Carole J. Bolster

If your staff won the lottery tomorrow, would they show up for work?

At a Glance
Successful healthcare organizations have many ways to motivate and inspire their employees:

  • Hire the right people. 
  • Communicate clearly and regularly to all employees. 
  • Encourage and support education and training. 
  • Reward and celebrate successes. 

What does it take to get your employees excited about their jobs? Money is a common benefit of working, but money isn't everything. Most people are happy to receive what they consider fair compensation for their job, but they also want other things. Those things can include recognition for a job well done, opportunities to learn and grow, a positive work environment, and a supportive team. HFMA research shows that, for healthcare financial managers, a key leadership challenge is to motivate and inspire employees. Keeping them energized about their job can improve morale, productivity, and teamwork while reducing turnover. The impact on the bottom line is positive.

Ways to motivate and inspire employees include getting the right team in place, communicating with them clearly and regularly, offering education opportunities, and recognizing and celebrating successes.

The Right Team

Senior executives generally agree that before they can inspire their staff to succeed, they need to have the right team in place.

"A basic premise for our organization is to hire the right people up front. If you hire the right people and if you do that properly, you enhance your chances for success," says Joseph Felkner, CFO at Baptist Health Care, based in Pensacola, Fla. Baptist Health Care employs more than 5,000 employees in 11 facilities.

"We do peer interviewing. Nobody gets hired at any level without interviewing with a group of peers. We also have standards of performance. Everybody who applies for employment at one of the Baptist facilities has to agree to follow the 10 standards of performance," Felkner adds.

David P. Cavell, CHFP, director of business office services at Chelsea Hospital, a 90-bed facility in Chelsea, Mich., also seeks his staff's input on hiring decisions. When a team leader position opened up, he asked every employee in that area for their thoughts about what was needed in the position. When he decided on the person for that position, the staff supported the decision because they were a part of the decision-making process.

"If you've got the wrong people on the team, they won't succeed under your leadership. It's critical that senior-level executives know their own style and the sort of team they need, or they set everybody up for failure," says MarieAnn North, director, Navigant Consulting, Inc., Charlotte, N.C. "Everybody needs the right environment in which to succeed, and executives need to know what environment they can create. You need to pick the right people who can succeed in that environment, because people will either thrive in it or really hate it."

There should be no ambiguity in the environment. The leader needs to continually provide stability, communication guidance, a plan, and feedback. North prefers a clear written work plan that designates responsibilities. Only significant issues, such as patient safety or losing a major payer contract, are allowed to affect the plan. When on temporary work assignments, North holds weekly brown bag lunches with her senior team to review the work plan. These forums allow the team to share ideas and information and help each other out to get the plan accomplished.

North also uses mentoring programs to motivate people. These programs need to be outside the evaluation system and with people who do not report directly to the mentor, because helping people grow sometimes means they grow into new jobs and new organizations, she said.

North cites three factors that affect employee motivation-compensation, what energizes a person in the job, and how the job fits in with the rest of the person's life. "I try to make sure that people on my team and people I mentor address those three areas in a way that ensures that when they make choices and sacrifices, they don't end up with regrets. You can't have it all, and those are very individual things," she says.

No Secrets, No Excuses

Baptist has a "no-secrets-and-no-excuses" culture. Communication is important throughout the organization. Every department has a communication board, which is organized around the organization's five pillars of excellence: people, quality, service, financial, and growth. Information posted on the communication boards includes the department's financial performance, statistics about department turnover, data from surveys on service or quality, and information about the organization as a whole.

Baptist also has adopted the daily lineup used by the Ritz-Carlton Hotel Company. The Baptist daily lineup is a 10-minute educational session held Monday through Friday for all employees throughout the organization. The sessions are held in each department or in small groups in large departments. Each day's topic is related to the week's theme, which in turn is related to one of the five pillars. The information presented might be about Baptist Health Care, the healthcare industry in general, or a specific approach to care delivery. Each session usually includes a motivational quote and perhaps a living tip of the day.

"The daily lineup is a 10-minute opportunity for departments to come together, learn a little nugget of something related to Baptist or health care, and build camaraderie. It's been a popular tool that we've used to motivate and inspire people," Felkner says.

