Behavior in the Workplace

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Behavior in the Workplace

• Evidence-Based Leadership Practices for Creating
  a Positive Workplace
• Jo Manion PhD RN CNAA FAAN
• 1/8/07
• NCSBN

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• Never before have organizations paid more
  attention to talent Keeping it. Stealing it.
  Developing it. Engaging it. Talent is no longer
  just a numbers game its about survival.
• Kaye Jordan-Evans, 2002
• --Bowles, 1991

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The Plan

• Cost of Turnover
• What is Being Done
• The Study Design
• What Managers Actually Do
• Ramifications for Individuals
• Organizations

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Cost of Turnover

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Economic Benefits of Retention

• Gelinas Bohlen, VHA
• Tomorrows Work Force, 2002

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Cost of Turnover

• Damages the Brand

• Loss of Experience, Knowledge
• Connections
• Felt Rejection

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Resignation is not just a behavioral act it is
also a state of being.
Manion, Health Forum
Journal, Sept., 2000
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Recruitment is a key strategy for the current
workforce shortages, but isnt enough. It does no
good to recruit and select the right people if
you cant keep em. Manion, Health Forum
Journal, Sept., 2000
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What kept you?

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What Kept You?

• Autonomy, creativity, sense of control
• Flexibility work hours, dress, etc.
• Security
• Location
• Diverse, changing work
• Fun
• Responsibility
• Being part of a team
• Work/life balance
• Loyalty commitment
• Comfort on the job

• Exciting work, challenge
• Career growth, learning development
• Great people
• Fair pay benefits
• Good boss
• Pride in organization, mission, product
• Great work environment, culture
• Recognition, valued, respect
• Meaningful work, making a contribution

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Why do people work?
89 of all managers STILL believe it is about

Kaye Jordan-Evans, 2002
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Intrinsic Motivation

Meaningful Work
Progress
Positive Relationships
Competence
Choices
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Strategies
Inspire for Meaningful Work

Cheerlead for Progress
Build Healthy Relationships
Coach for Competence
Create Choices
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How can we Create a culture of retention?
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• What does a culture of retention mean to you?
• What characteristics do you think of when you
  think of a culture of retention?

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The Key Question
What do leaders do to create a culture of
retention in their area of responsibility?
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The Participants

• Current managers with direct reports
• Recommended by others as an individual who has
  successfully created a culture of retention
• Combination of low turnover rates, waiting list
  of interested staff, positive patient or service
  outcomes, healthy employee relationships, high
  employee and physician satisfaction levels

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The Study Design

• Telephone face-to-face interviews with 32
  managers
• Face-to-face interviews with 3 of the people to
  whom they report
• 3 focus groups of their employees
• Nurse managers, directors of pharmacy, imaging,
  PT, RT Business Office

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Analyzing the Data

• Used a categorical-content analysis approach
• Let the themes emerge from the participants
  stories examples
• Code the interviews to determine most common
  strategies or interventions

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Defining a Culture of Retention

• Its creating an environment where people want to
  stay.
• It means that people enjoy their work so much and
  the people they work with that they want to stick
  around and get involved. Everybody is trying to
  make it a great place to work.
• Its an environment that meets peoples needs.

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Defining a Culture of Retention

• Its a culture where employees know they are
  valued.
• When they come to work, they enjoy being here,
  they feel good about being here. They feel safe.
  They can trust each other that the job will be
  done and done well.
• They wake up in the morning and want to come to
  work. They are interested and want to be here.

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• Its more than a culture of retention, its a
  culture of engagement contribution. Because
  that will lead to a culture of retention. Its
  not enough that you stayed for 30 years. Its
  what are you giving? How are you contributing?

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What do you do to create a culture of retention?
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Forge Strong Connections
Partner with the Staff
Put the Staff First
Creating a Culture of Retention
Focus on Results
Coach for Expect Competence
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Put Staff First

• My staff comes first, not the patient comes
  first. Because if I make my staff feel valued and
  respected and good about what they do, then
  theyre going to give the best care in the
  world.
• I know that if Im looking out for them, they
  will look out for the department. They know when
  they need me I will be there for them.
• If the staff is going to put service first, I
  have to put them first. They have to feel that
  you have their interests at heart. That they are
  important and not being used abused.

