus because they allow employees to take a mental breather.

Anthony Armada, CEO of Advocate Lutheran General Hospital in Park Ridge, Ill., says he encourages employees to take a "mental time-out" if they feel they are not performing at their best level. "I challenge everyone to always be the best," he says. "You know if you are at your best, and you know if you're not." At Lutheran General, employees are asked to tap their coworkers if they are feeling drained, take a time out and get back to work once they feel refreshed.

Dr. Lerner says this philosophy should apply to hospital management as well as staff members. "I've been doing this for 40 years," he says. "You just get burned out. Working in corporate or executive healthcare, you just need to take a break. We're not good at management sabbaticals."

3. Bureaucratic and technological hold-ups.
Few things are more frustrating than a department that won't answer emails or an electronic system that doesn't properly process orders. Don't let bureaucratic or technological hold-ups frustrate your staff. Make sure to conduct an employee satisfaction survey on a regular basis to determine areas that could be improved.

For example, Alan Channing, president and CEO of Sinai Health System in Chicago, says his system conducted a survey and found that physicians and staff were having difficulties with the registration process. "I've created a broad-based task force, from registration to physicians, using six sigma techniques to start to address the entire process and have committed to meeting with this team every two weeks," he says. "We're doing a lot of flow charting and finding that many things can be fixed very easily. It is a long-term exercise."

4. Invisible leadership. The traditional hierarchy of an organization like a hospital meant that upper-level leaders were relatively invisible to the front-line workers. CEOs might appear once a year at company meetings or gatherings, but mostly they stayed in their offices, attending meetings and dealing with operational issues. The time of the invisible CEO is past, Mr. Channing says. Employees want to know who they're working for and will work harder if they have a personal relationship with hospital management.

He says this interaction should start as soon as an employee joins the hospital. "Either myself or one of the C-suite members gives an hour welcome to every new orientation class," he says. "We talk about mission, vision, values, what it means and how you participate. When I talk to the new employees, I talk about them as individuals making a difference in other people's lives." He finishes the talk by making two promises: First, you'll be frustrated. You'll hear a decision and not understand what it means. Second, you'll be able to make a difference in someone else's life. He encourages employees to think of the second promise whenever they feel the effects of the first promise.

He says the hospital also improves management visibility by assigning each senior leader a week on-call. "I'm not on that call schedule, but I'm here almost every weekend walking around," he says. "When I don't come, they say, 'Where have you been? We miss you.' Most of the 3,000 employees feel like they have a personal connection with the leadership of the organization."

5. Hiring staff members who don't fit in the first place. The hiring process can be stressful for an understaffed, cash-strapped hospital, and many organizations rush to fill vacancies to make sure patient care continues as usual. But hiring staff members who don't fit the organization's mission, vision and values can have a severe negative effect on the hospital in the long term. Employees who don't fit the culture are more likely to complain, shirk their responsibilities and have disagreements with other workers, creating a negative atmosphere and dragging other workers down with them.

Mr. Armada says Lutheran General Hospital addresses this issue by following the Studer method of high, solid and low performers. The hospital partners with the high performers and gives the low performers a choice about their future with the hospital. "I've had conversations with individuals who don't want to be part of [the organization] and decide to move on," he says. "Those 8-9 percent that are totally disengaged are detrimental to the environment toward high performance for your organization." He says the majority of the time should be spent with the "solid and high" performers instead of the "low" performers; they are ripe for coaching and encouragement and may drop into the "low" category without attention, support and empowerment from leadership.

6. Limited opportunities for involvement.
If employees are not encouraged to give input on hospital initiatives, they may feel that the administration doesn't care about the issues that affect them on a day-to-day basis. Mr. Armada says his staff members appreciate the opportunity to involve themselves in hospital initiatives or areas for improvement.  "Give them multiple opportunities to share their input, and have the transparency to get back to them and let them know what you did with their ideas," he says. "If people believe their voice is heard, they will be more engaged." He says this type of involvement is not difficult: It simply means consistently reaching out to employees and then following up with an answer to their question or a solution to their problem.

He says his hospital hosts leadership webinars, and every hospital associate can participate. Lutheran General also holds open forums and town halls that are staggered to be convenient for every shift. "I still do midnight rounds every quarter," he says. "This kind of consistency is important. It can't be a flavor of the month. I get e-mails and letters from some of our nurses when they can't be there at midnight shift rounds but they have some ideas they want to share."

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