We knew we were in trouble when Nancy Steiger's revisions to our draft of this article stopped on the second page. Nancy is the new CEO of California's San Mateo Medical Center, located not far from San Francisco. Nancy doesn't mince words. Nor does she read superfluous text.
"The article should focus less on me," she said. "Hospital administrators are all seeking solutions to the same problems - severe staff vacancy rates, high turnover, overstressed employees. That's what we're interested in reading about. What if we framed the story this way..." Then, speaking extemporaneously, she rewrote the article for us.
"People are at the heart of quality healthcare," she said, "so a hospital is only as good as its employees. In the 1980s and '90s, we thought employee satisfaction was the answer. But often as not, employee satisfaction surveys left us, well, dissatisfied. The exercise gave us a packet of statistics but no solutions to our people problems." Likewise, she explained, vision and mission statements only take hospitals so far. "If you don't have the people, it doesn't matter how good your vision and mission are. For employees to stay and advance an organization's vision and mission, they have to be engaged. That's why I say I don't want satisfied employees, I want engaged employees."
A Culture of EngagementAn engaged work force is not what awaited Nancy when she took over as CEO of San Mateo Medical Center in early 2002. She found herself at the helm of a $124 million general acute care hospital and 14 full-service community clinics, with 800 employees and a budget shortfall. The facility was widely referred to as the county's "hospital of last resort." There was a culture of fear and blame. The staff was talented but dispirited.
SMMC had an unusually large number of longtime employees - professionals who could pass along their wisdom to newcomers and maintain a sense of continuity. Unfortunately, this same group of people at times impeded change with an attitude of "that's not how we do it here" or "that's just the way it is." Recently completed extensive remodeling and additions to the facilities, also had their downside: new break rooms in each department supplanted the cafeteria as the preferred venue for coffee breaks and meals. Without a central gathering place, the hospital-wide sense of community, once a hallmark of SMMC, was rapidly fading away.
Under Nancy's leadership, SMMC's newly stated mission was "to open doors to excellence in healthcare." This mission did not replace the critical mission of being a safety net hospital but framed it in a more inspiring way. In addition to fulfilling the mission and meeting her financial goals, Nancy had a vision for SMMC: to become an employer of choice with a culture of service, innovation, satisfaction and safety. Unfortunately, she had to do it all with very little money.
Taking ActionNancy knew the hospital could never meet its challenges without changing its culture and engaging its work force. Her first step was to gather data - systematic, objective data about the level of employee engagement. Consultant Susan Corning told Nancy about a new employee assessment instrument being developed by Workforce Engage LLC of Boulder, Colo. The product, was appealing because it focused explicitly on measuring a critical asset known as social capital.
Social capital, according to Harvard researchers Don Cohen and Laurence Prusak, is "the stock of active connections among people: The trust, mutual understanding, and shared values and behaviors that bind the members of human networks and communities and make cooperative action possible." Unlike human capital, which is the sum of the skills and knowledge possessed by an organization's employees, social capital accrues to the organization itself. Human capital embraces what an employee can do, but social capital determines what an employee will do. High levels of social capital are associated with improved organizational performance - a result of better knowledge sharing, lower transaction costs, and greater discretionary effort.
Assessing Employee EngagementThe heart of the Workforce Engage system is a web-based employee survey, which gathers data about social capital and employee engagement, and has the capacity to ask follow-up questions to better understand negative responses. The survey focuses on seven organizational practices that research has shown to be the key drivers of employee engagement.
SMMC's employee engagement initiative began in August of 2002. The hospital's first task was to design a strategy to overcome employee cynicism and gather support for the initiative. The entire leadership team signed a compact with employees pledging that the survey would be taken seriously, that there would be follow-up sessions involving all staff, and that the results of the process would have a definite impact on the hospital's future policies. To create an incentive to participate in the survey, SMMC offered pizza parties to any department achieving a participation rate of at least 50 percent.
Over the course of two weeks, fully two-thirds of SMMC's employees logged on to computers at work or at home and completed the confidential online survey. For many, it was their first experience with a computer. Step-by-step instruction sheets took the newcomers through the process of logging on, and from there, the Web site told them what to do.
