Creating a high performance work culture

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This is the first article in a three-part series examining how hospitals approach internal communications. Hospitals function best when their employees are fully engaged. A well organized building can contribute to efficiency but true effectiveness comes from a well organized culture. And one not only willing to change, but wanting to change This installment looks at the work Windsor Regional Hospital has done focusing on transparency to build organizational trust.

Windsor Regional Hospital’s intercom system, like that of any other hospital, squawks constantly. Short sharps bursts fire off first names, instructions and room numbers to fill the halls with the kind of background noise that is typical in a busy care environment.

But at 9:00 and again at 12:00 you will hear 18 seconds of ‘Lean on Me’. And some days, seemingly at random during regular hours, you may also hear 18 seconds of Brahms’s Lullaby. “The lullaby means a baby was born. And if it’s played twice, that means twins,” says Ron Foster, the hospital’s VP of communications.

Music can connect a web of thoughts and emotions, and in this organization, it also connects trust. “We use ‘Lean on me’ to remind staff of the emotional side of providing care. It’s a triggering mechanism,” explains Foster, adding that while staff satisfaction scores are high, it is important to deploy tactics that continually reinforce a positive atmosphere, one in which you can build trust.

Windsor’s focus is on fostering transparency as a way of building trust. The hospital’s outspoken CEO David Musyj (pronounced ‘moo-shay’) likes to stick his neck out every so often, exposing himself to potential criticism and even personal attack by handing out his home phone number and direct email address for employees to connect with an idea or a complaint, or for patients to discuss their quality of care.

Building a culture of trust is the foundation for good engagement strategies. Employees want to feel socially safe when changes are put upon them. If they function on a social perimeter, they are less likely to adapt to change, never mind contribute to it. But a big wide trusting space can create a climate where change is not as threatening. And if it is not threatening, staff won’t be defensive and will contribute positively.

Here are six things Windsor Regional is doing to strengthen its culture of trust:

1. REACH OUT TO GET GOOD FEEDBACK

When Musyj took over in 2007, Windsor had only balanced its budget twice in 14 years and clinical results were also “not the greatest” recalls the 40-something CEO.

A former lawyer, he joined the hospital in 2000 as VP of corporate services and was made chief executive officer in 2007 when his predecessor retired. “I couldn’t understand why we were struggling. Clearly everyone wanted to do a good job and be recognized as good caregivers,” says Musyj.

To find the answers he asked employees if he could interview them. Willing candidates were given a list of questions asking what was being done well versus not well (see sidebar) to prepare their ideas. Most, recalls Musyj, showed up with pages of typewritten notes.

It is perhaps a testament to Musyj’s disarming character that some of these face-to-face interviews yielded honest expressions of dissatisfaction – which were useful. “When staff tell me they are embarrassed about where they work, that’s the key to this. I don’t want them to be punching a clock. There’s so much more here than that. I want to provide that opportunity because when staff satisfaction goes up, patient satisfaction goes up,” he says.

Over 200 employees were interviewed in a three-month period in 2007, and the same method was again brought into play this past fall to manage the current realignment that has seen Windsor Regional become responsible for the Hotel-Dieu Grace Hospital, now known as the Ouellette site. And to align the entire organization, the hospital sends the same five questions annually to its board, to members of its medical advisory committee and to union executives. “If I’m getting generally the same responses from everybody, it means we are all moving in the same direction,” says Musyj.

2. PROVIDE DIRECT ACCESS TO DECISION MAKERS

Musyj is perhaps best known as the hospital CEO who hands out his personal contact information telling both patients and employees to call him up and discuss any issue. Every patient who enters the hospital gets a letter outlining the facility’s vision and letting them know how they can recognize an employee for outstanding care or contact him directly by email, cellphone and even home number if they have an issue. There has been surprisingly little abuse since he began the practice in 2011, and Musyj tends to get two to three phone calls from patients each day and upwards of 20 from staff.

One has to be mindful of the organizational structure when providing this kind of access, advises Musyj, explaining that you should be clear that you can’t step in and resolve an issue directly.  “If I start jumping to conclusions and trumping my managers’ decisions, I’ll end up running this place by myself,” he adds. Mainly, this type of access serves as a clearing mechanism to resolve small problems before they develop into larger ones. (It is also likely to encourage better employee performance given that their boss is very easily accessible to dissatisfied clients.)

3. BE A PARTNER AND NOT A ‘PARENT’

Guelph-based engagement consultant Brady Wilson draws a distinction between engagement and energy when looking at employee relations. You can be engaged and do your job, he says, but if you feel drained at the end of the day, you will not be able to consistently bring energy to your work. “And that can be demoralizing because we all want energy for other aspects of our lives,” says Wilson, whose firm Juice Inc. has consulted with health care organizations across North America.

