Written by: Jim Murphy & Beth Boynton RN, MS
Part I: Six Attributes From: The June 2013 Harvard Business Review
What would the ideal organization to work for look like in healthcare? Just to pose the question may feel depressing: most of us work for organizations so far that state that “ideal” seems chimerical. Still, developing ideals can have a positive effect by stimulating our imagination. Moreover, countless books and articles have offered prescriptions to organizations for becoming the best, the greatest, and so on.
A recent good example is the June 2013 Harvard Business Review by Robert Goffee and Gareth Jones entitled Creating the Best Workplace on Earth. Based on their own surveys of “hundreds of executives in surveys and in seminars all over the world” and the findings of other organizations such as the Hay Group, the authors boil it all down to six attributes, to which we have applied our healthcare “tailoring”:
- Individual differences are nurtured.
In healthcare: Staff are recognized by leaders and peers for offering insights and inputs that promote best care. This is evidenced by some staff being held in high esteem for clinical expertise and some for emotional intelligence.
- Information is not suppressed or spun.
In healthcare: The truth has high value. It is ok in the culture to say, “I don’t know”, time is available for research, and workloads allow for a reasonable pace.
- The company adds value to employees, rather than merely extracting it from them.
In healthcare: Employees tell their friends where they work with a sense of pride. They trust the organization cares about them and they feel respected for the work they do.
- The organization stands for something meaningful.
In healthcare: Safe, compassionate care IS the goal.
- The work itself is intrinsically rewarding.
In healthcare: The goal is attainable and employees go home, (most days) feeling like they were helpful and made a difference in the lives of the patients/clients they served.
- There are no stupid rules.
In healthcare: Right! The work is supported by management and policies require input from those impacted by them. Management and staff work to understand each other’s perspectives and concerns about rules and when necessary, compromise with respect.
Simple things, perhaps, but we all know that simple objectives are the hardest to accomplish. And, as authors put it, few, if any, organizations possess all six virtues. Several of the attributes run counter to traditional practices and ingrained habits. Others are, frankly, complicated and can be costly to implement. Some conflict with one another. Almost all require leaders to carefully balance competing interests and to rethink how they allocate their time and attention.
How does your organization measure against these six standards? And what other suggestions can you make toward defining the ideal healthcare organization?
Part II – Twelve More Attributes From: The Twelve Attributes of a Truly Great Place to Work
It is interesting to compare that list with one of twice that number of recommendations given by CEO and HBR blogger Tony Schwartzin September 2001, “The Twelve Attributes of a Truly Great Place to Work”. Maintaining that “great employers must shift the focus from trying to get more out of people, to investing more in them by addressing their four core needs — physical, emotional, mental and spiritual,” he gives the following mandates:
- Pay every employee a living wage.
In healthcare: We must promote healthy work-life balances so that staff are providing care when alert, rested, and have an overall sense of well-being. Discouraging overtime and double shift work goes hand in hand with safe care, positive patient experience, and respectful earnings and benefits.
- Give all employees a financial stake in the organization’s success.
In healthcare: We can be creative about incentives that are aligned with patient care, profit and employee rewards. Profit and profit sharing must be a secondary priority after safe, quality care. Healthcare staff is often very giving people and are likely to get satisfaction from donating to colleagues, patients, and larger social causes as well as financial gains.
- Provide work environments that are safe, comfortable, and appealing.
In healthcare: We must have enough staff, time, and resources so that staff can provide care according to standards and at a pace that can be sustained for the long term.
- Provide healthy, high quality food at the lowest prices.
In healthcare: Food services for staff and patients is a 24/7 business where healthy and affordable eating options can support and role model nutritional best practices.
- Create spaces where employees can rest and renew themselves and encourage them to take naps, etc.
In healthcare: There are times when the demands for long shifts and high stress are unavoidable. Having clean and comfortable lounges for staff is essential.
- Have a gym and let employees use it on work time.
In healthcare: We can decrease workplace injuries, stress that contributes to burnout, substance abuse and other coping habits by encouraging and supporting time for physical activities. Extended meal breaks, before or after work time covered could be prorated for full and part-time staff.
- Clearly define success for each job and allow employees to decide how to achieve it.
In healthcare: There must be a sense of collaboration and support to ensure that staff can meet professional and personal standards. Organizations can be creative about balancing structured expectations with varied pathways for a diverse population. Attention to both the skills necessary for clinical competence and those involving human interactions.
