Sharon Cox, MSN, CNAA
|
A healthcare administrator in Texas
was recently heard lamenting the fact that the organization had spent several
hundred thousand dollars in recruiting efforts and two years later, most of
those employees had left the organization. In New York,
a chief nursing executive found herself baffled by the pattern she could see
for the last three years, in which the nursing department would routinely hire
a hundred staff over the spring and summer, give them an extensive orientation
and a year later, less than half of those remained employed in the department.
These questions loom large on the healthcare horizon:
- How do we become the place where people want to work?
- What do we need to do differently so the investment we make in recruiting will pay off?
- How do we get people to stay over the long haul?
These questions can be answered with a simple phrase: It's
all about engagement.
This deceptively simple answer means the staff is
intrinsically motivated to work well together and provide high quality care.
While extrinsic motivators, such as incentive plans or employee of the month
awards, have a place in a strategy for retention,
thought also must be given to intrinsic motivation since this is a more
substantive approach. Rather than relying on toys and trinkets of
"flavor-of the-month" programs, efforts to cultivate an engaged
work force have a more lasting impact and a better return on
investment.
In his book, Intrinsic
Motivation at Work, Ken Thomas provides additional insight
into this concept of intrinsic motivation with four straightforward ideas. His
research shows intrinsic motivation increases when:
- People know they are doing meaningful work.
- They have choices.
- They have the opportunity to grow and develop.
- They feel they are making progress (something is better now than it was a year ago).
When these points are carefully considered, it would seem
the front line manager is in a
key role to influence each of these intrinsic motivators. Recognizing the key
role played by nurse managers or their counterparts in other departments is a
first step in creating a culture that fosters engagement.
It has often been said: You don’t leave a job -- you
leave your manager.
This statement rings true for many in health care. In most
surveys about retention in nursing, the relationship with the manager is among
the top three reasons why nurses leave their jobs.
The American Society for Healthcare Human Resources Administration (ASHHRA), an American Hospital Association (AHA) affiliated society, developed the following list of competencies for middle managers:
- Results Orientation
- Skilled Communicator
- Team Builder
- Agent for Change
- Commitment to Service
- Collaborative Relationships
- Resource Management
- Analytical Thinking
- Personal Integrity
- Talent Development
- Leadership Effectiveness
Want to see more of their findings? Click here to read more of the "What Makes A Good Manager?" article.
|
If the manager’s role is pivotal in creating an
environment for retention, one might ask: "What are the salient characteristics
of managers who have the knack for fostering staff engagement?" Using the
ideas of Ken Thomas as a starting point, these managers are skilled in letting their staffs know they are doing
meaningful work and giving
them choices.
They let the staff know they
are doing meaningful work by recognizing them for a job well done. This could
be with thank you notes mailed to their home, or recognition in a staff meeting
or hospital newsletter. One manager opted to highlight the exceptional work
done by her staff by taking time in staff meetings each month for the staff to
talk about their experiences with patients or families that had touched their
heart. Now "Heart Moments" is a regular agenda item in each staff meeting. This
has the added effect of reinforcing for each person present how much the work
they do matters, and affirming their efforts to provide high quality care.
Along these same lines, staff also feel valued when senior level administrators
take the time to write notes recognizing their work. Valuing what front line staff are doing is also reinforced when their directors or
administrators make rounds and ask, "What can I do to make your job easier or
help you feel more productive?" Following up on these requests and
communicating the outcome is essential in making this process credible with the
staff.
Effective managers see themselves as partners with their
staff and have moved away from the
old command and control approach to management. Managers who create an
environment for retention and staff engagement believe their job is to remove
the barriers that frustrate their staff and see that the staff have what they
need to get their job done. This approach to management and leadership, made
popular in the late seventies by Robert Greenleaf, is often called "leader as
servant." (Click
here for more information
about servant leadership.)
Redefining the role of the manager in this way means
managers listen to staff members and value their input. The staff
know they have been listened to because something happens with what they
said. Partnering with the staff and bringing out the best in them is a goal of
managers who believe management is about growing people rather than controlling
them. As one manager put
it, "My effectiveness is measured by what happens in my absence. The better job
I do, the less they need me."
Another key characteristic of managers who are effective
in fostering engagement is the way in which they involve the staff in
decisionmaking regarding issues that matter to them.
This may be with the use of a staff action team that deals with
operational issues or shared governance councils, or cross-functional teams to problem solve
issues with other departments.
The end result is the staff feel "in the loop"
on decisions that impact their work, they feel empowered to trust their own
judgment and act on what they know. Involving the staff in decisionmaking
creates a professional practice environment that fosters the growth and
development of staff as well as giving them choices,
two other key intrinsic motivators. Involving the staff in decisionmaking is an
approach that follows the principle of decentralizing decision-making. A basic
premise for effective managers is:
Whoever needs to make it work
should be involved in the decisions about the work.
This could take the form of a staff subcommittee that
manages a self-scheduling
process or a task force to improve a clinical outcome (such as reducing patient
falls or nosocomial infection rates). The growth and development of the staff
and the sense of autonomy they feel to manage their practice as they get
invested in issues that matter to them is one of the sources of job
satisfaction for managers who know how to foster engagement. As one manager put
it, "It just makes my day when I see that light in their eyes and see them
going above and beyond my expectations."