One way to boost energy is to give employees control to resolve conflict as much as to design systems. It’s what he refers to as partnering rather than parenting. Windsor took the partnering approach when it sought to resolve a persistent user problem: Eight per cent of the population the hospital served was consuming 50 per cent of its resources.

The hospital had funding to create a dedicated short-stay medical unit that could quickly accept these high-use patients from the ER to care for them in a unit designed for a maximum 72-hour stay. But what would that unit look like and how would it function? “We brought all the staff together, the nurses, physicians, lab techs, housekeeping, medical imaging and we said: Here’s the concept. Here’s how many beds we have money for. Now you guys design the unit,” says Musyj of a January 2013 meeting he had to initiate the project.

The unit was designed for patients with chronic conditions like urinary tract infections, pneumonia, or heart failure complications, as well as for patients who make multiple visits to the ER. Staff mapped out the patient journey from the moment they arrived at the ER to their move to the short stay unit right through to discharge. And it was operational by July that same year. Partnering to foster this type of ownership in a project creates a bias towards success, says Musyj.  “It works and whatever doesn’t work gets addressed as a hurdle, not a wall, because this is their unit.”

4. WALK IN YOUR EMPLOYEES’ SHOES

Inspired by an episode of Undercover Boss he caught while channel surfing one evening, Musyj adapted the idea to his needs and set up a job shadowing program. He pasted the television show’s logo onto an internal email for effect and told employees across the organization that he was ready to don scrubs and get to work learning their jobs and to contact him to set up a time.

 

“I had done rounding -walking around in a suit and tie with an entourage asking questions- but I felt it wasn’t getting us to where we wanted to be,” he says. Now he regularly accepts invitations to work with employees. Typically requiring a half-day, Musyj has tried his hand at everything from assisting nurses in the operatory, working in food services and portering patients, to changing beds, sweeping floors and cleaning toilets.

Besides experiencing the pride employees take in performing each task, which is an indication of how they perceive themselves as valuable contributors to a larger system, Musyj says he learns about small efficiencies. “You come across a lot of good ideas. I often tell them: You can ask for that to be changed,” he says, adding that again, like handing out your phone number, giving employees direct access to you does not mean you can ignore the formal feedback loop. “Always be careful to involve the employee’s immediate manager,” he cautions.

5. RECOGNIZE AND REWARD IDEAS WITH ACTION

Under Musyj, Windsor Regional’s strategic planning process in 2008 brought frontline staffers, physicians and volunteers to the table and all players continue to be involved in strategy. It is in this inclusive culture that a staff meeting yielded the idea of Genius Lab, an intranet portal by which employees could easily submit ideas that could be quickly implemented.

“Employee engagement initiatives have a shelf life,” says Brady Wilson. “Hospitals do engagement surveys and then pick the low hanging fruit to work on. Then, after a few years, over half the employees will indicate in a follow up survey that they don’t expect meaningful outcomes as a result of this survey.” By putting ideas into action quickly it reinforces the culture of change. Of course surveys, staff meetings and interactions with peers still constitute some channels for innovation, but having a formal mechanism that can give an individual the power to change a small process can have a lasting effect.

“We now have received over 1,000 recommendations and implemented hundreds of them, “ says Musyj, adding that they are often simple ideas that have a big impact, like putting handwashing stations in the elevators because it is the one place hospital employees will most assuredly stand still for a few seconds. “The CEO would never have figured that out. That takes frontline staff knowledge,” says Musyj.

He is also in favour of rewarding engagement through exposure. Two years ago the hospital was invited to present innovations such as its 15-minute Monday Morning Huddles (which track 14 key indicators to stay ahead of monthly and quarterly trends rather than have to react to them) at the Mayo Clinic’s Quality Expo in Rochester New York. Windsor regional sent its staff to present and Musyj promoted this fact internally.

6. TAKES MEASURES TO AVOID DRIFT

Measurement is part of the change, says Musyj, invoking the adage that what gets measured gets done. “You need measurements in place to ensure you are on track,” he says, explaining that change should look like a market index chart with lots of little ups and downs but a general upwards trend. If it’s trending downwards, that’s drift. Step back and look at the big picture. The idea, he explains, is to stay ahead of negative trends because if you are operating at capacity, any little change can really throw you off. “But if you can get ahead of this, it can be really enjoyable… even fun.”

Windsor Regional Hospital’s culture of transparency enables a core component of employee engagement, namely, to ensure that their employees’ work is meaningful and that what they are doing is making a difference to the organization as much as to patients. But it is also about being part of an organization that is widely recognized for its good work. “When you’re walking around the community and someone asks where you work, you can say you work at Windsor Regional Hospital and the discussion is a good one,” says Musyj. “I think more hospitals are realizing that this has to be their focus. Focus on this and the finances will take care of themselves.” Yvan Marston is a health care communications writer based in Toronto.   But change doesn’t always stick. So what do you do when you see it falter? In the series’ next installment we look at Kingston General Hospital’s approach to addressing its dip in handwashing rates.