Building Employee Engagement in the Health Sector: increasing staff performance through engagement

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Building Employee Engagement in the Health
Sectorincreasing staff performance through
engagement

• Wayne Balshin, Regional Director
• Employee Union Relations
• wayne.balshin_at_vch.ca
• 604.875.4563

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Engagement
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Engagement is

• A heightened emotional connection that an
  employee feels for his/her organization that
  influences him / her to exert greater
  discretionary effort to his/her work.
• Conference Board 2006

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Engaged Employees

• I feel good about the organization.
• I enjoy being part of the team.
• The organization supports the teams
  performance.

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Why Engagement?
Intuitively, it seems clear that employees that
feel strong, positive commitment to their jobs
and workplace are likely to outperform those who
dont. Gaining this discretionary effort from
employees may be the last remaining source of
productivity, now that so many companies have
already captured the efficiencies of technology
and streamlined processes. -- Working Today
Exploring Employees Emotional Commitment to
their Jobs, Towers Perrin/Gang Gang Research
2003
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Key Driver for Engagement

• An employee may join Disney or GE or Time
  Warner because she is lured by their generous
  benefits package and their reputation for valuing
  employees. But it is her relationship with her
  immediate manager that will determine how long
  she stays and how productive she is while she is
  there managers trump companies.
• - First Break All the Rules What the Worlds
  Greatest Managers Do Differently, Marcus
  Buckingham Curt Coffman

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Communication Engagement
Supervisor communicates employee strengths Supervisor communicates employee weaknesses Supervisor does not communicate
Employee Engaged 61 45 2
Employee Not Engaged 38 33 58
Employee Actively Disengaged 1 22 40

• Gallop Study of 1000 US Health Care Workers
  (2005)

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Level of Engagement

• Employee engagement in the Health Sector is
  generally lower than engagement in other sectors,
  whether public or private, in the United States
  or Canada
• Gallup (U.S.) documented in 2002 that nurses
  level of engagement scored 18 vs. 30 for
  overall working population

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Engaged Employees

• speak positively about the organization to
  coworkers, potential employees and customers
  (recruitment)
• have a strong desire to be a member of the
  organization (retention)
• exert extra effort to contribute to the
  organization's success (performance)

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A VCH Engagement Performance StrategyContinuou
s Communication
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Case for Continuous Communication

• 2004 Accreditation identified Human Resources
  needed to address the lack of performance
  appraisals for VCH staff
• Given the Managers large span of leadership, eg.
  between 75 200 staff, Managers were challenged
  to find the time to write annual performance
  evaluations
• Performance evaluations are specific to the
  individual, not department performance, they are
  retrospective and do not capture the level of
  employee engagement or process improvement
  opportunities
• Employees perception is that negative evaluation
  disengagement and grievance

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Case for Continuous Communication

• 2006 Accreditation endorsed HRs partnership with
  Royal Roads University to conduct Continuous
  Communication as an alternative to regular
  performance appraisals and as a component of
  VCHs Staff Performance Management Framework.

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Continuous Communication
Step 1 Continuous Communication Meetings
(semi-annual) Step 2 Ongoing staff
communication and recognition Step 3 Consider
process improvement ideas and challenges
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Continuous CommunicationStep 1 Meeting

• Semi-annual informal discussion (15 20 minutes)
  between a front line employee and union
  supervisor or manager about
• Whats working well
• Performance achievements and recognition
• Skill and career development
• Ideas for process improvements and discussion
  about operational challenges

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Continuous CommunicationStep 2 Recognition

• Positive and constructive
• Catch them doing something good
• Say it when you think it
• Say it often
• Smile when you say it

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Continuous CommunicationStep 3 Process
Improvement

• Supervisor/manager records brief summary of
  ideas/challenges
• Manager brings forward ideas and challenges to
  Director for consideration as appropriate
• Manager communicates outcomes to staff
• Some ideas may be feasible others may require
  further analysis some ideas may not be feasible
  for a variety of reasons

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Performance Assessment

• Staff new to a unit / department or to VCH
• informed of what is required to succeed
• orientation provided to facilitate success in
  position
• recognition, feedback, and coaching provided
• Coaching includes identifying strengths, areas
  for development and actions required
• Written performance assessment completed at the
  conclusion of qualifying period

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Performance Recovery

• Applies to staff whose job performance is
  unsatisfactory.
• Interventions to remedy performance
• supervision and instruction to the staff member
• learning plan and timelines
• alternative employment within the competence of
  the staff member and,
• warning(s) job in jeopardy.

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of Staff Impacted by Continuous Communication
Continuous Communication (90 staff)

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Pilot Study Continuous Communication
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Preparing for Continuous Communication

• June 2007 VCH
• Identified 6 units to pilot Continuous
  Communication
• Ask staff in pilot units to complete VCH
  Engagement Survey
• Trained supervisors and managers for the pilot
  units, plus Human Resource Advisors, on
  Continuous Communication
• Implemented Continuous Communication September
  2007 for the 6 pilot units

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Preparing for Continuous CommunicationEngagement
Survey

• Duties of my job are clear
• I have the material and equipment needed
• I receive frequent recognition for my work
• There is someone who encourages me to take
  advantage of career growth
• I feel free to make suggestions for improvement
• I receive feedback about my work
• I recommend my unit as a good place to work
• Answered on the Likert Scale
• Strongly agree Somewhat agree Neutral Somewhat
  disagree Strongly disagree

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Preparing for Continuous Communication Manager
/ Supervisor Training

