What makes a hospital workplace “Great”?

Preface

Health care is an extraordinarily people-centric industry. Aside from the obvious fact that the patient consumes services to his or her physical body, nearly all treatments and procedures are administered by people. The management of health care personnel takes place in a complex environment involving a variety of professionals, extensive use of materials and equipment, and an array of services that extend beyond health care to include food, hospitality and supplies. This challenging environment places a great deal of stress on the caregivers (hospital caregivers). The intention of this paper is to explore the satisfaction of caregivers across some of the leading hospitals across the US to determine the extent to which caregiver satisfaction relates to the quality of the patient experience. I hope that this paper will provide an overview of what really matters to a typical health care caregiver satisfaction that shows a direct and positive relationship between the satisfaction of caregivers and the quality of the patient experience.

What makes a hospital workplace “Great”

The challenges of the healthcare industry today require hospitals and health systems to apply all available resources to a strategy toward improving patient care quality while reducing costs. One of healthcare organizations' greatest resources — and often the key to the success of new initiatives — is their caregivers (employees). Attracting and retaining skilled caregivers necessitates nurturing an environment that encourages and rewards innovation through both material and nonmaterial benefits. While tangible benefits, such as training and development and compensation, are important to caregiver satisfaction, what may be more important are intangible benefits, such as respect and recognition. "It's not about the money," says Paul Spiegelman, founder and CEO of BerylHealth, a company focused on the patient experience. People want to feel valued. In fact, most of the following attributes of success involve abstract concepts that while difficult to define, may ultimately separate a "good" hospital workplace from a "great" one.

Culture

Hospitals and health systems identified by caregivers as great places to work have developed a culture that reflects the values of the workers and organization. "An overarching cultural tenet of the health system is transparency, inclusiveness and stewardship toward our caregivers. It's the overarching cultural component that drives everything else." says Stephen L. Mansfield, PhD, president and CEO of the Methodist Health System. Similarly, I found another hospital in Orange County that focuses on creating a friendly environment to make caregivers feel welcome and happy. To create this environment, the entire leadership team spend one hour in the morning and another in the afternoon walking around the hospital with a smile face badge and encouraging caregivers to always say hello to each other and smile. Just as something simple like saying hello with a smile can improve an environment, building a healthy workplace culture generally depends on many small factors rather than one expensive program. According to Mr. Spiegelman. "[It's about] very small things that simply show people that you care about them and not about doing expensive events,” Sending a note of recognition, for instance, can affect a caregiver as much as or more than a large, costly party. Dr. Mansfield attributes Methodist Health System's eight consecutive Dallas Business Journal Best Places to Work awards to a myriad of elements that "become embedded in the culture." Creating a culture focused on the organization's caregivers is important not only for caregiver’s satisfaction, but also for patient engagement. Mr. Spiegelman says healthcare organizations are beginning to realize that "the only way to be patient-focused is to be caregiver-focused and to start first with developing an environment in which caregivers enjoy what they do every day. "The organization's leadership is essential for developing an enduring caregiver-focused culture”.

Transparency

Being transparent with caregivers is critical to gaining their trust and engaging them in their work. Dr. Mansfield says Methodist Health System makes it a priority to notify caregivers of any major initiatives before they are publicly announced. "The basic premise is let's not surprise our caregivers," he says. "Let them hear what we're going to do from us. And if possible, before a final decision is made." Communicating directly with caregivers instead of indirectly through other sources indicates that the system considers its caregivers as key stakeholders in the organization. "We want them to feel like insiders — they are insiders. You should treat them like you treat your board from the standpoint of how you communicate with them," Dr. Mansfield says. "If you want caregivers to act like owners, you have to treat them like owners." When caregivers are informed about the hospital or health system, they become more invested in the organization. In addition, keeping caregivers up-to-date on changes within the organization ensures they are aware of its goals and can work to meet them. "People want to feel engaged in their work, so they want to understand the mission, vision and values of the organization," Mr. Spiegelman says. "They want to understand what they stand for, what their part is in helping the organization achieve [its] goals."

Communication

In addition to being transparent with caregivers, hospitals and health systems should communicate openly with caregivers on other aspects of healthcare that affect them. For instance, Barnabas Health educates caregivers on healthcare reform through multiple communication channels. Mr. Ostrowsky says hospital caregivers get little relief from the topic of healthcare because of its prominence outside the hospital in the media and even among friends and family. The system thus began discussing healthcare with caregivers to provide them with tools to use when faced with the topic outside of the workplace. Caregivers have responded positively to this initiative. "Our caregivers have become more intellectually inquisitive about the topic — more interested in where we're going as a society in terms of healthcare. They have the interest and we should be able to capitalize on that by providing effective information and education," says Mr. Ostrowsky. In addition, Barnabas Health keeps caregivers updated on the system's involvement in policy discussions with elected officials and other policymakers "so our caregivers know we're advocating on behalf of our enterprise and by extension on their behalf."

