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Health care reform starts with hospital leadership

August 17, 2009

Guest Column: Elaine Berke

OPINION Providence Business News

Seemingly absent from the health care reform conversation is the effectiveness of hospital leadership. With mandated and costly reporting of patient satisfaction requir-ed so that patients can compare medical and service performance, few hospital-management teams have created a detailed and effective strategy to improve patient satisfaction.

In patient survey results, the single most telltale question, “Would you definitely recommend the hospital to family and friends,” typically receives the lowest scores. In focus groups and interviews we conducted with hundreds of employees, managers, physicians and executives to understand the causes of low scores, the issues expressed point to outdated management practices within the hospital, specifically lack of accountability, professionalism and employee engagement.

Staff negativity is reported as the single most distressing issue that employees and managers face on the job every day. A limiting dynamic is the rationalization of negativity and belief that patient satisfaction scores in the 60th percentile are good enough.

The reasons against change are plentiful. For example, managers say keeping a negative employee is better than having to do more work as a result of a vacancy or training someone new, even in the current employment environment. Confronting the negative employee is seen as an invitation for retribution. Rarely are negative employees fired for poor attitudes or performance. Yet, employees say they witness a lack of respect from other employees toward patients, nurses or co-workers every day.

Hospital leadership and how employees are engaged must be brought into the discussion of reform. These issues present an untapped opportunity for innovative hospitals to stand out among the competition and become profitable, productive and positive places to work. For starters, it costs nothing to have hospital executives, vice presidents, directors and managers become visible and involved leaders communicating the vision and message to influence positive change, but it requires work.

It’s the absence of leadership that allows negativity and conflict to undermine performance standards and attitudes. Hospital leaders must replace simplistic slogans and gimmicks with a process for accountability, involvement and detailed plans to improve patient experience at each department level. These basic comments from employees in focus groups are worth considering:

Professionalism is needed with patients from staff, physicians and co-workers.

Customers need to see a smile from staff right away.

Too many employees have an attitude that brings down others’ spirits.

People join in with negativity rather than stand out by being positive.

Information and explanation are not shared by managers.

More thank yous from managers — managers ought to lend a hand vs. dictate.

Managers shut down new ideas and involvement.

Charge nurses who are negative should not be paid at a higher amount.

Executive leaders should be visible and sincere — don’t sit with each other at functions.

Executive leaders should show more human touch — say hello in the halls.

Physicians shouldn’t “fight” with patients.

Get rid of the deadwood.

The conversation of health care reform must start with hospital leadership. Hospitals invest millions in infrastructure and patient surveys to stay accredited, yet investment in employee training, tools and leadership is slim. Perhaps in the context of reform, it’s time for hospitals to upgrade the investment in human capital, its role in delivering a quality health care experience for patients, and the opportunity it presents for greater cost savings.

Elaine Berke is the founder of EBI Consulting Inc. in Westport, Mass., a firm focused on creating customer loyalty, leadership accountability and employee engagement.

EBI Consulting, Inc.
Westport, MA 02790
T: 508-636-5656
F: 506-636-4171

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