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Put Staff First

• Caring for them as people

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Caring for Them

• Its caring about people and not just their
  work.
• I dont allow staff to be dumped on. By
  anyone!
• They know I love them. I have fallen in love
  with my staff.

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• We are re-focusing on the deep longings we have
  for community, meaning, dignity, purpose, and
  love in our organizational lives. We are
  beginning to look at the strong emotions of being
  human, rather than segmenting ourselves by
  believing that love doesnt belong at work, or
  that feelings are irrelevant in the
  organization.
• Margaret Wheatley, 1999
• --Bowles, 1991

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• The caring part of empathy, especially for the
  people with whom you work, is what inspires
  people to stay with a leader when the going gets
  rough. The mere fact that someone cares is more
  often than not rewarded with loyalty.
• James Champy, 2003
• --Bowles, 1991

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Put Staff First

• Caring for them as people

• Treating others with respect

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Treating Them with Respect

• They have the right to challenge me on any
  decision. Im open to that. If I say something
  wrong, they will come and tell me.
• I always respect their opinions and I dont
  judge them. I listen to what they are telling
  me.
• I treat them with respect in all situations. I
  never speak badly of anyone in front of others.
• I am just in awe of what they do, I am just
  stunned by it. Their hearts are so big! They
  amaze me every day.
• I trust that they are honorable people, if they
  tell me they need something, I believe
• it.

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Put Staff First

• Caring for them as people
• Treating others with respect

• Using appreciation recognition
• liberally

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Appreciation Recognition

• Getting peoples accomplishments in a newsletter
• Bulletin boards to share the thank yous
• Recognition tool kits give aways
• Events during recognition weeks
• Displaying evidence of accomplishments
• Clinical advancement programs
• Taking peoples pictures posting them
• Thank you notes special occasion cards
• Acknowledgement in front of others

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Put Staff First

• Caring for them as people
• Treating others with respect
• Using appreciation recognition liberally

• Meet their needs

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• Getting involved in the everyday problems of
  your people may violate the HR rule-book, but
  its also the single best way to build an
  emotional bond with your employees.
  
• Katzenbach, Why Pride Matters
• More Than Money, 2003
• --Bowles, 1991

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Put Staff First

• Caring for them as people
• Treating others with respect
• Using appreciation recognition liberally

• Meet their needs
• Listen respond

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Put Staff First

• Ask questions listen to the answers

• What took too long today?
• What is just plain silly?
• What is holding you back from
• doing your best work?
• What keeps you up at night?

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Listen Respond

• They are the ones with the gems. They will come
  to you with their problems. Youll know what
  needs to be fixed, cause theyll tell you whats
  broken.
• I address issues they have brought up, it
  surprises them sometimes.
• I may not have the answer right away because I
  like to go back and process things, but I always
  get back to people and they really appreciate
  that.
• Listening is probably one of the most important
  things I do. I repeat what they said and then I
  get back to them on it.

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Put Staff First

• Caring for them as people
• Treating others with respect
• Using appreciation recognition liberally
• Recognize appreciate diversity
• Meet their needs
• Listen respond

• Support

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Forge Strong Connections
Put the Staff First
Creating a Culture of Retention
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Forge Strong Connections

• Connect with people, as people
• Get to know them

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Get to Know Them

• Its understanding whats important to them
  outside the institution. That theyre human, that
  they have important lives and need to feel
  valued.
• I know all of them. I know their names, their
  families, their dogs, what they like to do.
• I dont do it as a strategy. I do it from my
  heart, but I know it makes a huge impact on them.
  Because I remember.

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Forge Strong Connections

• Connect with people, as people
• Get to know them

• Create a sense of community
• Hire the right people

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Hire the Right People

• I look for people who are passionate around
  their work.
• Im very selective. I know that if people want
  to learn the job, they will. Im looking at
  attitudes and behaviors, enthusiasm.
• We look for people that really have the energy
  and the sort of sense of humor that fits with our
  group.
• I want someone who has the heart and the caring
  and this is of interest to them.
• We want someone who is going to contribute,
  participate on committees, be a part of whats
  going on.

