Increasing Medical Practice Team Commitment: Twenty-Five Strategies

Commitment is the center of many relationships, including your employees’ relationship with your medical practice and with you. If your employees have a high level of commitment, they will trust you and be loyal to you. They will look for and see the good in you and willingly provide their time, energy, hard work, and talent to help you and your practice succeed. With team member commitment, everything is possible.

The quality and depth of team member commitment is a critical factor in team success.

Conversely, when employee commitment levels are low, team members are likely to become cynical and to stop caring.(1) They may go through the motions every day, but they won’t excel. Often, they will look for the flaws and faults both in your practice and in your leadership, and most assuredly, they will find them. They will stop expending energy to help you and one another. And ultimately, they may become the dead wood in your practice, or seek employment elsewhere.

The quality and depth of team member commitment is, therefore, a critical factor in team success. Fortunately, the medical practice manager can use a number of tools to assess, foster, and increase employee commitment.

What is Commitment?

Some experts define commitment as both a willingness to persist in a course of action and reluctance to change plans, often owing to a sense of obligation to stay the course. According to Vance,(2) “Commitment manifests itself in distinct behavior. For example, people devote time and energy to fulfill their on-the-job responsibilities, as well as their family, personal, community, and spiritual obligations.” Commitment also has an emotional component, Vance says. People usually express positive feelings toward an individual, organization, or cause to whom they have made a commitment. Finally, commitment has a rational component. As Vance explains, “Most people consciously decide to make commitments. Then they thoughtfully plan and carry out the actions required to fulfill them.”(2)

Because commitments require an investment of time as well as mental and emotional energy, most people make them with the expectation of reciprocation. That is, they assume that in exchange for their commitment, they will get something of value in return, such as favors, affection, gifts, attention, goods, money, or property. In the medical practice, employees and employers have traditionally made a tacit agreement: in exchange for the employee’s commitment, the medical practice will provide forms of value for its employees such as skill training, secure jobs, fair compensation, bonuses, and opportunities for career advancement. Reciprocity affects the intensity of an employee’s commitment. As Vance suggests, “When an employer to whom an employee has made a commitment fails to come through with the expected exchange, the commitment erodes.”(2) Under such circumstances commitments are likely to weaken very quickly. This can be observed easily, for instance, when an organization goes through cutbacks and downsizing. Once-committed employees who believe that their employer has changed the deal and let them down often feel betrayed and put in less effort—or look for employment elsewhere.

Assessing Team Member Commitment

It is relatively easy to get compliance but often difficult to obtain a commitment from employees. Yet employee commitment is far more important to your medical practice team’s long-term performance. As Beck(3) suggests, “When someone is compliant, they simply obey—doing what is asked of them, but no more. Typically, they’re doing just enough to keep their job.” Conversely, Beck suggests, when an employee is committed, he or she will spend time and effort “outside of normal business hours thinking about work and solving problems, finding better ways to get the job done, seeking out new insights, and then acting on them.”

When assessing employee performance, it is not sufficient to look at their compliance with rules and your direction, but also at their commitment.

Therefore, when assessing employee performance, it is not sufficient to look at their compliance with rules and your direction, but also at their commitment. That means that you will need to consider what employees say and do, but also what they don’t say and don’t do. The following questions will help you assess team member commitment. Does the employee:

• Go above and beyond minimal job expectations?

• Demonstrate through actions a willingness to put others before him- or herself?

• Volunteer to do more when the practice hits a rough spot?

• Show consistency between what he or she says and his or her body language?

• Suggest new and better ways to do things that will benefit others?

• Come to you with suggestions that he or she developed on his or her own time, outside of usual work hours?

• Speak positively about the practice when he or she thinks you’re not listening?

• Maintain a high-quality work level when he or she thinks you’re not observing?

• Genuinely and wholeheartedly celebrate the success of the practice and of other employees?

• Become excited by new opportunities that will improve the medical practice?

If you were able to answer these questions with “yes,” the employee is likely to have a high level of commitment. However, if you’re not sure of a team member’s level of commitment, or if you know that it is low, it’s best to have a one-on-one conversation with him or her to learn more. The sidebar, “Discussing Commitment with Your Employees” offers a list of questions to help guide your conversation.

Inspiring Commitment in Others through Your Leadership

Inspiring, creating, and nurturing employee commitment is possible when medical practice managers practice and master a few key leadership activities. Rogers(4) has developed a four-part “roadmap” to inspiring commitment through leadership:

1. Care. Team members who know that you care for them are likely to return the favor with greater commitment to your vision. On the other hand, if your employees don’t feel that you care about them, they probably won’t care much either. Therefore, openly demonstrate your caring attitude to your employees at every level. Tell them that you care, too, and when you do, say it thoughtfully. Make sure that your employees know that you’re not just giving them lip service, but that you mean what you say.

