Keeping Engagement in Times of Change

Twice a day, Michael Weiss, DO, FAAP, leaves his office to interact with some of the 50 hospital employees he oversees in his division.

“Leadership, I think, is very personal. One can lead on a very personal level to keep people engaged,” says Weiss, vice president of population health at CHOC Children’s — the Children’s Hospital of Orange County in Orange, California — and a past president of the American Academy of Pediatrics’ local chapter.

This type of “rounding” for 10 to 15 minutes at a time is personal, he observes. It “can convey your energy and your excitement” about promoting healthy living and communities. Cultivating great listening skills in the process enables a leader to “have a good finger on the pulse” of employees’ varied values. And it empowers individuals to feel their contributions matter — that they’re not “just one little cog in a machine.”

In essence, effective leaders inspire people to become intrinsically linked to an organization’s growth and well-being. They excel beyond doling out directions.

But how do leaders maintain that high level of engagement in the radically changing realm of health care? How do they ignite or revive the energy and commitment of their staffs? And how do they keep others calm and focused on the tasks at hand without losing sight of the broader picture?

Being Visible and Accessible

Proximity, humility and purpose are significant drivers of successful leadership, says Derek Feeley, president and CEO of the Institute for Healthcare Improvement, a Boston, Massachusetts-based international organization.

“The leader needs to be visible and accessible,” he says. Instead of summoning people to your office, “you need to be present at the point of care, where the work is being done.”

Once they’re on site, leaders often make the unintended mistake of mapping out solutions too swiftly. “Go to ask questions,” says Feeley, who previously was chief executive of the National Health Service in Scotland. “Don’t go thinking that you’ve got all the answers.”

In coffee rooms and cafeterias, employees tend to divulge information they may be reluctant to disclose in formal meetings. There, he says, “you can really get ideas and a true sense of what’s going on.”

Connecting people to purpose is essential. Leaders should “be constantly reminding people why we’re doing what we’re doing,” Feeley says. “Why is it important that we are all engaged in this change? Why are we here to do this work?”

Referencing back to what really matters, leaders ultimately are accountable for reinforcing the health system’s mission of caring for patients.

Setting an Example

While “we’re all here working together for the same purpose,” the leader should set an example others would want to emulate, says Roberta E. Gebhard, DO, president-elect of the American Medical Women’s Association and co-chairwoman of its gender-equity task force.

A few years ago, she headed a family health center in western New York when its medical director took a sabbatical for a couple of months. She focused on team-building while nurturing a supportive environment for the staff.

“I wouldn’t ask them to do anything I wouldn’t do myself,” says Gebhard, a primary care physician. When an employee had to take time off, the office lacked a filing clerk for about two months. Gebhard stayed after clinic hours to file patient records, and her staff followed suit.

She made coffee in the morning, and if her employees had to work through lunch, she ordered food for all. When the medical director returned from his sabbatical, “he was completely shocked at the different office that he came back to,” Gebhard recalls. His reaction was: “You’ve been able to do more in the past couple of months than I was able to do in eight years. What did you do differently?”

Showing Appreciation to the Staff

Including not only physician colleagues, but also front-line staff members, in fielding suggestions for improvement fosters an atmosphere in which people feel valued regardless of their role, says Robin Zon, MD, FACP, FASCO, president and CEO of Michiana Hematology Oncology in Mishawaka, Indiana. At the independent community oncology group, which has eight sites in northern Indiana, she leads 13 other physicians, eight nurse practitioners, and a 160-person clinical office staff.

“Staff feel appreciated as team members, especially when their leaders take interest in them as people, not just as a nurse or a medical assistant,” says Zon, a past chair of the American Society of Clinical Oncology’s Government Relations Committee.

They are encouraged to identify problems and propose solutions both anonymously and in team meetings. Offering an alternative approach is regarded just as important as voicing a concern, she says.

In one case, a research nurse noticed a lack of diversity among the participant pool enrolled by the practice in a national clinical trial investigating the impact of diet on prostate cancer. To strike a better balance, the nurse visited local churches and recruited participants with diversity in mind. “She successfully developed and implemented the strategy,” Zon says of the initiative.

Looking to the Future

Extracting the best from people involves tapping into their individual talents and passions, says Fabrizio Michelassi, MD, FACS, surgeon-in-chief and the Lewis Atterbury Stimson professor and chairman of the department of surgery at Weill Cornell Medicine in New York.

A leader must delegate while resisting the temptation to micromanage people and being careful not to humiliate anyone. Instituting change also requires engendering trust and respect from others. “If they trust you, they will follow you, even if the solution will not be so obvious,” he says.

However, without honesty and transparency, erosion of that trust and respect is likely to occur. For instance, if a junior surgeon asked for more operating room time and the department chief agreed to consider that request but neglected to make any effort, the scenario could create a situation “where that individual does not trust you anymore,” Michelassi says.

“If you hire someone to be a busy surgeon, you need to give them the resources to be busy,” he explains. And if operating room usage is either inefficient or at maximum capacity, it’s the leader’s responsibility to resolve the issue while instilling a sense of calm and optimistic expectations in the interim.