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Forge Strong Connections

• Connect with people, as people
• Get to know them
• Create a sense of community
• Hire the right people

• Have fun together

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Have Fun Together

• We try to keep it lighthearted. I have a good
  sense of humor. They see that and it sets the
  tone for the department.
• I use humor and fun to emphasize the things I
  think are important. For example, we always
  celebrate the end of orientation. I take the
  orientees out to breakfast and the preceptors
  out to dinner.
• We have so much fun at our parties, we started
  having these little cookouts every month or so.
  One of staff brings his grill well do
  hamburgers hotdogs around 6 pm so oncoming and
  off going staff can have some. We invite
  everyone.

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Forge Strong Connections
Put the Staff First
Creating a Culture of Retention
Coach for Expect Competence
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Coach for Expect Competence

• Sets high standards expectations

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Sets High Standards

• My leadership team and I actually look for and
  create new goals every year so that people are
  always feeling challenged. So were always on the
  cutting edge. You cannot be satisfied with what
  you did last year.
• I have very high expectations, I expect them to
  participate in PI efforts, to attend the
  committee meetings that they are on, to practice
  their profession in a quality way.
• I dont expect anything of them I wouldnt do
  myself.
• I have high standards, but Im a soft touch
  person. There are a core set of rules, like
  patient safety. We dont bend rules there.

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Coach for Expect Competence

• Sets high standards expectations

• Coaches for development

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Coaches for Development

• I am very well known for developing my staff. I
  have given birth to 10 managers here
• I look for opportunities for them.
• I get them involved in things. I ask them, what
  do you want to do?
• Each employee has special strengths and it means
  recognizing those and asking people where they
  would like to develop. They may like teaching
  others, or improving their clinical skills, maybe
  they want to be a manager or a case coordinator.
  So what kinds of experiences would be beneficial
  to help them prepare for that role?

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Coach for Expect Competence

• Sets high standards expectations
• Coaches for development

• Models behavior

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Models Behavior

• I have faced many situations that would get most
  people down, but I dont let it. Im choosing my
  attitude every day.
• You have to lead by example. We have to help
  each other. This job is difficult enough as it
  is. We just need to be supportive of each other.
  If you see that someone is sinking and having a
  really tough day, help them out.
• I try to model the behavior I think employees
  want they want honesty, they want fairness, and
  they want to see that I treat everyone the same.

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Coach for Expect Competence

• Sets high standards expectations
• Coaches for development

• Models behavior

• Manages performance

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Manages Performance

• You have to deal with problems head on and not
  let them fester.
• I hold people accountable for their behaviors.
  We follow a process, its time-consuming, but you
  know what? They either comply or they move on.
• Heres the bar. Its set right here and if you
  dont get up to that bar, then there are
  consequences. Too many people are afraid to
  discipline, afraid to counsel, because of
  workforce shortages. But the reality is, you
  cant keep bad apples. You really dilute the
  quality of service and the morale.

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Manages Performance

• You know, it takes a lot of time and energy, but
  you have to.
• In my most difficult conflict times over the
  years in management, I never ran away from it. I
  knew I was going to be in the hotseat, but I will
  not let that stop me from doing what I needed to
  do.
• When employees bring these problems, they want
  to see that they are taken care of.
• They want to know, to trust that something will
  happen.

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Forge Strong Connections
Put the Staff First
Creating a Culture of Retention
Focus on Results
Coach for Expect Competence
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Focus on Results

• Solve problems

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Solve Problems

• I try and deal with whatever they need in a very
  timely manner. I try and be very responsive to
  them. They dont have to come back to me again
  and say whatever happened with?
• People know theyve been heard when the problem
  is solved.
• Taking action very quickly is crucial. Delay,
  delay, delay will kill them and the managers
  reputation credibility. If they bring something
  forward or you see something wrong, take care of
  it now.

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Focus on Results

• Solve problems

• Empower involve employees

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Empower Involve Staff

• A big role of the leader in this environment of
  retention is that you start giving up as much
  power as possible. I measure my success by how
  little they need me anymore!
• Micromanaging kills you. Youve got to let go.
  You think youre going to do it all, but you
  cant. It will kill you. Youve got to have
  everyone helping you.
• I want to create more leaders on my unit, people
  that can just take the ball and run with it
  instead of always feeling like they have to come
  to me. And my goal is to get them so
  self-sustaining that they dont need me anymore.