2. Create ownership. You can enhance employee commitment if your team members believe that your vision is also their vision. Give team members a say in how the work should be accomplished, and explain how and why each team member’s role is essential.

3. Ensure security. Team members will be more willing to commit to you and your medical practice when they feel secure. For example, if your team members know that you won’t punish them for taking prudent risks, they will more freely give the talent, time, and effort it takes to get the job done. On the other hand, if your team members know or suspect that you will punish them for making reasonable errors, they will be likely to hold back and they may not give you 100% of their effort.

4. Practice accountability for everyone, including you. Team member commitment and accountability are closely related. Make sure that each employee in your practice knows that he or she will be held to a certain level of accountability. A culture of accountability encourages teamwork, reciprocity, and a willingness to cover for each other, Rogers says.

You can also inspire commitment in others by demonstrating your own commitment. See the sidebar, “The Five Commitments of Leadership” to learn what great leaders are committed to.

Twenty-Five Strategies to Increase Employee Commitment

Your employees will be committed to you and your practice when you create a positive, nurturing work environment that is worthy of their commitment. Here are 25 strategies for making that happen:

1. Study employee retention. Employees who leave by choice to work in another medical practice or in another industry may be able to help you diagnose a management problem that weakens or interferes with employee commitment. Conduct exit surveys with your departing employees to learn both what you do well and what you can do better.

2. Clarify and communicate your mission. Committed employees feel that they are part of something larger and greater than themselves. Dessler(5) suggests that you create a shared mission and ideology that lays out a basic way of thinking and doing things in your practice. He also suggests that you can create “charisma” for your medical practice by linking your mission to a higher calling.

3. Use values-based hiring practices. In many organizations, the process of linking employees to the organization’s ideology begins before the employee is hired. Values-based employers first clarify what their basic values are. Then they create and enforce procedures for screening new employees, requiring evidence from job applicants of their commitment to the organization’s values. They also reject applicants who do not demonstrate those shared values. As Dessler suggests, “Value-based hiring screens out those who might not fit.”(5)

4. Stress values-based training. Steeping new and current employees in the practice’s values and culture will also foster their commitment.

5. Commit to people-first values. Treating your employees as important and demonstrating that you respect them will contribute to their commitment. Employee commitment will also increase in practices that put patients first.

6. Build your tradition. Tradition-building symbols, stories, rites, and ceremonies can further enhance employee commitment. For specific ideas about how you can build and promote rituals in your medical practice, see my article, “Using Rituals to Strengthen Your Medical Practice Team” in the September/October 2015 issue of this journal.

7. Promote organizational justice. As Dessler(5) explains, organizational justice is linked to employee commitment. Organizational justice is simply the extent to which fair procedures and processes are perceived to be in place and followed. It also includes the extent to which employees see their leaders as being fair and sincere and having logic or rationale for what they do. Fair procedures embodied in formal grievance procedures are one obvious source of organizational justice. Involving employees in decisions that affect them is another.

8. Create a sense of community. A sense of community contributes to creating commitment among the community members, who typically develop a “we” attitude, as though they are a family or tribe. Frequent group meetings and regularized contact can enhance your employees’ sense of community.(5)

9. Clearly define responsibilities. Each position in your medical practice should have a formal job description. Make sure your team members know up front to whom they report, what kinds of decisions they are allowed to make, and what is expected of them each day. Without these essentials in place, it will be hard for you to earn employee commitment.

10. Seek proper training. Medical practice managers should receive training both in management and in people skills. Employees often lack commitment to an organization because of a poor relationship with their boss, not because of the organization. The medical practice manager should be at the top of his or her managerial game.

11. Map out career plans. Team members will be more likely to commit to a medical practice when they feel that there is a career path carved out for them. Make career planning a regular part of your performance review process.

12. Conduct employee satisfaction surveys. Ask your team members what they want more of in their positions, and what they want less of. Then do what you can to show them that you are listening to them, even if you can’t accommodate their requests.

13. Enrich and empower. Increasing the breadth of responsibility and self-management in a job can appeal to your employees’ higher-level needs.(5) Empowering your employees in these ways will foster their commitment, Dessler suggest.

14. Promote from within. Employee commitment can soar when team members believe that the medical practice will provide opportunities for them to earn increasingly higher-level positions and pay.

