It is an axiom of business that employee engagement produces many positive results, no matter what the setting-manufacturing or service. This is true for healthcare as well. Employee engagement produces a better product or service. In healthcare, engaged employees produce enhanced patient outcomes. When employees are engaged there is less turnover, which reduces training costs. Engaged employees are problem solvers. These are just a few of the many benefits from engaging employees.
How can management engage employees at healthcare sites? A recent study by Manpower's Right Management emphasized providing opportunities for advancement and opportunities for development. In a survey of a wide variety of organizations it found that in settings where employees felt that there were career opportunities for them, 54% were engaged. In settings where employees felt that there job was a dead end, only 9% were engaged. The same study also showed that employees who had career opportunities were likely to stay much longer than employees who did not think they had good career opportunities. For the former only 5% said they planned to leave their organization in less than one year. For the latter, 22% said they were likely to leave within a year.
Let me share an example of a primary care site which has engaged an employee through development. This site has found that the percent of collections from billed charges has drastically fallen from 75% to 60% in the past year. The practice administrator suspects that there may be several factors which have led to this, including poorer coding and physicians seeing fewer patients. Wanting to be objective, she decided to "go and see" what the real causes are. She talks to several of the staff to get their point of view. She reviews a recent external audit of billing and coding. She finds after a thorough analysis that the primary cause is coding; the percent of collections and reimbursement from first time coding has slipped. She talks to her coders and finds that the new codes are causing problems. With a team of physicians and coders she decides that the best strategy to solve this problem is provide online training to her coders. The coders in turn will instruct the physicians on how to better detail the patient visit so that the coding will be more accurate. This approach soon solves the problem. The coders believe that have played an important part in serving the practice and feel engaged.
Another way to engage employees is to provide them ways to identify and solve problems. The best healthcare sites do this by borrowing from the Lean model of Toyota. For simple problems, such as organizing a storage area that is continually disorganized, making it harder to find needed supplies, the administration has instructed the staff how to quickly form teams to provide simple solutions that can be carried out quickly and cheaply. Other sites, alternatively, may solve its simpler problems by having regular voluntary team meetings of staff in a work area, such as staff of a lab, in which problems are identified and solved in one setting.
For larger problems administration can assemble a team of those affected and use the kaizen approach that Toyota champions. This problem solving approach is carried out over a longer period and is based upon the Plan-Do-Check-Act approach. Before applying the PDCA though, the problem is thoroughly explored by "going and seeing." A detailed analysis of the problem is presented to the kaizen team and agreement is reached that this is the real problem. By doing so, a good solution is much easier to achieve.
An example of using this kaizen approach to engage employees in problem solving is found in a primary care setting that is implementing an electronic health record. Since EHR's are so complicated and multifunctional, it makes good sense to form an implementation team at a site, perhaps one with a leader who is an expert trained in Lean approaches and team building, a consultant if necessary, so implementation is less disruptive as new processes are created to fully make use of the EHR. Sites using such teams see a drop of only 3% or so in patient flow in the short term as implementation proceeds and income actually increases in a very short time. One site team decided to focus on using electronic prescribing features of EHR's first in order to realize benefits right away, both in safety and in freed up time. EHR's virtually eliminate the problems created by handwritten prescriptions-errors in dosing and drug names. This function freed up time for staff who were taking calls for refills and transmitting them to the physicians, time which could be better used for patient care. Interaction of drugs problems were also avoided.
Another example of positive results from engaged employees is my experience with the staff of Baylor Hospital in Dallas, Texas. My mother had to have a pacemaker inserted at Baylor to help with her ventricle electrical pulses. The nursing and support staff worked to make my mother as comfortable and anxiety free as possible. I was able to view this close-up as her room had a pull out bed and I stayed with her for two nights. The nurses were timely in their care and answered our questions with excellent detail. They demonstrated that the quality of her care was of utmost importance to them. They were obviously fully engaged. In fact, the Health Grades web site ranked them as providing excellent care overall.
I hope it is evident that engaged staff can provide superior quality for patients and dramatically improve the bottom line. Engaging staff by providing educational opportunities, by offering opportunities for advancement and by involving them in problem solving are just three ways to make good use of staff abilities. If such benefits are clear why aren't more healthcare sites making use of this approach? I believe one of the reasons lies in the inability of management to let go of the control they have, to trust in the abilities of their staff. I recall just such an occasion with one physician recently. The staff nurse was complaining to me that the office would run much more smoothly if the physician did not try to micromanage every detail and let the staff do its job.
As you can see staff engagement is a Win-Win for all, even though such a transition may be difficult for some management. Taking a gradual approach to integrating staff engagement as a policy at your site will be beneficial to staff, patients and management.
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