Leader Visibility Transforms Engagement at UF Health Jacksonville

Added on Dec 15, 2016

Leader Visibility Transforms Engagement at UF Health Jacksonville
By Audrey Doyle
Industry Edge December 2016

The nurses and support staff at University of Florida Health Jacksonville weren’t actively disengaged. They consistently delivered compassionate, patient-centered care; they believed in the hospital’s mission, vision and goals; and they were committed to their jobs and to the organization as a whole.

So when the facility’s 2013 employee engagement survey revealed that its employee engagement score had plummeted from the 43rd to the 12th percentile, CEO Russ Armistead was stunned. “Our employees weren’t acting like they were unhappy and we weren’t experiencing high employee turnover, so our engagement score taking such a dive in one year hit us head-on,” he said.

To resolve the problem Armistead quickly put into motion a plan that may appear inconsequential on the surface, but in fact had a significant impact: He made himself easily accessible to the staff and highly visible throughout the hospital. And it worked. In 2014 the facility’s employee engagement score climbed to the 34th percentile, in 2015 it rose to the 43rd percentile and in 2016 it skyrocketed to the 76th percentile.

“I had joined the hospital just a few months before we were surveyed, so making myself accessible and visible to the staff helped them to get to know me,” Armistead said. “But it also showed them that I’m engaged in my job and in the organization. And an engaged leader creates and fosters an engaged team.”

Fiscal and Leadership Upheaval Take Their Toll

UF Health Jacksonville is a private, not-for-profit hospital affiliated with the University of Florida Health Science Center campuses in Jacksonville and Gainesville. The facility, which employs approximately 4,000 people, is a safety net hospital, meaning that it provides services to patients with limited or no access to health care due to their financial circumstances, insurance status or health condition.

The hospital is located in a neighborhood that has three of the poorest ZIP codes in Duval County; in addition, 45% of its patients are on Medicaid and 15% are uninsured. Like other safety net hospitals, UF Health Jacksonville has always struggled financially. In fact, according to Armistead, it has a history of living hand-to-mouth. “Our employees have seen some pretty hard times. Yet through it all, they remained dedicated; they still cared deeply about the place and wanted to stay on,” he said.

However, just when it seemed as though things couldn’t get any worse, they did: In June 2012, the hospital reported a loss of $24 million; earlier in the year the CNO had resigned, and in late December the CEO resigned. “I started six days after the CEO announced that he was leaving, and the nurses and hospital staff had no idea what sort of changes I’d make or the impact the changes might have on them and the organization,” said Armistead. “With our finances the shakiest they’d ever been and the upheaval at the leadership level, they started to question whether we were going to stay in business. They really started to worry.”

Of course, Armistead and the rest of the leadership team were aware of the hospital’s financial situation and the effect the recent departures could have on employee morale. “But my sense was that maybe we would have dropped from 43rd to 35th or 30th. But not 12th,” Armistead said. “The staff was saying, ‘Yup, that’s how low we feel right now,’ and that was a huge wake-up call for all of us.”

Accessibility and Visibility Go a Long Way

Realizing the need to act quickly, Armistead met with Lesli Ward, the hospital’s vice president of human resources, and together they devised a variety of ways to put a plan of increased accessibility and visibility in motion.

By expressing their feelings through the survey, the nursing and support staff had shown that it was time for their leaders to know precisely how they felt, so in the spirit of continued openness, a series of town hall meetings were scheduled to encourage employees to engage in dialogue with Armistead. The goal was for the employees to see that Armistead cared not so much about the fact that the hospital’s engagement score was so low, but rather, why engagement was so low.

A dozen meetings were held in a three-week period in spring 2013. At each meeting, compassion and empathy took center stage—when employees asked questions about the hospital’s future Armistead did his best to answer them, and when they vented about their working conditions he listened.

Importantly, he also apologized. “Russ had only just come on board, but he told the staff he was sorry things were so bad, and he told them he owned the problem now and that it was his to fix,” said Ward. “That message was very powerful and really resonated with the staff.”

Armistead wanted to encourage employees to feel comfortable coming to him with workplace issues they felt needed to be addressed, so he gave them his email address, office phone number and cellphone number and told them they could contact him at any time. Although he didn’t promise them he’d be able to fix every issue they identified, he did promise them he’d respond to each request so that they knew they were being heard. “They weren’t bashful,” he recalled. “I heard about 10 to 12 issues a week—the parking lot’s not paved, the lights aren’t on somewhere, the food in the cafeteria could be better—random things, but obviously important to morale.”

Meanwhile, Armistead started to increase his visibility among the hospital staff. For example, he began regularly visiting various departments to greet and converse with staff members, making it a priority to acknowledge housekeeping, security and patient assistants in particular. “In general, these people are fairly low in the health care pecking order. But even though they’re not providing direct care to patients, what they do is very important and I wanted them to know I believe that,” he said.

He also started rounding on the nursing floors. The nurses were surprised at first, but then they began to take advantage of his presence by pointing out their need for additional clinical equipment. Their requests weren’t unreasonable, Armistead said—for example, it was common for one bladder scanner to be shared among three different floors, when there should have been two on each floor. “But historically, the culture was one of ‘don’t spend a dime because we’re trying to keep the doors open,’ so they felt like they couldn’t ask for things before.” As with the more random requests, Armistead and his colleagues found a way to meet many of the nurses’ equipment needs.