Most important, a leader must “paint a canvas of the future to capture the enthusiasm of the team members and catalyze their energy,” Michelassi says.

Just as space is a valuable commodity, time is a precious resource. Leaders can help eliminate waste by closely examining clinic staffing, says Carlos A. Pellegrini, MD, FACS, professor emeritus in the department of surgery at the University of Washington School of Medicine in Seattle and a past president of the American College of Surgeons.

For instance, he says, how often does it occur that a clinic is understaffed due to a lunch break or employee’s absence? And how frequent are no-shows for confirmed appointments, making it reasonable to double-book patients for some slots?

“You look at trends. You look at predictive analytics,” says Pellegrini, who has directed the organization’s annual course, “ACS Surgeons as Leaders: From Operating Room to Board Room.” Algorithms, he notes, can help maximize the effectiveness of the clinic.

However, double-booking an eight-hour operation wouldn’t make much sense. Very rarely does a patient cancel an extensive procedure that involved a lot of decision-making to schedule, he says.

Acquiring Best Practices

In the operating room, Zaiba Malik, MD, an ophthalmologist, advises residents to focus on learning best practices instead of simply replicating the steps of attending physicians. “Each time we do an intervention, I go back and explain why that’s a standard of care,” says Malik, a clinical assistant professor of surgery in the Boonshoft School of Medicine at Wright State University in Dayton, Ohio.

She offers reassurance when her trainees take correct measures. “They are hard on themselves when they make a mistake,” she says. This encouragement “gives them a little more confidence, and then they are able to bring that confidence into the next cases.”

With advancing technology amid decreases in funding and reimbursement challenges, both attending physicians and residents are under pressure during long days. Leaders should emphasize that, despite the competing demands of clinical responsibilities and research deadlines, clinicians should sacrifice neither compassion nor ethical care in seeing patients, Malik says.

To ease the workload, she recommends outsourcing some nonclinical tasks — for instance, recruiting someone who is savvy in social media and marketing — instead of attempting to do everything yourself. In building the best team, “don’t be afraid to hire people who are better than you,” she says.

A proponent of collaboration, Malik believes in learning from colleagues in other specialties. She says it helps to not be stuck in her “own little corner.” To that end, she teaches in the undergraduate premedical programs at the University of Dayton, where she’s an adjunct faculty member.

She also lends her expertise on cataract mission trips to other countries, sharing her knowledge with local health care providers, primarily in India, but also in Ecuador and Fiji. “We’re teaching them, but they’re also teaching us,” she says, stressing the importance of skills transfer.

Prioritizing Projects and Funds

In a family medicine clinic, a leader may have to prioritize a variety of projects as each department chief jockeys for funding. “They all see theirs as really vital,” says Russell W. Kohl, MD, FAAFP, a family physician living in Stilwell, Kansas, and vice speaker of the American Academy of Family Physicians’ Congress of Delegates.

But too often, he adds, money is insufficient to undertake them all, so the leader must make overarching decisions from a big-picture perspective. The allocation of resources should be data-driven and aligned with annual assessments of the social determinants of health.

“As we’re trained in family medicine, it’s based entirely on the needs of the community,” says Kohl, who works in a rural Kansas health clinic one day a week and serves as a medical group commander in the Air National Guard.

Charting a vision for the future and guiding others in that joint pursuit falls under the leader’s responsibilities. “A leader has to help people set their expectations about what the future holds,” he says. “It’s only when the reality meets, or exceeds, those expectations that your people can achieve happiness.”

Relying on the Tried-and-True

Engaging clinicians to provide patient-centered care can be challenging “in an environment that is constantly changing to go faster.” Providers have to manage in-person visits while answering nonurgent questions through the patient portal. Overall, they are “juggling more care needs in front of them, says Ingrid Gerbino, MD, FACP, chief of primary care overseeing 10 clinic sites in the Seattle, Washington, area.

Even as health care continues to evolve, she notes many of the approaches aimed at fostering employee engagement are tried-and-true. Virginia Mason Health System in Seattle relies on a shared vision, illustrated in a one-page color-coded triangular figure, as it has done for two decades.

While moving more toward a value-based purchasing model, “that has been really foundational for me in helping introduce change into the department,” Gerbino says of the pictorial guide with “patients at the top of the pyramid.”

Every meeting, improvement event and strategic step is designed with that visual element in mind. As a result, she says, the health system “would not entertain a change” that appears cost-effective but not likely to enhance the quality of patient care.

Sometimes a compelling patient story or outcome can incite the staff to action sooner rather than later. For that to happen, Gerbino says, “we have to create a sense of urgency for our team members to want to change.”

Engaging on a Budget

Money alone doesn’t make employees happy. Wisely chosen nonmonetary rewards, on the other hand, will help you keep your employees engaged over the long term. So says research from the Business Development Bank of Canada, which published a report on seven low-cost ways to keep employees engaged and productive. While written for Canadian audiences, the list has wide practical application.

• Recognize and appreciate.

• Offer the opportunity to make a difference.

• Target continuing education.

• Offer flexible schedules.

• Implement job rotation.

• Small gestures go a long way.

• Organize team activities.