Survey ResultsPersonal Strengths
Of the Seven Practices of an Engaged Work Force, SMMC scored highest on the practice called Embrace Personal Strengths. Fully 93 percent of respondents agreed that the work they do is important to the overall purpose of the organization, 84 percent liked the challenge of their work, and more than three fourths were satisfied with their level of independence on the job. These dramatic scores confirmed for Nancy that SMMC had a foundation of dedicated employees on which to build her program of change. And no surprise to her, the survey found a number of things that needed changing.Sense of Community
Research has shown that organizations with a greater sense of community (quality caring relationships across the organization) are more resilient to challenges. Generate a Sense of Community was SMMC's lowest-scoring practice: less than half of respondents agreed that people feel included at SMMC and only 39 percent agreed that employees are recognized for the contributions they make. SMMC also drew a low score on the practice called Establish an Open Learning Environment, which includes effective communication and involvement of employees in decision-making - both key factors in building employee engagement.Effective Communication
Almost three-fourths of respondents agreed with the statement "My co-workers (in my department) are good at sharing information." But only one-fourth agreed that "there is good information sharing between departments." Vertical communication, too, was in need of improvement. More than half of respondents did not agree that SMMC does a good job of keeping everyone up to date on critical issues. "When things change, put out a memo," one respondent requested. "Make sure everyone understands and is held accountable."Employee Involvement in Decision-Making
Nearly 60 percent of respondents did not agree that management listens seriously to employees' ideas and opinions, and 55 percent did not even feel safe expressing different views. One voluble respondent, making a comment that was typical in terms of content but memorable in terms of style, said, "We are all a part of this picture, and the employees are told but not listened to, and I feel management could learn a lot if they listened, and we could problem-solve together to make this place a better place for everyone." Another summed up the issue more succinctly: "Management would benefit by working with employees suggestions instead of continuously demanding the impossible."Dialogue: Spreading the Word
A critical part of the Workforce Engage process was the rollout of survey results via an organization-wide learning event. SMMC's survey results were presented in town-hall-style forums involving employees at all levels and from all worksites and departments. In addition, department managers participated in dialogue training sessions, then led dialogues themselves with the employees in their departments. The objective was to involve everyone in the process, an explicit acknowledgement that authentic cultural change cannot be handed down from above.Employees helped both to interpret the survey results and to identify SMMC's top organizational issues. Of the latter, communication and employee recognition were selected as the two most important. SMMC then formed employee task forces to tackle these issues. A diverse group of employees volunteered, including those with formal power and those without. Members received training in techniques to promote change, break through cynicism, think creatively and act collectively.
The task forces were charged with studying where and when effective communication and recognition take place (or fail to take place), and polling fellow employees for ideas and suggestions. Because the ideas came from the employees themselves, the work force was engaged in the process of improvement. Instead of impeding change with an attitude of "that's just the way it is," the employees became a positive force for change.
SMMC is considering other initiatives, including peer-to-peer coaching for supervisors and mentoring workshops. Nancy Steiger approaches training not as an expense, but as an investment - a perspicacious outlook in an era of work force shortages and staggering turnover costs.
After participating in the dialogues, no one was repeating the earlier refrain that "employees are told but not listened to." On the contrary, participants expressed appreciation for "being able to speak out and [have] someone listen," and being part of "the beginning of exciting changes." For most, it was their first experience of a dialogue between staff, department leaders, and executives.
Six months after the dialogues, the promising beginning is living up to its potential. The Communications Task Force set up a bulletin board in each department with a standard format and content, initiated a hospital-wide newsletter, and recommended the development of an intranet which is now in operation.
D.C. Maharaj, a senior accountant and Communications Task Force member, reports a "humongous difference" in the outlook of SMMC's employees. "There was a lot doubt, anger, frustration. No one felt able to speak for fear of retaliation. People are more open now. Some are still skeptical, but the majority sees that there's a new culture here, and this is the way we are going to be."
One such employee, Lina Ahoia, a patient service assistant and member of the Recognition task force, wrote in an e-mail to Nancy, "I want you to know how excited and hopeful I am... To be honest with you, I had not been very proactive with anything at the Medical Center until you launched the [employee engagement program]. It gets me involved, and it gives me the drive to make a difference for myself as well as the people we work with and serve." After many years in the same job, Lina is now inspired to pursue a position of greater responsibility. "I feel, now, that I have something to work toward."
SMMC does not officially track turnover. However, total employee terminations - a figure that includes separations usually excluded from turnover, such as those due to retirement, illness, and performance - have declined more than 15 percent since the employee engagement initiative began in August 2002. This improvement may be the result of a number of factors, including the weakening economy, but clearly turnover trends at SMMC are headed in the right direction. And turnover is not the only indicator going that way. Lost days on the job due to injuries are down by almost two-thirds since FY 2002, average length of stay for medical/surgical declined from six days to five, and net income jumped from a $9 million loss to a an estimated profit of $500,000. All these improvements are the result of multiple factors and initiatives, but as Nancy likes to point out, "It wouldn't be happening if we weren't engaging our workforce."
We don't know if Nancy still thinks this article is too focused on her. We're wagering she has more important tasks at hand than debating with us. "People here are fired up," she says. "There's lots of momentum; it feels like we're really making a difference."
Matthew Simon is the CFO of Workforce Engage LLC, a Boulder, Colo., firm specializing in measuring and enhancing employee engagement. He may be reached at . Bridget Jeffery is a senior associate at Workforce Engage. She may be reached at .
