Creating the Ideal Healthcare Organization: The Importance of Involvement

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jim murphyWe compiled a list of the ten key attributes of the ideal healthcare organization.  The first concerned organizational mission, vision, ethics and values. The second was that “employees are treated and compensated fairly and receive great benefits.”  The third was about programs, policies, roles and responsibilities, and the fourth on the role of diversity.

The fifth characteristic of the ideal healthcare organization is that “everyone is involved, is engaged, can express their thoughts, and shares in power and decision-making.”  This may be the most important, as well as the hardest to achieve.  Although employee engagement is a mantra these days, studies show that the reality is that it is not the norm.  The Gallup poll shows that current levels of employee engagement are at an all-time high – with just one-third reporting themselves as in that category!   

Researchers cite proof that employee engagement can improve healthcare quality and increase financial returns.  Gallup reports that when hospital employees are engaged patient safety – certainly one the top concerns of healthcare leaders these days – is better.  Yet in their success case study put the level of engagement was 70 percent, admittedly much higher than the average workplace, but still leaving a large fraction of employees unengaged.  (Imagine a hospital with a 70 percent success rate in operations!)

Surely the ideal healthcare organization would have 100 percent employee engagement.  Everyone in the organization should be fully cognizant of, enthusiastic about, and capable of the mission, the work and the service.  Nor is such a state actually impossible if there is the right leadership and organizational culture.

A key requirement is that management needs to listen to employees.  Surveys can be can one way to do that but should not be the sole method.  Just as annual review of employee performance is no substitute for what managers should be doing with employees every day, so an occasional survey regarding  employee engagement cannot provide the information that leaders need to have at all times.

And for leaders to be successful in promoting engagement the organizational culture must allow employees to say exactly what they think.  The Challenger launch decision is the classic example of what happens when people do not have such freedom.  In particular, patient safety depends upon the ability of healthcare employees to speak up – e.g., a nurse to a doctor or an attendant to a nurse.

For employees to feel safe in expressing their thoughts they must trust co-workers and management.  Trust is perhaps the most important ingredient of a good organizational culture. But employees also need to know what they say will have effect.  The ideal organization thus has to involve all employees in decision-making.  Organizations in which communication and influence are exclusively top-down are bound to fail.

Traditional methods of engaging employees, such as recognition programs and economic incentives, will not do the job and can even be counterproductive.   In particular, there can be no engagement without empowerment.

Employee engagement is a matter for all in the organization.  CEO’s and other leaders must model and promote involvement. Their awareness of what employees are doing and thinking cannot come just from reports and surveys: they need to be talking with everyone in the organization and creating forums in which organizational matters can be discussed and decided by all.

Unit managers, being in the middle, may have a particularly difficult role. They must encourage employees and communicate upward their needs for engagement. 

Individual contributors – doctors, nurses, technicians, attendants, and so on – must monitor their own behavior regarding engagement and colleagues’ behavior in the interest of promoting it.  They also need to practice self-empowerment.

Even patients have a role in engagement.  They can empower themselves regarding their care and will find that being engaging themselves will foster engagement in care givers.

Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Being semi-retired, Jim is willing to provide very reasonably priced consulting, coaching or  project work for organizations aspiring to improvement in organizational culture, effectiveness and employee engagement.

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.


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3 Responses to Creating the Ideal Healthcare Organization: The Importance of Involvement

  1. Anonymous says:

    Unfortunately, this was not the case in the hospital I used to work for and I eventually suffered the consequences when I tried to bring up a very serious issue. The management style was basically a dictatorship and decisions were made without our input, hence morale was very low. The staff was not supported and any suggestions fell on deaf ears. I whole heartedly agree with this article and I hope to find a position in a facility that implements these important factors. I strongly believe working as a team is what it’s all about–regardless of whether you’re a staff nurse or a manager!

  2. Beth Boynton, RN, MS says:

    Thanks for such a well-written and researched post, Jim. This point about employee engagement can not be overstated and I think taps into one of the biggest problems we are facing in healthcare today. Staff don’t feel respected, heard, or valued. This manifests in workplace violence, medical errors, burnout, and poor patient experience. The hierarchy, as it is, is failing. I think we need the hierarchy for clinical decision-making and related use of expertise, but not for egos, power, or anything else. Collaborative leaders who understand this and support staff to bring their best to the table will be making a huge contribution to creating the ideal healthcare organization! Yesterday’s post by surgeon and author, Starla Fitch shares a wonderful example of integrating roles of being in charge and collaborating as does the post about ED doc Tony Salerno. Links:

    Starla’s post: “How to Turn Around a Very Bad, No Good Day!

    “Hi, I’m Dr. Salerno, but please call me Tony”.

What are your thoughts?