My effectiveness is measured by what happens in my absence.
The better job I do, the less they need me.
|
Speaking of expectations, this is a key factor in
fostering the growth and development of staff. Effective managers have high
expectations and expect their staff will function as competent professionals.
As one manager put it, " I have learned that if you
raise the bar, people meet it—and if you lower the bar, people will also meet
it. I see my job as raising the bar to bring out the best in my staff."
Effective managers back up these expectations by providing
support for those whom are continuing their education or involved in a
certification process with flexible
scheduling and adjusting assignments when possible. Providing staff
development programs or support with educators or clinical specialists also
lets the staff know the manager values their career development.
Another key value of effective managers is in getting to
know their staff as individuals and recognizing they have a life outside of
work. Taking the time to get to know each person on the staff is a time
consuming commitment but one that is frequently practiced by managers who are
committed to staff engagement. The staff feels valued as individuals, not just
names on the schedule, when managers invest time in getting to know them.
Valuing this sense of connection with the staff is a
characteristic feature of top performing managers. They know what motivates
their staff and how to adjust for generational
differences. They show their respect for the staff by doing the
little things that mean a great deal to them. A nurse manager in Michigan makes
it a routine practice to remember each of her staff members’ birthdays by sending
a card to their homes. She relates the
story that another hospital was vigorously recruiting one of her best staff
nurses, offering a substantial pay increase. When the staff nurse turned down
the offer, she explained to this manager,
"You are the only manager
I have ever had who remembered my birthday.
I decided that I wanted to work in
a place I know I am cared about.
That means more to me than money."
Jo Manion3 writes
about this in a recent article for Nursing Management magazine in which
she interviewed 26 nurse managers from across the country, many of whom had a
waiting list of people who wanted to work in their departments. Her research
indicated this "personal, individual connection with staff" was a common theme
in her interviews. She quotes one manager who said, "I know all of them. I know
their names, their families, their dog’s name and what they like to do." Taking
the time to invest in relationships and really get to know the staff is
essential for staff engagement.
Having the time to invest in relationship building leads
to the other major dimension of staff engagement -- ways in which the
organization influences the process of fostering a culture of engagement.
The middle manager position is a key leverage point in fostering engagement.
The organization needs to value the role of the manager by making the job doable. All too often, organizations say
they value managers--then they fail to provide them with clerical support, or
make the manager role the "catch all" job. In too many organizations, managers
are expected to do payroll, hand out parking tickets or monitor mandatory
education requirements in between the wall-to-wall meetings that typify their
week.
Making the management role a viable role is an organizational
responsibility.
It also is important that the human resources function in
the organization is progressive with policies that support things like flexible
scheduling, tuition reimbursement or even concierge services so the quality of
work life in the organization is not influenced by the manager alone.
Physician relationships also
are part of the picture and the emphasis on a collaborative work environment is
key. Policies to deal with disruptive physicians as
well as joint nurse-physician committees contribute significantly to creating
an environment of partnership and collaboration. Poudre
Valley Medical Center in
Fort Collins, CO, has a
tradition of honoring the Physician of the Year in each specialty as well as an
overall Physician of the Year, elected by votes of the nursing staff.
Commenting on the success of this effort in improving nurse-physician
relationships, one doctor said, "This has made us make more of an effort to be
'user friendly' and really cooperate with the nurses."
In reflecting on the need to foster staff engagement and create
a culture for retention, the question is often asked, "Where do we start?"
Where are the best practices and how do we begin to change
the culture? Clearly, the development of middle managers is a top priority so
they have the tools they need to be effective in their roles. Secondly,
surveying the staff to determine their level of job satisfaction provides a
baseline for developing a culture of engagement.
An administrator in Florida takes
the staff survey process one step further by routinely meeting with the staff
in generational cohorts. She has "lunch with Lynn" each
month and asks those present to tell her:
- What are the things that keep you here?
- What frustrates you so much that you sometimes want to leave?
- What else would you like to tell me?
She learns a great deal about the generational differences
in the staff using this approach and has been able to tailor the
employee benefit package according to the demographics in the workforce. Senior
level administrators who take the time to listen to staff and invite their
insights simply reinforce a culture for engagement.
While the ideas presented here are not new or costly, they
have been shown to significantly impact staff morale, retention and ultimately
the quality of care in an organization. Opting for this more substantial
approach to retention and cultivating an engaged workforce is an idea worth
considering. Staff retention is a complex issue in some ways, but in other
ways, it is rather simple.
It really is all about
engagement.
Sharon Cox has
conducted workshops, seminars and consulting engagements for nearly 300
hospitals in the US and Canada. She is known
for her lively and entertaining presentation style and effective facilitation
of organizational culture change. The
centerpiece of her organizational development and training work is a year-long
program called Leading and Managing Generation 21. Sharon is a popular presenter and keynoter at national meetings of
professional nursing organizations. Her consulting firm, Cox & Associates, is based in Brentwood, Tennessee. Contact Sharon at esharoncox@aol.com.
Robert Greenleaf graphic courtesy of Greenleaf Center for Servant-Leadership.
|