• Communication Skills Model
• Effective Communication
• Recognition
• Conducting the Continuous Communication Meeting

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Manager / Supervisor TrainingCommunication
Skills Model

• Developed by Roger DAprix, ABC, an
  internationally-recognized communication
  consultant, lecturer and author in collaboration
  with International Association of Business
  Communicators
• Model based on experience working with managers
  and employees in Fortune 500 companies
• Model describes the questions employees need
  answered to reach engagement

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Manager / Supervisor TrainingCommunication
Skills Model
Job Responsibilities
Engagement
Vision, Mission and Strategy
Performance Feedback
Department Objectives, Results
Individual Needs
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Manager / Supervisor TrainingEffective
Communication

• What Is Effective Communication?
• It is two-way
• sender ? receiver
• receiver ? sender
• It is balanced
• listening talking
• talking listening
• There is feedback
• discussion, questions, answers, analysis,
  exploration of alternatives

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Manager / Supervisor TrainingEffective
Communication

• The most basic and powerful way to connect to
  another person is to listen.
• Just listen.
• Perhaps the most important thing we ever give
  each other is our attention
• Rachel Naomi Remen

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Manager / Supervisor TrainingEffective
Communication

• Active Listening Techniques
• Paraphrase
• Re-frame
• Acknowledge both content and feeling
• Use bridges
• Use positive words
• Wait to hear what the other person is saying
• Empathize
• Accept silence
• Ask open-ended questions

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Manager / Supervisor TrainingRecognition

• - Recognition has been shown to motivate staff,
  increase morale, productivity, and employee
  retention, and decrease stress and absenteeism. 
  
• individual recognition was one of the top
  three factors for improving the levels of
  employee satisfaction and employee engagement in
  the BC public service.
• 2002 report, Auditor General of BC on Building a
  Strong Work Environment in British Columbias
  Public Service A Key to Delivering Quality
  Service

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Manager / Supervisor TrainingRecognition

• Bi-annual Continuous Communication Dialogue
• Supervisor asks employee, Whats going well?
• Actively listens
• Supervisor recognizes employee for his/her
  contribution and performance

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Manager / Supervisor TrainingRecognition

• Ongoing Spontaneous Recognition Feedback
• Positive and constructive
• Catch them doing something good
• Say it when you think it
• Say it often
• Smile when you say it

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Manager / Supervisor TrainingRecognition

• As a manager, you add value to overall
  performance when you motivate your staff to
  achieve performance levels not otherwise
  attainable. Employee motivation comes from
  working with a leader who is open to ideas, who
  is accessible and who recognizes performance.
• - Roger DAprix, ABC

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Manager / Supervisor TrainingConducting the
Meeting

• Bi-annual Continuous Communication Dialogue (15
  20 minutes)
• Supervisor asks employee, Whats going well?
• The CC dialogue is informal and positive.
• The managers role is to recognize performance
  and listen to ideas, opinions and suggestions and
  follow up where appropriate

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Manager / Supervisor TrainingConducting the
Meeting

• Choose topics appropriately dont need to cover
  all every time. For instance
• Long-term employee
• ?process improvements/barriers
• 2-3 year employee
• ?skill and learning development
• Everyone
• ?Recognition

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Manager / Supervisor TrainingConducting the
Meeting

• No formal record-keeping
• Barriers and process improvement ideas
• Employee describes ideas pinpoints barriers
• Manager records ideas barriers for follow-up
• Barriers process improvements follow-up
• Discussion at staff meeting
• Forward to Director
• Follow-up with employee on action or reasons for
  non-action
• Acknowledge employees contribution to others for
  process improvement ideas

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Results from Pilot Study September 2007 June
2008
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Feedback from Pilot UnitsWhats Working Well
with CC

• Informality of CC process is positive
• Gives structure to conversation
• Sets the tone not a performance appraisal
  putting people at ease
• Increases opportunity for manager and staff to
  meet
• After meetings, staff feel more comfortable to
  approach managers
• Staff now coming up with improvements by phone,
  e-mail or in person

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Feedback from Pilot UnitsWhats Working Well
with CC

• All staff who participated in one unit said they
  appreciated the ability to talk to their manager
  one-on-one
• Prefer this process to yearly, long drawn out,
  labour intensive reviews that dont get done
  this is a great compromise and covers the real
  purpose of these interviews
• Improved engagement at local level

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Feedback from Pilot UnitsCC Challenges

• Some managers found their large span of control
  was a challenge for scheduling meetings
• Staff need more communication around the CC
  process as units adopt this approach
• Continued need for training program, especially
  for staff with limited experience in difficult
  conversations and coaching.

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Feedback from Pilot UnitsProcess Improvement
Ideas

• Storage of linen items to where staff could
  access them more easily streamline the
  environment
• Unit layouts (2) One of the old patients rooms
  changed to a store room and another changed to a
  patient room closer to the nursing station
• Identified educational need around a number of
  patients with delirium from alcoholism was
  addressed educational need around skin care

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Feedback from Pilot UnitsProcess Improvement
Ideas

• Equipment requirements ordered gowns more
  appropriate to nurses size
• Converting a portion of a nursing vacancy into a
  care aide position
• Recycling

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Next Steps
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Next Steps

• VCH Steering Committee reviewing feedback from
  pilot units and distributing follow-up engagement
  survey in September 2008 (approximate)
• VCH to assess CC roll-out across organization

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Manager is fundamental to Engagement

• No one is a more influential leader than our
  immediate boss. He or she sets the tone,
  provides the example, and either motivates or
  destroys our engagement.
• Roger DAprix, ABC