North agrees that interaction, such as weekly informal meetings and some play time together, helps team members bond. A cohesive team that is loyal and supportive can help that staff get through the inevitable rough times, she says.

Catherine Jacobson, senior vice president, CFO, and treasurer at Rush University Medical Center in Chicago, says, "We've spent a lot of time at our organization in the last couple of years making sure that all of our employees know what our mission is in terms of where the emphasis is and the direction that we're heading. We've articulated our goals for the next five to 10 years, and we've articulated our values in terms of how we expect people to behave. We've made a big effort to get every employee versed in at least those three basic things-our mission, our vision, and our values. And we've made it incumbent upon our managers to understand how they relate a specific employee's job to where we're going overall."

Motivating and inspiring employees involves providing information about job expectations and feedback. "You should give more positive feedback than constructive feedback. We believe in a three-to-one or a four-to-one ratio. And you give positive feedback as soon as you can after the event occurred, but you also have to make sure that if you need improvement, you communicate that to the employees as well," said Jacobson. For example, a senior executive who reports to her had a goal of improving his public speaking ability. After he spoke to a group of almost 200 employees, and did well, she immediately sent him a message commending him.

Rush, a 613-bed teaching hospital with 8,170 employees, also conducts an employee survey three to four times a year. Some of the feedback received from employees has resulted in changes being implemented.

"It's dangerous to ask for feedback if you're not going to do anything about it. And certainly if you do do something about it, you need to communicate that to the employees, because not all of them may know why you're making that change," Jacobson says.

Reenergizing and Learning

Providing opportunities for professional development is another important motivator. "We want to continue to work on employee satisfaction. Our next step is to get our line managers better trained at communication, giving feedback, and writing performance evaluations. We're spending more time on manager training," Jacobson says.

"Getting staff out of the office and reenergizing them is not a luxury," North says. "It's a necessity. I encourage involvement in a professional organization not just for networking, but also for new knowledge. I think that's critical."

Leadership development is also an important part of the Baptist Health Care culture. Baptist has a formal leadership development program, which incorporates Baptist University. Baptist University offers a variety of programs, including some that are one day and others that are one or two hours. The managers go off site once a quarter to attend a daylong program at Baptist University and then teach their department staff what they learned. They call that "cascade learning."

All of Baptist's 600 managers are expected to complete 60 hours of continuing education each year. The daily lineup counts for 40 hours of that requirement; the managers can usually receive the remaining 20 hours through Baptist University programs.

Baptist also hosts quarterly employee forums. The forum is a one-hour educational program organized around the five pillars. In any given quarter, the forums will be offered 20 to 22 different times to accommodate all employees on all shifts. Topics cover such areas as the organization's quarterly financial achievement and employee satisfaction scores.

"The forums are an opportunity for employees to learn about everything that is happening within the organization and have an opportunity to speak with administrators or other senior executives in their specific entity," Felkner explains.

It's important to lead by example, says Jacobson. "If you expect your employees to work hard, you'd better be around," she says. "You also need to show your employees that you support them. If they make a mistake, stand behind them to correct it. Show that this is a team problem, and not just an individual's problem." 

Recognition, Rewards, Celebrations, Oh My

Denied claims are a pain point for healthcare financial managers, because denials mean delayed, and sometimes lost, revenue. To patient financial services staff, trying to resolve a challenging denial can seem hopeless. But some keep plugging away until they get the problematic claim paid. At Chelsea Community Hospital, one billing specialist persevered for two years until a troublesome denial was resolved and paid.

"I thought that deserved recognition. That's one thing we can give people that doesn't cost anything," says Chelsea's David Cavell.

So the Hopeless Award was born. The award is given every month to a business office employee who uses persistence and creativity to get a seemingly impossible denied claim paid. The winner is announced at a meeting and receives a $20 gift certificate for lunch at a local restaurant or a gas card. Cavell also gives a write-up about the award winner to the hospital's CFO to remind him that billers do more than send out bills.

"One recent award recipient had to make 14 contacts with an insurance company and the patient to finally get a claim resolved and paid. It's that kind of extra effort that makes things happen. Plus, by sharing the information, we all learn something about how to do better next time," Cavell says. "I like participatory democracy. I ask everybody for input on a variety of issues. I listen to everything they say, ask them questions, and then make a decision, so they feel like they participated and are part of the process."