15. Encourage upward evaluations. Medical practice managers who truly want their employees to give them ideas for making productivity improvements will be open to their suggestions. They will ask their employees to tell them how they can do their jobs better and how they can make their employees’ work lives more effective. When team members see that their managers are willing to improve themselves in this way, they will realize that the practice culture respects them and values their ideas. This strategy will enhance their commitment both to the manager and the practice.

16. Provide fair and competitive salaries. Below-market wages will not foster employee commitment, but, rather, will encourage team members to look elsewhere for employment. Stay up to date on what other medical practices in your area are paying for similar work and be competitive.

17. Create an effective employee orientation program. New employees will feel a stronger commitment to you and your practice if you demonstrate your interest in their success from the start. Start strong. Once you get off on the wrong foot, it will be difficult to turn things around.

18. Be forthright with news. Keep your team members informed of any changes that you must make. Let them hear good and bad news from you first.

19. Create learning opportunities. Developmental activities such as workshops and conferences enhance employees’ opportunities for promotion from within, appeal to their desire to grow and learn, provide opportunities for lateral moves, and give them a chance to grow both personally and professionally. Employees interested in advancement will certainly want to learn new things and create value in their position. Provide those opportunities with either internal or external education, sponsored by your medical practice. Make professional development a part of your regular employee review process.

20. Offer competitive benefits. Team members will be more committed to you and your practice if they feel that you’re taking good care of them and their families.

21. Provide tools. Employees need equipment and supplies to do their jobs well. Employers who get behind on technology and best practices or that provide insufficient resources often thwart employee commitment. After all, if an employer is not worried about giving employees the tools they need to do their jobs, why should they feel committed?

22. Listen. Your employees want to know that their voices and opinions are heard. Medical practices that listen actively are often rewarded with employee commitment and higher productivity.

23. Ask employees to verbalize their commitment. Words can be very powerful. Ask your employees to speak their commitment to your mission and vision, to their colleagues, and to providing the best healthcare possible for every patient.

24. Get employees involved in something they truly enjoy. Look for projects that engage your employees and that have wider implication and benefits for your medical practice community. Provide opportunities for your team members to be creative and to exercise their talents.

25. Reinforce employee commitment. For example, hold ceremonies to recognize outstanding employee commitment. Give your team members years-of-service certificates or pins, especially for milestone employment anniversaries. Or put the number of years an employee has worked in your practice on his or her nametag, for all to see every day.

References

1. Eaton R. Why commitment matters so much to leaders and teams. Bizcel. July 15, 2014; http://bizxcel.com/blog-post/why-commitment-matters-so-much-leaders-and-teams. Accessed September 17, 2015.

2. Vance RJ. Employee Engagement and Commitment: A Guide to Understanding, Measuring, and Increasing Engagement in Your Organization. Online Report: SHRM Foundation’s Effective Practice Guidelines. Society for Human Resources Management. www.shrm.org/about/foundation/research/Documents/1006EmployeeEngagementOnlineReport.pdf . Accessed September 17, 2014.

3. Beck M. Compliance vs. commitment. Eliciting Excellence. March 11, 2014; www.michaeljbeck.com/leadership/4784 . Accessed September 17, 2015.

4. Rogers JR. Enabling others to act—inspiring commitment. The Leadership Challenge. www.leadershipchallenge.com/resource/enabling-others-to-act-inspiring-commitment-.aspx . Accessed September 28, 2015.

5. Dessler G. How to earn your employees’ commitment. June 1999. Academy of Management Perspectives. 1999;13(2):58-67. www.wku.edu/cebs/doctorate/documents/readings/dessler_1999_employee_commitment.pdf . Accessed September 29, 2015.

Discussing Commitment with Your Employees

Below is a list of questions to ask an employee whose commitment level to your practice is low or unclear. It’s best to carry on such a conversation in private and in a helpful, nonthreatening way. Encourage the employee to answer you honestly and to open up about his or her feelings. Through a free give-and-take, you may be able to uncover reasons for the employee’s lack of commitment and to turn things around.

When you speak with the employee, ask: “Do you feel that . . .

• You want to participate on our medical practice team?

• You have/had a choice about working in our practice or with our team?

• You have input about our direction, goals, and choices?

• Our mission is important?

• You’re part of something that is bigger than yourself?

• Your work is valuable to our practice?

• You make a difference?

• Our practice does a great service to our patients?

• What you are doing now will help you with your long-term career?

• You are growing professionally because of this job?

• You would stay with our practice even if you were offered a comparable position and similar pay and benefits at another practice?

• You have a good and important use for your discretionary time and effort at work?

• Our practice is the right place for you?

• You are proud of our medical practice and the work you do here?