- Have two-way performance reviews.
In healthcare: We can train all levels to be respectful and comfortable in giving and receiving feedback. Managers who advocate for staff while observing organizational goals and budgets will help to build bridges between direct care staff and senior leaders.
- Hold management responsible for treating employees respectfully and recognizing their positive accomplishments.
In healthcare: Good conduct standards must be role-modeled by senior staff with no mixed messages or double standards. Clear expectations and trust-building efforts may be necessary initially for toxic cultures or dysfunctional teams.
- Have policies that allow employees to focus on priorities, including time to work on projects they are passionate about.
In healthcare: Integrating program or project development time for staff while ensuring manageable workloads and appropriate staffing is key.
- Give incentives for employees to grow and to develop both “hard” and “soft” skills.
In healthcare: We must balance the emphasis on clinical expertise with developing communication, collaboration, and emotional intelligence skills. (Programs inMedical Improvare well-suited for this work).
- Don’t just focus on making a profit – add value to the world.
In healthcare: Most organizations have a mission statement that includes ‘care for the patient’. This can be improved with two efforts, one to ensure that the work to accomplish this mission is supported and two, to include a component of caring for caregivers.
Twice as many items as by Goffee and Jones, and rather different, too – but also a very good list! Who wouldn’t want to work for an organization that did all these things? Alas, however, there are probably very few places that could get a good score on all twelve of these indicators.
But there are many who do at least some of them. For example, Western National Mutual Insurance Company, which calls itself “The Relationship Company,” offers what a business writers calls “deluxe benefits to recruit long-term, reliable employees. Investing in employees is also commonly urged as good business practice. A software company has even devised a measure call ROEI: Return on Employee Investment.
It would be rewarding to know about healthcare examples of organizations that invest in employees and are a “truly great place to work”. Do readers have any examples?
Part III – Ten More Attributes From: Examiner.com
Beginning what seems to be a series, we asked earlier this summer “What would the ideal organization to work for look like in healthcare?” We gave six answers, based on an article in the June Harvard Business Review. In a Part II, we added twelve more attributes from an earlier HBR blog post.
Here is another list! A blogger with an HR background, Peggy Castellano at Examiner.com, offers identifies the top 10 characteristics of a great place to work as follows, with our comments on application to healthcare:
- Being an employee champion, offering fairness in all ways.
In healthcare: This means balancing the interests of doctors, nurses and other staff and providing a work environment that is free of bullying, respectful of difference, and ensuring enough staff to provide professional care at a high standard. Administrative leaders must seek to understand the complexity of providing medical and nursing care so that efforts to support the work are respectful and helpful.
- Promoting continuous learning and development at all levels.
In healthcare: There needs to be ongoing learning not just on the required training to meet regulations and technical and clinical skills, but also on so-called “soft skills” such as leadership and communication. Progressive healthcare organizations will create opportunities to practice, learn, improve, celebrate, practice and will include input from staff about what kind of training would be helpful in serving the organizational mission. Learning Medical Improv holds huge promise for developing the “soft skills” that individuals, teams, and organizations need to provide safe care, create positive workplace cultures, provide optimal patient care, and work in alignment with the mission and within financial limitations.
- Having strong values and ethics.
In healthcare: There is a strong tradition of medical ethics and values ever since Hippocrates, but given the current influence of financial factors there is a definite need for re-emphasizing these as core principles. The first priority must be care and it must be consistent, clear, and true. Whether for profit or not for profit, financial limitations should be transparent.
- Celebrating diversity in all respects.
In healthcare: Just as the patient population has become increasingly diverse, so to the workforce needs to be diverse and sensitive to diversity. The healthcare system is truly a
‘melting pot’ of difference with age, gender, profession, ethnicity, sexuality, etc. In addition, recognizing individual strengths, preferences and limitations regarding work schedules and job matches, while maintaining and enforcing clear expectations that ensure organizational operations and excellence in care.
- Having visionary leaders.
In healthcare: The complexity of systems and issues and the constancy of change certainly makes visionary leadership necessary and many such leaders have been identified (one even in this blog), though in some cases the attribution may be more hype than reality.
- Having a fully engaged workforce.
In healthcare: “Patient engagement” has become one of the trendiest catchphrases, but of course to reach that goal all parts of the health workforce also need to be engaged. Listening is key. Honest efforts to consider ideas and respectfully set limits will go miles towards this end.
