What does it mean to be a great hospital or healthcare system? There are as many ways to answer this question as there are patients, industry professionals and organizations with great stories to tell. But if asked to sum up what makes a hospital great I would do it in a single word: engagement.
When employees and physicians are engaged and aligned with mission, patients thrive. This truth can be seen in the metrics we use to grade organizational performance: clinical outcomes, HCAHPS results, safety results and so forth. There's plenty of evidence showing that when engagement improves, performance follows. 
For example, a study from The University of Alabama at Birmingham School of Business shows a connection between engagement and safety. It suggests that employees with low engagement are more likely to work around safety protocols, while highly engaged employees are not.1
The good news is there's plenty your organization can do to engage employees. The best news is that most of these efforts won't cost you a penny. You'll just need some deliberate, focused effort from leaders. Here are a few examples:
Make sure the "fit" is right from the beginning. It's important to hire the right people for your culture. Studer Group recommends that a team of high performing employees give a candidate their stamp of approval before you hire. Peer interviewing at the beginning of the selection process can prevent a lot of pain later on.
Hardwire leader rounding for outcomes. This may be the single most critical thing you can do to engage employees. When practiced daily, it improves staff satisfaction and decreases turnover. It also improves patient's perception of the quality of their care.
Here's how it works: Leaders consistently ask staff specific one-on-one questions and act on the answers. The questions are really simple:
- What's working well today?
- Is there anyone I should recognize for doing great work?
- Are there any systems or processes that need improvement today?
- Do you have the tools, equipment and information you need to do your job today?
- Is there anything I can help you with right now?
This tactic packs a lot of punch — it's a "foundational" strategy that every organization needs to start with when seeking to improve engagement.
Respect people enough to tell them the truth. Uncertainty creates anxiety and muddled thinking. Transparency and clarity alleviate our worries and sharpen our focus. They also create a needed sense of urgency to help us meet the big challenges we face.
John P. Kotter, the author of "A Sense of Urgency," says the biggest mistake we make when trying to drive change is not creating a high enough sense of urgency. I agree. I find when leaders are transparent about challenges their organization faces, it pushes employees out of their complacency and compels them to act.
This is also why evaluations based on objective performance metrics work so well —knowing what "success" looks like is extremely motivating. You can't hold people accountable until you tell them the truth about how they're doing. This isn't always fun to hear but it's always beneficial. Most people really want to know the truth, even if it's "bad news."
Stop letting low performance slide. Employees notice when coworkers are slacking off or performing poorly in other ways. When leaders let bad behavior slide, it harms morale and demotivates the rest of the team. The fact is, good employees will "disengage" when low-performing coworkers aren't addressed. Low performers drag everyone else down to their level. And many high performers will simply leave.
The other problem is that leaders spend far too much time and energy dealing with issues created by the 8 percent of employees who are low performers. There is little left for the 92 percent of high and middle performers who deserve far more attention than they get.
Leaders can correct this imbalance by holding highmiddlelow® conversations with all employees. The idea is to recognize and re-recruit high performers; reassure, re-recruit and develop middle performers, and move low performers either up or out. Not only do low performers finally get dealt with (often after years of incompetence or laziness or both), the entire organization improves.
Don't underestimate the power of a front-line supervisor. In 2008, Studer Group conducted a study on Work/Life Blend Among Women in the Healthcare Industry. Among other findings, it showed that the number one factor determining employee satisfaction is the supervisor relationship. In other words, most people don't quit their job; they quit their boss. This is why it's critical to make sure supervisors are well trained, not just in fundamental leadership skills, but also in engagement issues. All good things flow from this pivotal relationship.
Don't be "all business." Make personal connections when you can. People want to know leaders care. And the way we show people we care is by letting them know we see them as a person, not just an employee. Ask about their family often. Know their hobbies and interests. Send birthday cards to their kids. It's really easy (effortless, in fact) to take a few second to make a personal connection with employees — and it's one of the most impactful ways to create the positive supervisor/employee relationship I mentioned earlier.
