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The Healthcare Employee Engagement Enigma: 4 Flawed Assumptions that Limit Improvement

by Jim Thomas, Ph.D.

Healthcare professionals engaging in conversationUnless you’ve been marooned on a desert island for the last decade, you likely understand that employee engagement is an important imperative for healthcare organizations. As evidence, a quick Google search of the keywords “employee engagement” nets more than 28 million hits. Refining the search to “employee engagement in healthcare industry” narrows that down to a paltry 2.9 million hits.

The interest in healthcare employee engagement extends beyond web searches. According to one study, “culture and engagement” was the number-one topic on the minds of CEOs and senior healthcare HR leaders in 2015. The fact that over 20 percent of the presentations at this year’s American Society for Healthcare Human Resources Administration national meeting were related to employee engagement suggests that this continues to be a hot issue.

That’s as it should be.

A considerable body of research shows significant links between high levels of healthcare employee engagement and important healthcare organizational outcomes, including:

  • Retention of clinical and professional staff.
  • Patient safety (including hospital infection rates).
  • Patient perceptions of their experience and the quality of care they receive.
  • Reduced patient mortality.
  • Operating margin and other financial metrics.

Imagine the monetary value to a healthcare organization of even a fractional improvement in any of these measures. Unfortunately, the most recent research published by Gallup reveals that only about one-third of U.S. workers are actively engaged in their work. While healthcare industry scores are somewhat higher, published research makes it abundantly clear to even the most jaded skeptic that there are big organizational performance improvements to be had by taking steps to enhance employee engagement.

According to a report by Towers Watson, the single-most critical engagement lever available to healthcare organizations is the quality of leadership: “We can’t emphasize enough the importance of leadership. Great leaders articulate mission, values, and strategy in a compelling way.” This seminal research also notes the critical importance of frontline supervisors and managers. “These are the people … who translate strategy into day-to-day actions, enable individuals and teams to work productively, and coach people on their job performance and development.”

Deloitte’s 2017 Global Human Capital Trends report also identifies supportive management as one of the critical links to creating a positive employee experience. This research stresses that it’s the employee’s experience that results in the positive feelings of engagement.

So where’s the enigma?

I recently partnered with a healthcare system’s internal OD function to develop a frontline leadership curriculum. The curriculum’s objective was to support the development of leadership skills closely associated with engagement, including communication, encouraging innovation, coaching, work unit planning, and effective interactions.

The design team created a targeted six-month learning journey that integrated an upfront diagnostic, classroom training, self-directed learning, and web-based performance support tools. The total investment required to support this learning journey for 50 frontline nurse leaders was relatively modest, amounting to slightly less than the cost of turning over one nurse in the first year of employment.

Yet, the program was never launched because there was, ultimately, no money for it in the budget.
 

This frustrating example isn’t an aberration. I can recount numerous instances over the past several years where well-designed nurse leader training initiatives have been shelved because there just wasn’t financial support for them.

The result, however, is that in many healthcare organizations, managers and supervisors are left to their own devices to master the complex leadership skills required to engage the workforce. But given the apparent consensus about the value of healthcare employee engagement, why don’t organizations seem willing to pony up the investment necessary to do something about it?

My experience suggests there are a number of factors—call them “flawed assumptions”—that contribute to this disconnect:

1. “Initiatives to improve engagement don’t really provide a return on investment.”

Talent management professionals have sought to monetize the benefit of leadership development programs for decades, with limited success. Despite the avalanche of articles, books, blogs, and “ROI calculators,” many HR professionals are still poorly equipped to build a business case for these initiatives.

If organizations are going to move the needle on engagement, those responsible for leadership development must compete with professionals in other disciplines who live and die by the business case. Without a concerted effort on the part of HR to speak the language of business, training budgets will continue to be early casualties when organizations tighten their belts.

2. “Employee engagement is so complex that we aren’t sure where to start.”

Employee engagement is a complex construct. It’s the way employees feel about their work experience that results in a sense of ownership, involvement, and commitment. These feelings are directly associated with how an employee finds meaning in the work, receives support from management, has positive relationships with peers, sees opportunities for growth, and shares a commitment to the organization’s mission and purpose. Some of these engagement drivers can be managed by leaders, like growth and development, and some, such as whether a person aligns with the organization’s mission, cannot.