- Letting every opinion count.
In healthcare: The large number of stakeholders (patients, doctors, nurses, insurers, regulators, advocates – just to name a few) renders it very difficult to have an environment in which everyone has their due voice, but without attaining that objective and in particular enabling the employee voice, no organization can be truly successful. Listening is key. Honest efforts to consider ideas and respectfully set limits will go miles towards this end.
- Linking performance goals and objectives to the organizational mission.
In healthcare: Performance management has so many specific aspects that there is at least one organization devoted simply to this topic. When room for improvement exists, efforts to include both the employee and leadership in finding out what each could do better to ensure that goals are met.
- Reinventing as needed through change management and organizational development.
In healthcare: Change is enormous and there needs to be a strong organizational culture to cope with it. Ensuring time, reasonable workloads, effective delegation training, and celebrating diversity will contribute to a culture where individuals and teams grow and flex under the constant pressure of change. The sense of support will outweigh any fears.
- Rewarding employees for modeling positive values and behaviors.
In healthcare: As has been noted here before, positive behaviors have to be developed by experiential learning as well as fostered by reward systems. In addition, leaders must look for individual and team examples of positive behaviors and engage both for input around rewards.
Castellano’s list is a very “human resources” type agenda, and we like the emphasis on organizational development. The items are pretty high on Maslow’s Hierarchy of Needs. One can hardly argue against any of the items on the list (weak values or blind leadership, anybody?), and certainly an organization that met all these criteria would be an exceptionally rewarding place to work for.
But, while we can all agree that such attributes are highly desirable, have we seen them in practice? Here and there, certainly, and we’ve mentioned some examples in this blog. Collectively, probably not: can anyone suggest a healthcare organization that meets all ten of these standards?
Maybe, however, we can learn how that could be done. If readers can nominate healthcare organizations that meet one of the individual criteria on the above list (or those in the earlier two posts in this series), perhaps we can gain some insight on how the ideal healthcare organization can be achieved. Such nominations could provide wonderful material for blogging. Please let us know if your organization is ideal in one or more ways. We’ll accentuate the positive, right here!
Part IV – Ten More Attributes From: 30 Reasons Why Employees Hate Their Managers
We recently started a series on what the ideal healthcare organization would look like. In our first installment we cited six characteristics, based on an article in the June Harvard Business Review (HBR). Then we added twelve more attributes from an earlier HBR blog post. In our third article, we listed ten more as given by a blogger for Examiner.com.
Now we suggest ten additional attributes of a great organization and how they would appear in healthcare, based on a list in the current newsletter “Improving the Workplace” by local guru Bruce Katcher. Bruce is an organizational/industrial psychologist and is founder of Discovery Surveys, Inc., and the Center for Independent Consulting. He wrote the book 30 Reasons Why Employees Hate Their Managers.
Bruce’s newsletter is one of the most useful in the business. In the September issue, he asks “Are You Proud of Your Organization?” He proposes ten factors that make employees proud and thus make for an ideal organization.
- Giving back – organizations should give back to the community.
In healthcare: The core mission is to serve the community, though, alas, many hospitals now see themselves as working for a constituency, not the whole population. But one can find much giving back in healthcare, from summer youth programs to charitable donations. Certainly there is room to develop the idea that healthcare itself is integral to the health and well-being of the community and this may manifest differently than marketing efforts.
- Optimism – in a good organization employees feel good about its and their own future.
In healthcare: The constant pressure to cut costs can work against optimism. Employees too often feel stressed out and fearful about their jobs. This last winter the Lucien Leape Institute-National Patient Safety Foundation released an important Roundtable report called, “Through the Eyes of the Workforce”. It raises serious Further, when there is confusion about reducing costs versus making money, staff are pulled in different directions and care may become secondary. This chips away at the integrity of professionals and organizations and speaks to having a clear, honest, and consistent vision.
- Quality products and services – in the ideal organization these should be first rate.
In healthcare: There is a federal agency devoted to improving service quality and more than one journal covering this topic. But for all the attention the issues get there is still dissatisfaction, as the existence of the patient engagement movement shows. Many consumers report positive experiences in healthcare and many do not. This gap between what healthcare professionals can and should do in terms of quality (and safe) care is reflective of unclear or inconsistent priorities, fragmentation, and understaffing.
- How decisions are made – employee involvement in the decision-making process helps.
