John Muir Health: Action Planning & Customized Coaching to Nurture Its Workforce

Added on Oct 20, 2016

Driving Engagement: John Muir Health Uses Action Planning and Customized Coaching to Nurture Its Workforce
By Diana Mahoney
From Industry Edge October 2016

With the growing body of evidence linking employee engagement to key health care safety, quality and experience outcomes, a highly engaged workforce is a must-have for hospitals and health systems striving to deliver patient-centered, value-based care in today’s consumer-driven health care marketplace.

For San Francisco-based John Muir Health, this realization prompted the implementation of a targeted engagement strategy when the organization’s employee engagement scores began to decline sharply in 2012. Fueled by advanced analytics and a focus on leader development, the program, Driving Engagement, has transformed the organization’s mid-level leadership culture and, by so doing, has changed the direction of its engagement trajectory.

Prior to the drop in engagement scores, John Muir Health performed consistently well on its employee engagement surveys. In 2008, the system’s employee engagement was in the 98th percentile of the national Press Ganey database. In 2011, performance was still above the 80th percentile.

In 2012, however, John Muir Health, like many health care organizations nationally, began implementing systemwide changes aimed at cost reductions. The initiatives included a voluntary separation program, closure of the system’s outpatient reference lab, and labor benchmarking and staffing changes. According to Lisa Foust, senior vice president of human resources, the changes took a toll on employee engagement, as evidenced by the results of the 2014 Employee Voice Survey, which showed that employee engagement had dropped to the 57th percentile.

“The pace and volume of change, while necessary if the organization was to achieve critical strategic objectives, had resulted in a significant reduction in employee engagement,” said Foust. “For the first time ever, John Muir Health had a significant number of departments falling into Tier 3 engagement as measured by our 2014 Employee Voice Survey,” she said, referring to a tier classification system that reflects performance on key drivers of workforce engagement.1 As the lowest engagement category, Tier 3 designation signals a work unit in trouble. Unlike highly engaged employees, employees with Tier 3 engagement exert little to no discretionary effort and display little commitment to the organization. They don’t feel supported, valued or respected, and as a result, they are more vulnerable to burnout, attrition and medical errors.

Realizing that high employee engagement is a key indicator of an organization’s health and “a critical component of fulfilling our mission to improve the health of the communities we serve,” the health system and HR leaders viewed the declining performance as a call to action, said Foust. “We developed a recovery plan to coach and develop our unit managers and supervisors through action planning, employee feedback sessions and closed-loop communications.”

A key component of the strategy was a structured leader development program featuring one-on-one and peer coaching. The program was initiated in July 2015 and ran through November of that year. Leaders kicked it off by sharing results of the Employee Voice Survey with employees at all levels through multiple modes and venues. “We created a template for leaders to use in staff meetings that focused on organization-wide survey results as well as department-specific results,” said Foust.

The template included discussion items around the key engagement drivers, as well as the highest- and lowest-performing survey questions. Among the highest-scoring questions across the organization were work-unit collaboration, fair pay and benefits, and pride in the provision of high-quality care, while the most common lowest-scoring questions dealt with job security, involvement in the decisions that affect the work unit, and whether information gathered from the survey would actually be used to make improvements, Foust said.

Following the presentation of survey results, supervisors held structured employee feedback sessions, after which they incorporated employee feedback, ideas and suggestions into action plans.

Not all of the work units were ready for action planning, however, as indicated by their Action Planning Readiness (APR) score, which is derived from a proprietary set of survey items. A low APR score indicates the unit is not ready to begin action planning, often because of communication and trust issues between unit managers and their teams.

Tier 3 units whose readiness scores indicated challenges with their leaders’ management style were assigned trained facilitators to share departmental survey results and conduct the employee feedback session in the absence of the department leader. “This method ensured that candid employee feedback would be received during the feedback session,” Foust said, noting that the facilitator then shared the feedback with the supervisor “in a private and sensitive manner.”

The next phase of the engagement program involved leader development activities, including workshops focusing on problem-solving, collaboration and leveraging strengths. Leaders of the 53 lowest-scoring departments were assigned to one of five cohorts through which they received one-on-one coaching from third-party professional coaches, Foust explained. The average employee engagement score for the departments managed by this group of leaders was 3.60 (5-point scale). “The cohorts met over six sessions to debrief, share ideas and best practices, identify team-building opportunities and discuss challenges,” she said.

Individualized coaching occurred between cohort sessions to evaluate progress and provide the coach and the supervisor with a “safe” space to discuss personal challenges and talk about strategies for leveraging strengths and overcoming leadership obstacles.

One of the side benefits of the cohort approach, according to Foust, was the development of a “lasting professional network of colleagues throughout the organization that participants can consult with for support and guidance.”

The feedback from coaching participants was extremely positive. “The overall feeling was one of support and the sense that John Muir Health was willing to make a significant investment in their success as leaders,” said Foust. Employees feel a greater sense of engagement with their supervisors and the organization, and our leadership team feels supported with the tools and competencies to continually engage employees and positively lead through change.”

In addition, results from a December 2015 Pulse Survey administered only to units whose 2014 Employee Voice Survey scores placed them at mid-Tier 2 or below confirmed significant increases in engagement in this population. “The average 2015 Pulse Survey engagement score—representing only the 53 units who had previously scored poorly—increased from 3.60 to 4.16,” said Foust. This bodes extremely well for the outcome of the forthcoming 2016 Employee Voice Survey across all units. “We are optimistic that our results will bring John Muir Health back to the top quartile of engagement,” Foust stated.

Though generally well-received by senior leaders, the Driving Engagement program was not universally accepted across all departments initially. “In the majority of departments, senior leader engagement in the process was high and sustained over the six-month period,” said Foust. “In one area, however, senior leader engagement was not as high, and this lack of support was reflected in departmental Pulse Survey results.”

This validated the importance of senior leadership support, reinforcement and role modeling of behaviors for the managers and supervisors reporting to the senior leader. “When senior leaders made the program a priority and became personally involved and invested in the success of their managers and supervisors, it was reflected in very positive Pulse Survey results,” asserted Foust.

1 Building a High-Performing Workforce, Press Ganey white paper, 2016.