Reading Hospital: A Focus on Workforce Engagement Drives Far-Reaching Change

Added on Aug 22, 2019

teamworkReading Hospital: A Focus on Workforce Engagement Drives Far-Reaching Change
By Debra A. Shute

Pennsylvania’s Reading Hospital has undergone a profound change over the past several years, driven largely by a targeted focus on workforce engagement and a commitment to the improvement journey.

In 2012, the flagship facility of Tower Health was experiencing negative trends in financial performance, patient experience, turnover, and quality indicators, prompting leaders to look closely at the organization’s culture, according to Tony Grycewicz, vice president of talent management for the system, which includes six hospitals, 19 urgent care locations, a large ambulatory network, a home health division, a joint venture behavioral health hospital, and a health plan. “Volume was down and it was time for a change,” he said. As a result, the hospital board brought in a new C-suite to improve the work environment, focus on quality, and improve the level of employee and provider engagement and pride in the organization.

Chiefly, these new leaders were charged with restoring the hospital’s declining workforce engagement. A deep dive into the hospital’s engagement surveys identified areas of weakness in detail, which included worker frustration with not feeling heard, as well as a lack of accountability throughout the hospital. What’s more, employees were so desperate for a voice that they began reaching out to unions for representation. “The engagement challenge made us vulnerable to union organization,” Grycewicz said. Although the hospital avoided a vote for a union campaign, the message was clear that employees were displeased and wanted to gain a measure of control within the organization.

A Multilevel Improvement Approach

Hospital leadership listened to what the workforce had to say and took action, dividing their improvement strategy into three parts based on the units’ engagement level as determined by performance on survey items identified as key engagement drivers. For example, workgroups at the top third of the engagement index have high scores on all the drivers of engagement and require the least action planning. At the other end of the spectrum, those in the bottom third of the index require significant action planning and likely require additional training and resources.

Fortunately, the hospital already had a business-partner model of operation, which helped facilitate the tier-based improvement effort, Grycewicz said. In this model, business partners are assigned to specific departments, such as nursing or business services, and work with those departments’ senior leaders to get through the day-to-day challenges around human resources and employee relations, as well as help with engagement and leadership development. “This team’s role is to help workgroups get from where they are to where they want to go,” he explained.

For top-tier work units, business partners interviewed leaders to understand their approach to engagement and identify strategies used to drive results. “These stories and strategies were used in forming improvement plans for other areas of the organization,” Grycewicz said.

What stood out about these leaders’ management style was the way they kept employees involved in decision making and in celebration of the hospital’s achievements. “We have a lot of great things happening here on a regular basis,” Grycewicz said. Managers of highly engaged workgroups keep their employees in the loop—through staff meetings, huddles, and general conversation—about everything from new clinical advancements to awards to new initiatives throughout the organization, he explained. For instance, they’ll share with their teams not just the fact that the hospital has earned an “A” grade in quality from the Leapfrog Group, but also why that’s meaningful.

Regardless of whether it’s a clinical department, finance, or environmental services, “[the communication] still links them back to why they come to work every day,” Grycewicz said. “A lot of our leaders of highly engaged teams make that inherent. That’s how they manage. That’s how they live.” As a result, the hospital continues to work on hardwiring that philosophy into its overall management approach. This year the organization is set to launch a mentoring program in which leaders of highly engaged workgroups will be paired with those who need more help expressing clear expectations, recognition, and overall communication.

For workgroups with mid-level or moderate engagement, business partners and leaders were tasked with identifying and tackling one or two elements of engagement to improve their performance. “Conversations around clarifying the data would solidify whether this was appropriate. Communications and efforts were focused and produced results,” Grycewicz said.