Another way Cavell inspires his staff is to ask them for their "wild ideas" about what they would like to have in an ideal work situation. He believes such creativity helps bring about improvements. As a matter of fact, Cavell feels so strongly about creativity that he tells his employees it's OK to daydream for five or 10 minutes. "We're always reacting. We're always answering a phone or sending out a bill," he says, "but it's all right to sit back for a few minutes and just think about things. That generates ideas."

Cavell also likes to pilot new ideas with other departments. His department recently developed a model for ideal verification benefit information and implemented the model with the behavioral health areas in the hospital. The model worked well and generated positive feedback from the user departments. With the support of these departments, the business office works more efficiently. Revenue increases, and the back end is better off because of front-end improvements.

Cavell's strategy must be working, because for two years in a row his department has scored the highest in Chelsea's annual employee satisfaction survey (technically tied with two other departments for the top spot).

Baptist Health Care also has a reward and recognition program. "Our reward and recognition program is a very formal, well-developed process," Felkner says. "We encourage folks, especially at the manager level, to continually recognize people for achievements or for nice things that they've done. It can be an e-mail, a handwritten note, or a pat on the back. But recognition is very important."

The organization has a reward and recognition handbook that is used to help train managers on how to recognize employees. One recognition tool Baptist uses is a Wow certificate. When an employee does something nice, it is written up on the certificate, and the employee's manager presents the certificate to the employee. An employee who collects five Wow certificates receives a reward, such as a gift certificate.

"We also believe in celebrating, and we try to do that often. Our philosophy is that celebrating helps to build camaraderie among staff, enhances teamwork, and ties results to actions," Felkner says.

Another tool used to recognize Baptist employees is the Bright Ideas program, which is an employee suggestion program taken to the next level. Employees are asked for ideas on how to improve the business. Submitted ideas are logged into a database and sorted by pillar and then by leader and department. Employees receive a $1 coupon for the cafeteria for every idea submitted. The goal, however, is not just to submit an idea, but to get the ideas implemented. Prizes are awarded to employees who implement five or more ideas on an annual basis. Then the departments receive recognition if they achieve certain goals related to Bright Ideas. In addition, the names of employees who submit an idea are entered into a drawing. Prizes include gift certificates to local restaurants and department stores. Ideas should suggest a way to improve the business, but do not have to be related to the employee's specific job.

Two indicators of employee satisfaction used by Baptist Health Care are employee turnover and employee morale. Employee turnover at Baptist Health Care has dropped every year since 1997. Employee morale is measured by an outside firm that reports Baptist is in the mid-80 percent range for this indicator, compared with a norm of 40 percent to 60 percent for most organizations monitored by the firm. In addition, Baptist won the Malcolm Baldrige National Quality Award in 2003. You don't do that with dissatisfied employees, says Felkner.

Celebrating successes also is important at Rush University Medical Center. The celebrations include all employees. For instance, after receiving a three-year accreditation from the Joint Commission on Accreditation of Healthcare Organizations recently, Rush treated all employees to lunch.

Rush has recognition programs, such as Employee of the Quarter and Manager of the Quarter. Its Star Program provides an award every quarter to the employee who received the most positive compliments from patient feedback. The Star of the Year award is given to the employee who received the most positive compliments for the year. The recognition programs focus heavily on the impact to the patient, Jacobson says, because that impact aligns with the organization's corporate mission and vision, which are to support the patient.

Key motivators for senior executives are compensation and promotion. A senior team bonus based on organizational performance and individual contribution is critical, according to North. Additional motivators include recognizing people publicly for what they've contributed and giving them highly visible projects. That gives them visibility and allows them to take credit for their work. In addition, she says, you've got to treat the team right, whether it's a dinner out or saying thank you. Simply writing a thank-you note to someone who has gone above and beyond is an important motivator.

Road to Success

Motivating employees can pay off for healthcare organizations in terms of employee morale, teamwork, and lower staff turnover, which can lead to more efficient operations and higher patient satisfaction. Finding ways to motivate and inspire your employees can make the difference between an organization that is just surviving and one that is happily thriving.

Carole J. Bolster is a senior editor in HFMA's Westchester, Ill., office.

Publication Date: Monday, January 01, 2007

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