In healthcare: The complex and hierarchical nature of organizations is a barrier to employee participation, despite evidence linking it to patient satisfaction. Interventions that bring together the people in the various healthcare roles, such as medical improv, are thus very important. Leaders and managers including nurses and doctors must be fluid in their abilities to provide structure and empower staff and promote collaboration. In healthcare, a command and control element is key, but when employed all the time is oppressive and counterproductive.
- Respect for employees – management needs to listen and people to trust one another.
In healthcare: With all the pressure on healthcare leaders, it is all more imperative that they pay attention to employees and earn their trust. We posted a story of a leader who listened. One example trust building is the no-layoff policy of Scripps Hospital in San Diego. Employees who are listened to by leaders will be learning to listen to patients.
- Employee development – learning opportunities and career growth are essential.
In healthcare: Continuous learning is imperative as new technology and new mandates are implemented. Employee development has been called “a prescription for better healthcare”. Ensuring that ongoing training is interesting, engaging, and meaningful to staff and the organizational mission should be a priority. Computerized, mandated training is often lacking in all of these.
- Cost control – employees must believe that quality is not being sacrificed.
In healthcare: No issue is more in the news than reducing costs, and it seems that everyone has their own list of ideas on the subject. How that can be done without sacrificing quality of care may be the number one question in healthcare. Further, when there is confusion about reducing costs versus making money, staff are pulled in different directions and care may become secondary. This chips away at the integrity of professionals and organizations and speaks to having a clear, honest, and consistent vision.
- Personal accomplishment – employees must know about their performance and purpose.
In healthcare: The key to good patient-centered care is employee engagement, which requires a sense of accomplishment. Employee engagement has even been linked to good HCAHPS scores! Personnel evaluations should be inspiring and supportive of growth. Too often, a punitive approach such as feedback about poor time management skills without acknowledging organizational accountability for staffing insufficiencies may push employees into a corner. Shortcuts, silos, defensive behaviors are counterproductive consequences.
- Transparency – a good organization is clear about goals, pay and other matters.
In healthcare: Transparency is a difficult goal, with patients often being kept in the dark purportedly for their own benefit. Yet it has been said to be the “most powerful driver of healthcare improvement”. Leaders, staff, and consumers must all be active players in understanding and influencing statistics that arise from increased transparency in healthcare. Safe staffing, infection incidence, workplace injuries are complicated phenomenon.
- Strong benefit program – a great organization provides great employee benefits.
In healthcare: The cost cutting imperative again can adversely impact employee benefits. But the industry may actually have the ability to provide great benefits while still holding down cost; in fact, it has been suggested that hospitals could actually lower costs by providing employees with some of the benefits that they provide their patients! It is also imperative to have a long term vision that includes the costs of staff turnover and injuries. Taking care of staff and supporting the work has to be part of any safe and cost-effective strategy.
Surely a healthcare organization scoring highly on Bruce’s list of attributes would be an ideal place to work. And we’ve seen some cases where such things actually are happening.
Can readers help provide more examples to aid our quest of creating the ideal healthcare organization? Do you know of any employer who does exceptionally well on any of the above characteristics? Or maybe you have thoughts about what the barriers are. We would love to hear from you.
Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium. His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices. Having produced newsletters for several organizations and being a frequent content writer for the ”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching.
Beth Boynton RN, MS is a national speaker, organizational development consultant, and the author of the award-winning book, “Confident Voices: The Nurses’ Guide to Improving Communication and Creating Positive Workplaces”. She specializes in communication, collaboration, & emotional intelligence for healthcare professionals and organizations and is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She offers medical improv training for communication, emotional intelligence, culture change, and teambuilding efforts. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety” and blog, “Confident Voices in Healthcare” have drawn audiences from all over the world. She is currently writing a core text with F.A. Davis Publishing Co. tentatively titled Successful Nurse Communication: Safe Care, Positive Workplaces, & Rewarding Careers, practices as a Per Diem RN in a LTCF for folks with dementia, and a student of improv. Her complete CV is online.
“Beth Boynton has graciously agreed to supply the JFSEM with insightful articles that demonstrate the nursing perspective on healthcare issues. With Free-Standing Emergency Medicine resurrecting so many nurse’s and physician’s job satisfaction we are delighted to have the input from an expert such as Beth Boynton.”
– JFSEM Editorial Staff