Broach the subject of growth and personal development. Leaders might assume their staff members will come to them and say, "You know, I was thinking about becoming a team leader. How can I get on the management track?" or "I'd like to get certified as a Registered Nurse Anesthetist." But this doesn't always happen. Sometimes even employees who have lots of potential don't see it in themselves — they may feel they're not good enough, not smart enough, too busy or whatever else.
That's why it's up to leaders to bring up the subject of development. Don't wait for them to ask about it. Push a little. You might do it while you're rounding on staff or you might invite them to lunch. Being proactive in this way shows that you see employees have a lot to contribute and that you care about their future.
Encourage mentorship. Mentoring has always been a big part of healthcare. Even when we don't call it by that name, it is the foundation of staff development. Unfortunately, when time and resources are scarce, mentoring can fall by the wayside. It shouldn't —research shows employees who are paired with a mentor are twice as likely to remain in their job as those who aren't.
I always urge organizations to make mentorship a priority. It engages both the older, more seasoned employee (who feels valued) and the newer employees (who appreciate the wisdom they're gaining).
Ask for input. It's impossible to engage anyone by simply imposing your will on them. Employees need to feel free to offer up their bright ideas and suggestions for improvement. And this isn't a ploy to make people feel important — the people who do the work often have the best solutions. This makes sense, as they live with the problems day in and day out and have often figured out creative ways to work around them.
And it's not just employees who want to give input. Physicians want it, too. When we at Studer Group developed our Provider Feedback System — a system that helps organizations provide data to physicians to get them aligned and motivated — we saw right away that physicians needed to help select the metrics that make up their goals. Seeking and acting on physicians' input makes them true partners.
Always ask for input from employees, physicians and leaders. Don't assume people will give it unsolicited. You will be amazed at the brilliant ideas and insights you'll hear.
Say thank you. (And put it in writing.) Thank-you notes are powerful. Over the years Studer Group has really emphasized this simple, yet amazingly impactful tool to organizations seeking to engage people. I've seen grown men cry over thank-you notes. I've seen people keep notes for decades. I've heard them read out loud at funerals.
It's better not to just randomly write notes when you happen to think about it. Instead, hardwire them into your operations, so leaders write a set number of notes each week. Make sure they point out something specific the staff member or physician does well. Handwrite them and send them to the person's home if you want maximum impact.
A heartfelt "thank you" really moves people. And it has another benefit — it encourages them to repeat the behavior that earned the "thank you" in the first place.
Conclusion
Being a great healthcare organization doesn't happen by accident. Neither does engagement. An engaged culture happens by design — the result of an organization that recognizes its advantages and makes a commitment to taking the steps to make it happen.
I hope you'll work toward becoming that kind of organization. It's the greatest gift you can give your employees, physicians and the patients they serve.
1. Halbesleben JRB, Savage GT, Wakefield DS, Wakefield BJ. Rework and workarounds in nurse medication administration process: implications for work processes and patient safety. Health Care Manage R. 2010; 35(2): 124-33.
Quint Studer is the founder of Studer Group, a recipient of the 2010 Malcolm Baldrige National Quality Award. He is a regular contributor to Becker's Hospital Review, which recently identified him as "one of the 40 smartest people in healthcare." Inc. magazine named Quint its Master of Business, making him the only healthcare leader to have ever won this award. Twice Modern Healthcare has chosen him as one of the 100 Most Powerful People in Healthcare. He is the author of numerous books. There are currently 700,000 copies of his BusinessWeek bestseller, "Hardwiring Excellence," in circulation. His most recent book, "A Culture of High Performance: Achieving Higher Quality at a Lower Cost," helps healthcare leaders lay the foundation they need to thrive in a disruptive external environment.
To learn more, visit www.studergroup.com.