• You would recommend our medical practice as a place to work?

• You are recognized for your achievements?

• Our medical practice and its leaders are committed to you?

• Our practice inspires you to do your best work?

The Five Commitments of Leadership

Employees know that there is a huge distinction between what a leader says about commitment and what he or she actually does. As Leheney(1) suggests, the concept of a commitment means that it shows up in a leader’s actions, not just in his or her words. This can be the difference between the “talk” and the “walk,” Leneney suggests, citing five commitments every leader must make:

1. Self: Leaders need to learn about and know themselves first. And with this knowledge, Leneney says, commitment can follow. For example, a self-committed leader does not dictate strategy, but, rather, explains his or her thought process and requests feedback. Self-learning can happen this way because blind spots, oversights, and faulty assumptions can surface, Leheney says. Additionally, a leader who asks for feedback demonstrates that he or she does not think he or she always has all of the answers. A self-committed leader checks his or her ego at the door and is interested in other opinions, Leheney explains. He or she is committed to his or her own development and therefore is humble enough to learn from others.

2. People: When employees see leaders focusing only on a task, output, or goal, they can feel as though they are no more respected than machines in a factory. However, people want to know their contributions are valued. No one ever thanks a machine, Leheney says. Therefore, the committed leader responds by saying *thank you *and by doing more. There are several strategies you can use, Leheney says. For example, you can help your employees learn new skills to further careers and their importance to your medical practice. Or you can recognize a team member’s willingness to help and acknowledge how he or she has made a difference. As well, a genuine display of empathy can be a welcome outreach to those looking for signs that a leader respects their work, Leheney suggests.

3. Organization: A committed leader finds meaning, value, and purpose in the organization and then shares that commitment with everyone else. Anything less than a total commitment to the practice and its mission is likely to be picked up by sensitive employee antennae, Leheney warns. This, in turn, could easily hamper or weaken a leader’s effectiveness.

4. Truth: Commitment to the truth is perhaps the most difficult of all the commitments because it requires up-front honesty, Leheney suggests. Any attempt to sanitize reality through spin or less-than-forthright assessments could permanently damage your credibility and erode any possibility of trust. That is why Leheney suggests, “Anything less than the truth from leadership is unsustainable.”

5. Leadership: A committed leader is committed to leading, more so than to him- or herself. Such leaders are incredibly ambitious, Leheney says, but their ambition is first and foremost to their organization and its mission, not to themselves. In fact, leadership-committed leaders often display surprising humility and don’t let their egos get in the way of their effectiveness, Leheney says.

Reference

1. Leheney M. The five commitments of leadership. BA Times for Business Analysts. July 21, 2009; www.batimes.com/articles/the-five-commitments-of-leadership.html .

Four Drivers of Employee Commitment

Employees will commit to you and to your practice for different reasons. That is why you need to observe each employee and listen carefully to that employee to increase his or her commitment. According to Beck,(1) there are four possible drivers of employee commitment:

• Intrinsic motivation: Employees who commit are already self-motivated individuals, or they must at the very least have the capacity for self-motivation, Beck suggests. Therefore, you may not be able to increase an employee’s commitment to your practice if he or she is overwhelmed by the other commitments in his or her life or if he or she lacks self-motivation. Assess whether the employee’s commitment is within your control. If not, that employee may not be a good fit to your practice and be better off elsewhere, Beck says.

• Leadership: Some employees will find it easier to commit to individuals rather than to the organizations that employ them. Such employees will likely pledge their allegiance to a practice manager they admire, like, and respect. Likewise, Beck suggests, a motivated and committed employee will soon become unhappy, and his or her commitment will deteriorate, if he or she believes that the practice manager is untrustworthy, whether or not that is true.

• Organizational culture: An organization that claims certain core values but acts in ways that clearly demonstrate that those values don’t matter soon causes widespread disillusionment and disengagement, Beck says. As well, when an organization tolerates bad behavior, it demonstrates a lack of integrity. This, in turn, leads to a loss of trust in, respect for, and commitment to the organization, Beck says.

• Initiatives: An organization’s new initiative taken without a reason is simply a goal, Beck warns. And goals without purpose are “cold, unemotional targets, lacking any purpose other than to make the person who set the goals look good,” Beck says. Employees become more committed when they believe in what they’re doing and when they believe that they are making a difference through their work. Therefore, projects and goals require employee buy-in. Your team members, therefore, need to know the why, not just the what, Beck suggests.

Reference

1. Beck M. Compliance vs. commitment. Eliciting Excellence. March 11, 2014; www.michaeljbeck.com/leadership/4784 . Accessed September 17, 2015.