Another way Armistead increased his visibility among the staff was by making it a point to eat lunch in the employee cafeteria. This encouraged employees to start a conversation with him. In addition, said Ward, “When employees walk into the cafeteria and see the hospital CEO eating his lunch there it shows them he doesn’t consider himself to be any more important than they are.” This conscious effort to make himself “more ordinary” made him even more approachable, she said.

Ward is quick to point out that the leadership culture prior to Armistead’s arrival was not so much unapproachable or closed-door as it was less visible. “There’s a difference,” she said. Employees could talk to the leadership team before, she explained, but they tended not to because the leaders weren’t walking the halls and visiting the departments, seeking out employees in both obvious and subtle ways to connect with them on a more personal level.

To expand Armistead’s presence even further, Ward encouraged him to begin a biweekly intranet video segment intended to keep employees informed on what’s happening within the hospital. Called “A Few Minutes with Russ,” the segments also are used to recognize employees for industry accolades they’ve received and to keep the staff up to date on legislative issues, which is concerning to them considering the hospital’s dependence on federal funding.

By being accessible and visible throughout the hospital, Armistead said he showed the nursing and support staff that he was holding himself accountable for improving employee engagement. But if those gains were to be sustained or improved even further, he and Ward knew it was also necessary to educate supervisors and managers on the importance of keeping employees engaged.

Toward that end, Ward developed a series of semiannual training sessions. The first session, based on the book Patients Come Second, by Britt Berrett and Paul Spiegelman, focused on the correlation between employee loyalty and patient loyalty. “The authors came to the hospital and spoke about the importance of keeping the staff engaged so that they’d want to continue providing great service to our patients,” Ward said. “It really got our managers and supervisors engaged in treating all of our employees with respect and equity.”

A subsequent session, dubbed “hospitality training,” focused on building a culture in which employees are friendlier to one another as well as to patients. A systemwide initiative initially developed by University of Florida Health, the four-hour session integrated employees from all areas of the hospital—from managers to doctors and nurses on down. “We integrated the employees because we wanted them to engage with their co-workers regardless of their position,” Armistead said, adding, “You can see the difference the training has made. When you walk through the halls here 95 out of 100 people make eye contact and say hello and speak with one another. That wasn’t happening before.”

Ongoing Momentum Achieves Sustainable Results

The gains that UF Health Jacksonville has achieved in employee engagement are impressive, to be sure. Because hospitals whose employees are highly engaged typically achieve better clinical quality outcomes, it’s not surprising that the facility’s quality scores have improved as well.

In particular, the number of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) occurring hospital-wide has dropped dramatically—from 59 CAUTIs in the first quarter of 2014 to three or fewer per month from February to May of this year, with none in June; and from 20 CLABSIs in May 2014 to five or fewer per month from February to May of this year, with none in June. To keep the quality momentum going, senior leaders demonstrate the hospital’s continued commitment to building a culture of safety by conducting weekly safety rounds in patient care departments as an informal way to talk with front-line staff about safety issues and show their support for staff-reported errors.

Meanwhile, to keep the engagement momentum going, Armistead continues to employ many of the techniques he began using three years ago. For example, he broadcasts “A Few Minutes with Russ” every two weeks. He continues to visit different departments, round on nursing floors and eat lunch in the employee cafeteria. And he still encourages employees to contact him with workplace issues—which, he noted, have dwindled from 10 or 12 per week to only one or two per month.

In addition, all new hires, including staff and contract physicians, are required to participate in hospitality training. “If we don’t do right by one another, we won’t do right by our patients,” said Dan Kurmaskie, director of training and development.

“None of these were one-off, flavor-of-the-week initiatives,” Kurmaskie added. “We do them consistently, and they’re all integrated into the culture here. Employees know we mean what we’re saying. They know we’re not just paying lip service.”

A Hospital on the Mend

Although the future for UF Health Jacksonville looked bleak in 2012, it holds much promise today, as evidenced by the numerous accomplishments the organization has achieved over the past few years.

For example, in 2015 it was recognized as part of The Joint Commission’s annual report, “America’s Hospitals: Improving Quality and Safety,” for attaining and sustaining excellence in accountability measure performance in five categories: heart attack, heart failure, pneumonia, surgical care and perinatal care.

This past June the American Nurses Credentialing Center renewed the hospital’s status as a Magnet organization, recognizing the hospital and the staff for providing quality patient care, nursing excellence and innovations in professional nursing practice.

And in 2017, UF Health Jacksonville plans to open a new 92-bed inpatient tower that will complement UF Health North, an outpatient medical complex that opened in 2015 and consists of a full-service emergency room, outpatient surgery, occupational medicine, birth center, advanced imaging and other diagnostic services.

“These accomplishments have employees feeling a lot more positive about the future,” Ward said.

Armistead added that, by continuing to be compassionate, authentic and visible, leading with integrity, and holding himself accountable for keeping the engagement level high, he’s confident the positivity will continue to increase and will be reflected in the hospital’s next survey.

“When our employee engagement score reached the 76th percentile I was pretty excited, because I knew everything we’d done had made a difference and employees felt better about the place and about the future,” he said.

“But I believe the nurses and hospital staff can reach the 95th percentile, so that’s our goal for 2017,” he concluded. “I believe in our employees and they believe in themselves, so I know we’ll be able to do it.”