Imagining the Ideal Organization in Healthcare – Part VI: Eight “Untraditional” Attributes

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By Jim Murphy and Beth Boynton

This continues our series on imagining the ideal organization in healthcare.  We’ve compiled these in various ways, some based on fairly well known sources of what makes for a great organization and some adapting ideas that were more specific into ones of more general organizational application.  Not only do we hope to generate thought and discussion, but are very interested in publishing success stories.  (Write to, )

This installment is one of the latter. It is taken from an interesting article on “8 Untraditional Ways to Retain the Best and Brightest in Healthcare” by Gary George, Senior Vice President of Human Resources, Mercy Northern Region.  Our thinking is that policies that foster retention should be attributes of the best organizations.

1.  Provide a living wage.

In healthcare, some occupations (laundry work, for example) have traditionally been compensated at a minimum wage.  George correctly argues that setting a higher wage will reduce turnover.  People who fill these positions are often dealing with hazardous waste, stressful dynamics, and conflicting direction from various healthcare professionals who are in charge of different aspects of patient care.  In addition, they must be vigilant about following infection control protocols that may be high stakes for patients and themselves.  Isn’t this worth a little more?

But one can push this argument further.  The same reasoning regarding retention could be used to justify increasing nurses’ pay.  In the ideal organization, should not everyone receive a wage that they themselves think is fair?

2.  Survey employee engagement, not just satisfaction.

In healthcare, employee satisfaction surveys are not uncommon.  The author suggests that the survey focus should be on how engaged the employees are, based on the quite correct belief that engagement drives satisfaction.  Engagement is vital for positive work culture, collaborative problem solving, patient experience, and safe and cost-effective care.

But, as has been pointed out in this blog, surveys can have other purposes.  They can generate questioning and thinking about how close the organization is to the ideal.  If leaders demonstrate that employee feedback is respected it will automatically increase engagement.  Not by granting every wish, but considering them, validating them, and trying out feasible new ideas.

3.  Peer interview new hires

In healthcare, the technical qualifications for most positions are demanding and naturally are highly emphasized.  But people skills can be equally important in ensuring quality service and patient satisfaction, and considering such factors in evaluating candidates has been held necessary for making best choices.

Panel interviewing can be complicated but offers a good away to assess candidates’ people skills. Moreover, involvement of employees in the selection process is a strong way to have them engaged; Semco’s policy of allowing employees to choose their supervisor may be rarely followed but it is a powerful method.

4. Hold high-performance conversations

In healthcare, annual reviews are commonly conducted, though their abolition has been called for.  George maintains that these should be “conversations” about performance; he also recommends that more attention be given to high performers.  Elements of leadership coaching and opportunities for advanced clinical training can help direct energy and enthusiasm for continued career development and have a rippling effect on care provided throughout the facility.

It has been estimated that managers (good ones, at least) spend more than half their time in workplace conversations.  In an ideal organization, these might arise naturally, with no formal structure needed; but in the meantime, anything that can be done to promote discussion and inquiry in the organization will be beneficial.  “How did that conflict with the nurse manager go last week? Have you had a chance to read that paper on XYZ clinical trials? What did you think?”

5. Reform or eliminate low performers.

In healthcare, patient experience surveys are the latest tool being used to identify and improve low performing employees.  The author points out that high performers are demotivated by toleration of bad performers.  It can be very frustrating to work side by side with someone who doesn’t seem to care or lacks skills to complete goals. Although a highly functioning team can tolerate occasional dips in performance by members and provide support, members who are chronic low performers drain the team of enthusiasm and valuable time.  After a while, the lack of enthusiasm or low standard of care can be contagious.

In an ideal organization, low performance might not exist.  With that goal before us, performance improvement should be obtained by methods that are consistent with the characteristics of the ideal organization, such as honesty and empathy.

6. Perform weekly rounding on units

In healthcare, “making the rounds” is a venerable tradition, one which has been extended from doctors to nurses and even pharmacists, not to mention robots.  Hospital managers should also make rounds, George says.  Build a relationship with staff, be willing to learn what their ideas and challenges are.  Help when you can and set limits when you need to. These are the keys to collaborative leadership.

The lesson here is that more involvement and more conversations can make for a better organization.  The ideal health organization might promote the idea of every employee “making the rounds” and would use tools such as medical improv to connect people in a way that stimulates new thinking.This combination of positive relationship and co-creative problem solving will not only generate new ideas, but a genuine investment in making strategies work.

7. Use thank-you notes

George reports that Mercy Hospital leaders send hand-written letters of thanks to employees, delivered to their homes so that their families can share in the recognition.  Each describes the particular good action felt worthy of reward – certainly a better technique than the commercial variety of similar products that are widely advertised.

Employee recognition is certainly called for even in an ideal organization.  Quite possibly, home-sent notes could be combined with the various forms of on the job rewards;  using every method rather one specific type certainly is the way to make sure that all the diverse people in the organization get the form of recognition that is best appreciated by them.

8.  Consider the emotional demands on employees

Of all industries, healthcare ought to be the one most aware of stress; yet studies show its workface to be considerably more stressed than the norm.  The author notes the advisability of in-house employee assistance programs.  Adding this awareness to your rounds or workplace conversations will enhance engagement, foster empathy, and ultimately improve patient experience.  “How are you doing with all the departmental changes?  I know this must be a challenging time.  Is there anything I/we can do to help?”

An ideal organization is ready to help employees in any way that is needed.  Such a workplace recognizes the need to understand and deal with emotions in the workplace.

So, once again, a pretty good list! No doubt anyone reading this post will feel that they would like to see all eight of these policies in their organization.  But can anyone provide us with examples of healthcare organizations that actually do these things?  We would love to promote you/them!

Jim murphyJim 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.      BB closer Headshot 1-13 Cherations


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.



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