Units at the bottom third of the engagement index required the highest level of intervention. “We took the data generated by the survey and used it for discussion to clarify and identify the areas of concern,” Grycewicz said. “We brainstormed solutions, which were turned into action plans loaded into the Press Ganey Workforce Platform,” he explained, noting that the action plans proved pivotal to the ensuing incremental improvements. In particular, the hospital launched a “We Heard You” campaign, which featured employee recognition, awards, and storytelling to communicate throughout the hospital the ways in which employees’ ideas solved problems and created a better, safer environment.

Helping to guide this process was the fact that leaders followed up with staff in order to fully understand the survey results, according to Grycewicz. For example, if employees indicated that respect was lacking in the workplace, leaders asked them what respect meant to them and what type of help they desired in that area. “Then, after hearing their ideas, leaders worked with the operations group to figure out how to not just check the box but incorporate solutions into the day-to-day operation of the group,” he said.

Over time, this work can help nudge workgroups up the engagement index. “It’s a gradual process,” Grycewicz stressed. “You don’t see great leaps, but over time, you start to see things churning and moving along.”

However, when workgroups stagnate for too long, leaders have to be held accountable, Grycewicz stated. “If this is the first time they’re going through the survey, I’m going to work with them to figure it out. But if it’s the third time they’re going through this and there still isn’t progress, it has to be addressed.”

This philosophy carries through all aspects of the hospital’s quest for improvement. The unequivocal message is this: “As an organization, we are rising. We are going to improve our quality, safety, patient experience, and employee experience, and do so on a continual basis. If you, as a leader or employee, aren’t on board with that and willing to rise with us, then this isn’t the place for you,” Grycewicz said. Committing to this approach takes courage, he added, noting that setting solid expectations is the first step. Following through with recognition or consequence is the second.

For example, in response to feedback that the hospital’s existing attendance policy was unclear, senior leaders wrote a new one, using guidance from elite health care organizations and HR departments across the country. With the new, 18-point attendance policy, employees who were late or absent too many times were terminated. “We were trying to get our arms around people showing up and on time, and now there’s that level of accountability that allows for more consistent staffing,” Grycewicz said.

Similarly, some employees were struggling with the conduct of peers who did their work but exhibited negative behaviors or attitudes that caused the department’s performance and engagement to suffer. Prior to developing a clear and robust behavior policy, leaders were at a loss for how to handle such employees. Now they have the framework to set clear expectations for behavior and provide training where needed, said Grycewicz.

Provider Relations

In 2015, Reading Hospital conducted its first Press Ganey provider engagement survey, which showed fairly low satisfaction. Grycewicz followed up on the results by talking to approximately 100 physicians through interviews and focus groups. These discussions revealed that physicians felt they weren’t adequately heard or involved with the direction of the organization, Grycewicz said.

To help physicians feel more connected to the organization, the hospital implemented its Applied Physician Leadership Academy (APLA) in 2016, which brought together hospital chairs, section chiefs, and key potential leaders to work with physician educators and leaders from across the country. These experts taught participants many skills that weren’t covered in medical school, such as delivering feedback to other physicians, group dynamics, clinical integration, and more. The program also featured open Q&A forums involving physician and administrative leaders.

Measures of Success

While Grycewicz describes the process as a marathon versus a sprint, there was a tipping point several years into the effort in which employee and leader engagement in the improvement journey became palpable and produced measurable results, including a 40% improvement in net revenue and a 24% improvement in HCAHPS performance overall.

Additional awards and recognition include a 5-star ranking from the Centers for Medicare & Medicaid Services (CMS) in 2019 (one of only 11 hospitals in the state to achieve this ranking), ANCC Magnet® recognition, and a Hospital Safety Grade of “A” from the Leapfrog Group.

The upward trajectory for Tower Health is far from over, Grycewicz said. In 2018, the system purchased five hospitals. Going forward, leadership is working to integrate all the facilities and enhance their engagement by replicating what they’ve learned through Reading Hospital’s journey.

“It’s going to take time. It’s been a year and it’s going to take three to four more,” Grycewicz said. “As for Reading, we’re into a rhythm. Now the goal is to keep the momentum.”