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Focus on Results

• Solve problems
• Empower involve staff

• Responsiveness to staff
• Provide adequate resources
• Create a pleasing physical
• environment

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Forge Strong Connections
Partner with the Staff
Put the Staff First
Creating a Culture of Retention
Focus on Results
Coach for Expect Competence
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Partner with the staff

• Works interdependently

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Partners with Staff

• My job is to facilitate their work. I make a
  joke about it, but really the truth is that I
  work for them. They dont work for me I work
  for them.
• All of these things create a sense that Im
  working for them, and it creates an environment
  where theres mutual respect between us.
• Its understanding that its never about me
  its about we. Im not retaining people, we
  are.
• My job, and I can never forget this, my job is
  to provide service to those employees. Thats my
  job, Im working for them.

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Partner with the staff

• Works interdependently

• Visibility

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Visibility

• I just make a point of getting out at least once
  a day, making rounds and seeing everyone.
• Where ever I can just jump in and help out
  thats a good opportunity to be with that
  employee.
• Im here in the morning to see the night shift,
  and then in the afternoon to see the evening
  shift.
• I spend time out at the desk I take as much of
  my work out there that I can. Just to be around
  people.
• I block time out on my calendar to make rounds.

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Partner with the staff

• Works interdependently
• Visibility

• Accessibility

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Accessibility

• Im out there with them. I tell them, Im
  available this is what Im here for. If you
  need me or need to talk about something, Im
  here.
• Things like where your office is is important.
  What you wear to work. If you come in dressed to
  work or you are in business attire. Wearing the
  proper clothing that sends the message, if you
  need my help, Im ready.
• I post my schedule on the my door so people will
  know where I am at all times. If they want to
  talk to me and dont know where I am or when I am
  coming it, it creates a lot of frustration. This
  way they know.

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Partner with the staff

• Works interdependently
• Visibility
• Accessibility

• Establishes clear boundaries
• Communication is open honest

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Open Communication

• I am very honest with them and tell them I
  will tell you the way it is, whether you like it
  or not Im going to tell you. Its going to come
  from me. The good and the bad, you will hear it
  from me. If you hear it elsewhere, its gossip.
  
• I dont hide anything from my employees that
  they need to know.
• I am very up front with them. The previous
  leader lost their trust because of misinformation
  given. I expect the same from them that they
  expect from me.
• I try and approach things from a no surprise
  perspective.

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Forge Strong Connections
Partner with the Staff
Put the Staff First
Creating a Culture of Retention
Focus on Results
Coach for Expect Competence
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• The people in the good-to-great companies did
  things that seemed so incredibly obvious,
  straightforward, simple the comparison companies
  may have been very smart people, brilliant, but
  they saw things as complex, and they had
  elaborate plans and complicated strategies.
• Jim Collins,in HealthForum
  Journal,2002
• --Bowles, 1991

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Action Plan

• What should I start doing?
• What should I stop doing?
• What should I keep doing?
• What are 3 action steps to which I will commit?

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Ramifications/Individual

• Do an honest self-appraisal--- How do I measure
  up against these five principles?
• Look for opportunities to apply these 5
  principles
• Seek out other supportive managers
• Incorporate self-care into daily routine
• Find your voice, speak up speak out
• Use evidence-based leadership practices

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Ramifications/Organization

• Know what makes the difference, expect
  evidence-based leadership practice
• Provide necessary resources, not just lip service
• Leaders need authority to solve problems and
  change what needs to be changed
• Provide support for dealing with polarities
  managing boundaries
• Recognize reward those who are effective rather
  than letting them be penalized in the system
• Strengthen the working effectiveness between HR
  and operational managers

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• Creating a culture of engagement is hard work,
  but, it isnt rocket science and it doesnt cost
  a lot of money. Developing such a culture
  requires being authentic, caring about people and
  making yours a good place to come to work.

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• . . . it is far too late and things are far too
  bad for pessimism.
  In such times as these, it is no failure to
  fall short of realizing all that we might dream
  the failure is to fall short of dreaming all that
  we might realize.

Dee Hock, 1999