Focusing on the drivers of the employee experience that are difficult to manage diverts attention from those that can be managed and improved. And the experts generally agree on which drivers fall into the “can” category:

  • Establish clear and meaningful work goals.
  • Remove barriers to effective performance and provide support.
  • Interact respectfully with others and create a positive work environment.
  • Deliver effective coaching and growth opportunities.
  • Recognize and value individuals.
  • Inspire others with mission and purpose.

The key is not only for organizations to understand where they can impact the drivers of engagement, but also to make the necessary investment in leaders so they have the skills to make it happen.

It’s also true that organizations can start small. You don’t have to address every driver at once. If resources are limited—and they always are—pick one engagement driver and take action to address it. Sadly, many healthcare organizations, overwhelmed by the total number of factors they could address, leave their newest leaders to tackle these drivers unaided.

3. “Training doesn’t result in sustainable changes to leader behavior.”

I suspect there are many talent management professionals who believe that training doesn’t really change behavior. Why else would those responsible for leadership development fail to act with passion and urgency?

Yes, there is ample reason to view training solutions with skepticism, but there’s an important caveat: Much of what passes for leadership training is what I term “awareness building.” These initiatives, which often include psychological inventories, leadership style analyses, or self-assessments make for interesting seminars. People have a “wow” experience that generates personal insight, but these experiences are generally ineffective in creating any lasting change in behavior.

In contrast, behavioral training, which includes descriptions of positive behavior, observation of positive behavioral models, skill practice, and post-training application support, does result in sustainable behavior change. Research demonstrates that this type of training increases the frequency and effectiveness of behaviors directly connected to employee engagement such as coaching, goal setting, delegation, and positive conflict resolution. This same research, which included data from more 18,000 leaders, showed that that 81 percent of employees reported improved levels of engagement after their leader participated in behavioral training. The actual improvement in engagement scores averaged 51 percent.

4. “Measurement is the key to improving employee engagement.”

Everyone’s heard the adage, “You can’t manage what you don’t measure.” But there’s an important corollary: measurement doesn’t necessarily result in management.

Many organizations spend considerable time and resources measuring and tracking employee engagement. Unfortunately, in far too many instances this zeal for measurement has not been matched with enthusiasm—or resources—for taking action. One reason is that measurement projects are fairly straightforward to plan and execute. And the results, from a project manager’s standpoint, are guaranteed – you know you’ll end up with a nice stack of reports and loads of data to report to eagerly awaiting senior leaders.

On the other hand, taking action to impact future engagement levels is risky and scary. Putting a stake in the ground and implementing improvement efforts requires that project sponsors overcome the biases and flawed assumptions described above.

A further irony is that extensive measurement efforts, which can prove costly, actually reduce the resources available for follow-on improvement initiatives. Healthcare organizations need to consider the time and expense associated with measuring employee engagement and then commit to spending more on post-survey efforts to drive improvements.

But here in the real world…

I don’t mean to paint an overly dismal picture about the state of healthcare employee engagement and leadership development. There are thousands of dedicated leaders, inside and outside of talent management functions, who devote considerable time and energy to engaging the workforce and promoting leadership development. These leaders work hard every day to realize the promise of an engaged and committed workforce. And much of this work is paying dividends to their healthcare organizations.

Yes, the financial resources available to most healthcare organizations are tight. Everyone associated with modern healthcare in the U.S. is facing tighter budgets and calls to further cut expenses. Investments in leadership development and employee engagement must compete with more pressing priorities.

But the data is clear—employee engagement improvement efforts represent a significant opportunity for healthcare organizations to improve both operationally and financially. Solving the healthcare employee engagement enigma requires organizations to better understand the real costs associated with less-than-desirable levels of engagement, like turnover, poor quality, and safety incidents, and challenge the flawed thinking that prevents investment.

Jim Thomas, Ph.D., is a DDI vice president who's held a variety of roles spanning consulting, business development, and general management in his 23+ years with the organization. His work has literally taken him around the world, including extended expat assignments to the Middle East and China.

Aside from his passion for helping organizations acquire and engage talent, Jim's personal interests mirror his active, globe-trotting DDI career. He's a private pilot, an accomplished sailor, and an avid motorcyclist. That blur that just whizzed by? Yeah, that was Jim.

Posted: 13 Oct, 2017,

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