Listening

As important as providing information to caregivers is soliciting information from them through surveys or other discussions. Dr. Mansfield and one or two other senior Methodist Health System leaders meet with all the system's directors and managers each year. These meetings give caregivers an opportunity to share their successes and improvements as well as barriers to success. Dr. Mansfield then compiles the responses and assigns a member of the executive team to address any issues frequently cited as a barrier. The progress on addressing those issues is reported to the front-line staff throughout the year. For example, one year many directors identified IT communication and response times as a barrier. The IT executives then redefined their roles, acting as vendors to the hospitals, which became clients. This new framework spurred the IT team to work with the hospitals directly to meet their technology needs. The next year, the issue was not mentioned as a barrier and was even listed as a success by the directors and managers. "For me, it's a way to get unfettered dialogue from them to me and me to them," Dr. Mansfield says. "Making that overt effort to try to get frontline feedback at least once a year from across the enterprise and doing something with that feedback has contributed to our success as a culture." In addition to formal discussions, informal interactions with caregivers can be valuable in caregivers’ needs. "Just as important as a formal survey and benchmarking year-over-year improvements are informal ways to get feedback during the course of the year," Mr. Spiegelman says. Rounding on the floors, for instance, can give hospital leaders a real-time view of the caregiver experience.

Caring

Showing caregivers their leaders and colleagues care for them is important in enhancing job satisfaction and caregiver retention. Methodist Health System has a program in which caregivers can voluntarily designate some of their payroll to a fund for caregivers in need. A committee of caregivers determines how to allocate the funds. For example, a caregiver whose home burned or who lacks the money necessary to pay for medical care may receive some of these funds. "We try to create a sense of family and mutual respect and caring for one another," Dr. Mansfield says. Barnabas Health has a similar program. Last year, nearly 20 percent of caregivers contributed a total of $130,000 for caregiver’s assistance. Another way Barnabas Health shows caregivers it cares was by introducing a dry cleaning service, a full bank branch and an entertainment center into the hospital. "Caregivers could [order food], rent a movie and leave from work ready for an evening of relaxation," Mr. Ostrowsky says. "We didn't make any money renting movies and having a full bank branch, but caregivers understood that we were concerned [and wanted] to develop something that could make their lives easier and less stressful when they left the job."

Empathy

Empathy takes caring one-step further by expressing an understanding of caregivers' situation. Making caregivers aware that their leaders understand the challenges of their job is critical in engaging caregivers in the workplace. "If you're going to dedicate your professional life to working in healthcare institutions and supporting families and the sick, you have a personality profile and character that is unique and admirable. What we need to do every day as the employer is to connect with that emotion, that inner spirit that drove a person to want to be employed in the industry," Mr. Ostrowsky says. Barnabas Health supervisors, many of whom have been on the frontline before, are trained to support their staff emotionally by expressing an understanding of the difficulty of staff members' jobs. "You have to start with empathy," Mr. Ostrowsky says. "It's not enough to say 'Thank you for your great work.' You need to say 'Thank you and I understand how difficult it is.' Expounding on that will allow the caregivers to understand that we really do appreciate what is done on a daily basis. “Supervisors who previously served on the frontline are also encouraged asking their staff what has changed since they left to gain a sense of new challenges the workers face. “If you miss that connection on the emotional level, then you're not going to make the workplace attractive to incumbent staff or new staff," he says.

Recognition

Recognizing caregivers for their efforts significantly affects caregiver job satisfaction. Dr. Mansfield believes one important thing CEOs can and should do is to personally acknowledge caregivers accomplishments and successes. One small thing he does is to drop a personal note to the home of caregivers who are featured in their weekly system newsletter for achieving a goal such as receiving a certification, award or other accomplishment. This small act creates great value for the caregiver at little cost to the health system. "That costs nothing, really — just a little time and a stamp, and I love doing it," he says. Caregiver recognition should be timely and continuous, according to Mr. Ostrowsky. He suggests healthcare leaders recognize a caregiver— whether through a formal award or informal acknowledgment — as soon after the behavior they wish to reward as possible. Responding to caregivers' successes in a timely manner demonstrates the leaders' value of and commitment to caregivers.

Professional development

Professional development opportunities are also central to an attractive workplace because they show the organization's investment in caregivers and their desire for them to progress in their careers. Methodist Health System has an emerging leader program for frontline caregivers identified by a manger as potential leaders for the future. Similarly, Barnabas Health has a management institute that trains caregivers. Training healthcare caregivers may become increasingly important as healthcare becomes more focused on the patient experience, which depends in large part on patients' interactions with the people in the organization. "In healthcare, people are highly trained in a specific skill set. But they're not generally trained on what it takes to run a business in terms of personal interaction and team development," Mr. Spiegelman says. "Providing an environment in which they can learn those skills is critical."

Organizational pride

Mr. Ostrowsky says hospitals and health systems identified by their caregivers as great places to work are those that make their caregivers proud of the organization, such as by getting involved in the community. "If the caregiver doesn't have a warm feeling about the accomplishments of the overall organization, or the caregiver doesn't acknowledge to him- or herself that the organization is trying to accomplish something that's important, you lose an opportunity to make the caregiver feel good," he says.

Fun

Becoming a great place to work in healthcare also requires opportunities for caregivers to have fun, according to Mr. Spiegelman. One way to have fun is encouraging caregivers to decorate their office space. He also cites the case of one hospital that shows funny videos to staff, schedules dress-up days and has social events outside the facility. "They realize that as serious an environment as a hospital is, they can still find the time to have fun with each other."

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