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A Hospital Story: From Worst to First

Case Study

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Employee Engagement in Healthcare

It was a meeting I’ll never forget. I was going in to deliver some of the worst employee-survey results that I had seen in quite some time, and I had to give the news to an entire executive team of about a dozen people. I was well aware of other situations like this where the clear strategy had quickly become “kill the messenger”. I was prepared to defend myself in what was sure to be an ugly battle. I sure wasn’t looking forward to it.

The even worse news was that this was not only a hospital, but indeed, a large children’s hospital. This was the place where people from a four-state area brought their most precious gifts in all of life when they were in pain, danger, or scared to death, or all of the above. After seeing the engagement scores of the nursing departments and the level of disengagement that currently existed, I certainly wasn’t sure if I would want this hospital’s staff sticking needles into any of my children. So, carrying this burden, the meeting began.

From the start, everyone was warm and welcoming. The introductions were well received. After explaining the process, the research steps—giving them a thorough understanding of the type of information we measure and why we measure it—I was afraid the fun was over.

After displaying their scores on the four engagement items and the overall engagement index, I had to explain to them that these were the lowest, organization-wide scores we had ever seen. Yep! They were the very worst of a large sample of hospitals. Time to put my armor on, right?

It didn’t go that way at all! I don’t think I have ever been so impressed by a reaction to bad news. Of course, they had to tug on it and question what it meant,
and even how accurate it was—but good leadership reigned. The top few executives were united in their response, and the others clearly trusted that response and got on board.

Huh, I thought. I think that’s what you call leadership!

They may not have understood all the details, or the science, but they understood one thing: “This is not who we are! We are better than this.”

Immediately, I loved these people! There were clearly reasons for the low scores. Times were tough back then. But instead of using those reasons for excuses, they took responsibility and declared that they would get better.

I spent the next hour interpreting the data so that it accurately told the engagement story of this particular hospital in a way that the execs could relate to, and understand. People forget scores, correlations, and analysis, but they remember stories. So, naturally, they are much more likely to share and discuss the stories.

But the story wasn’t just about where they were and why. In fact, most if it was about the path forward—how to apply the data so that everyone understood the best opportunities to make the most progress the fastest. And fortunately, the data had revealed some low hanging fruit. The executives started grabbing this fruit immediately, and before long, we had a plan of action. What a great day to be a
human-resources consultant!

I was now completely committed to help this organization in any way I could. So when they asked me to come back and share our findings and tell the analytical story to a gathering of all their managers, I enthusiastically agreed. So, the following week, I showed up for the second time, charged up and ready to continue this important journey.

This time the meeting was in a large auditorium instead of a comfortable conference room. I was hoping that was what explained the icy feeling that seemed to permeate the room. But as it turned out, there was more to it than that. Apparently in hospitals rumors make the rounds about as often as doctors. They knew that they were going to receive some bad news, and this group was prepared to defend themselves.

It was a very difficult meeting. I was embattled. Instead of reacting as the executives had, there were excuses, defensiveness, and even outright denial. I heard comments, either out loud or under someone’s breath like:

“You don’t understand us.”
“That won’t work here.”
“We’ve already tried that.”

But some of the hospital’s executives were in the room, and they did what good leaders do. The executives’ message was loud and clear to this large group of managers: “We are better than this.” “You all WILL take this seriously.” And “Together, we are going to get better.” The challenge was laid down, as were the next steps, and the planning process.

Fast forward one year…

I don’t know if I have ever been more curious to see a set of survey results. When I saw that this hospital had made one of the biggest jumps in employee engagement that I had ever witnessed in a single year, I felt like celebrating. I felt like I worked for that hospital. I couldn’t wait to get back in front of the executive team.

It was a great meeting. As you could imagine there was an appropriate degree of self-congratulations, which I reinforced to the hilt. They had earned it! The story changed in year two and so did the path forward and the action plans. But their confidence and commitment remained stronger than ever.

I was hoping that they might forget to invite me back to their next managers’ meeting. Given the way the first managers’ session went, I didn’t think that they much liked me. When they did ask me to meet again with their managers, I knew I had to do my part in this journey, so I agreed.

I won’t soon forget what happened in that meeting. It was the most vivid and visual example of the difference between disengagement and engagement I had ever witnessed live and in person. Changes in scores are one thing, but behavior says it all. The cynicism and the defensiveness were completely gone. Instead, there was actual enthusiasm. The comments went from “you don’t understand us”, and “that won’t work here”, to “I knew we could do it.” and “now we could….”. and “what if we tried…?”. It was amazing and so revealing to me. I’d given hundreds of presentations on the power of engagement, but to actually see this magnitude of change with my own eyes was really kind of a gift.

This was the beginning of a ten-year journey that took this hospital from worst to first. Yep, they made it! They now had the best engagement scores we had ever seen in any healthcare organization. And by now, our database was even bigger. What an accomplishment! They were proud and I was so proud of them. Every year they had taken the process seriously, had believed the data, had expanded the story, and they had adjusted appropriately.

So, what does this kind of improvement mean? Were these employees just happier or did they actually get better? As I had pointed out in Case Story I, doing research in a hospital is a lot different than doing research in a fast food chain where they have consistent measures across lots of business units. Of course, there were many stories about how much better they were, but was there really any proof? One of the concrete outcomes was that their “employee brand” had changed dramatically over time. This occurred during an era of really big nurse shortages—but not for these folks. They had become THE place to work for healthcare professionals in their part of the country. They literally could get the pick of the litter from the nursing schools in the area. Good people from other local hospitals could now be recruited. While others were spending small fortunes on temporaries and travel nurses, these people didn’t have to. What’s that worth to the bottom line? Then there were all the stories and feedback from grateful patients and their families. These stories only added to the sense of pride that the employees felt for “their” hospital.

There certainly was some good science involved in this transformational process. But on the other hand, it wasn’t all like “rocket science” or ‘brain surgery”. I think back to some of the ‘low hanging fruit’ that I alluded to earlier that the data had revealed in year one. For example, although people complained about turnout or feeling overworked, what was really going on was that they were starved for a little encouragement and recognition. I think there had been enough negativity going on that it just felt recognition was out of place and it wasn’t happening.

So, one part of the action plan from year one was to implement a program that was all about “star cards”. They had hundreds of them printed up and they were distributed to places where anyone could get their hands on them. They were intentionally not very big. There was just enough room for a date and about two sentences. That way they couldn’t consume too much time and add to the workload. Anyone could write and give away a star card to any other colleague, but managers were directed to issue at least three a week. Just as the data had revealed that recognition had been a major “driver” of engagement in year one, it also revealed that it was a major factor in the improvement in year two. Improvement doesn’t have to be expensive if you know what to focus on.

On balance, one of the smartest things the executive leaders did was more about what they didn’t do. They never tried to “boil the ocean” or do too much in any single year. The research had identified a whole myriad of problems and opportunities. Instead of diluting their energies by trying to tackle them all, they selected two things that they thought were particularly actionable. Then they put all their energy and creativity around those two things. And they did this every year.

I think we were in at least our eleventh year when the Chief Operating Officer was touring me around their facility proudly showing me some of their recent advancements. We walked past some workstations and I took the opportunity to kind of look around. Sometimes you can tell a lot about a culture from people’s workspace. You’ll never guess what I saw! Hanging on their bulletin boards or some other visible space, were star cards, some of them dated ten years earlier. Apparently, a little encouragement goes a long way! Anyway, that’s what the data had said.