SOLUTION BRIEF EMPOWERED EMPLOYEES
Solution Brief Empowered EmployeesSOLUTION BRIEF EMPOWERED EMPLOYEESEmpowering frontline staff to solve problemsCopyright Vocera, Inc. 2014.Copyright Vocera, Inc. 2014.Page 1 of 13
Solution Brief Empowered EmployeesCONTENTWhat is Employee Empowerment? 3The Case For Employee Empowerment 3Leadership’s Role in Supporting Staff Empowerment 4Understanding Employee Sentiment: the Pulse Survey 4Approaches that Help Build Employee Empowerment: The No Excuses Team 5The Value of The No Excuses Team 6Creating a No Excuses Team 6Participants 6Team charter 7Getting started 7Sample No Excuses Team Solutions 9Other Approches to Employee Empowerment 10Leadership Rounds for Staff 10Empowerment for Service Recovery 11Physician-Led Technology Planning 11Innovation Funnels / Bottom-Up Ideas 12Copyright Vocera, Inc. 2014.Page 2 of 13
Solution Brief Empowered EmployeesWHAT IS EMPLOYEE EMPOWERMENT?Employee empowerment is a key driver of cultural strength and resilience. It results whenemployees have the competence and confidence to make key decisions about their work,without constant recourse to leadership. This results both in lower management overheadfor trivial operational decisions, and higher likelihood that employees will make decisionsthat align with organizational goals and values because they have embraced them as theirown.Employee empowerment is not a tactic. Instead it results from an approach tocommunication, shared decision making, change management, and recognition that is focused on enabling physicians and staff toreach their full potential and create and optimal healing environment. There are many different tactics to help build employeeempowerment and engagement, but all share four fundamental actions on the part of leadership:1. Inspire employees to embrace the mission of the organizationand/or the goal of a change process by appealing to their innate desire tohelp patients and create an efficient, effective work environment.2. Listen to the voice of physicians and staff to understand keybarriers, issues, and opportunities to driving improvement, and allow themto have a voice in crafting solutoins.3. Enable frontline workers to execute change by supplying resources(education, funding, access to other skillsets within the organization, etc.)and removing obstacles to change.4. Reward employees for effort and successes, and createopportunities for successful frontline leaders to expand their influence.THE CASE FOR EMPLOYEE EMPOWERMENTBased on extensive research, Gallup estimates that only 30% of U.S. employees are actively engaged in their work. Of the remainingi70%, 50% are not engaged, and 20% are actively disengaged. This matters because engaged employees provide higher quality work,produce better results, and have a greater entrepreneurial spirit to support their companies through changes in market conditions.Actively disengaged employees, on the other hand, sabotage experience and productivity by spreading discontent. Often thedifference between engaged and disengaged employees, is leadership’s ability to inspire and empower. This is as true in healthcareiias in other industries. According to Towers Watson, higher employee engagement leads to: Higher patient satisfaction and loyalty. Comparing HCAHPS overall ratings and nurse communication scores against anemployee culture index (confidence in leaders’ long-term business strategy, trust in senior leaders, and adequacy ofleaders’ communication of company goals and objectives) at a large system of 536 healthcare facilities found that facilitiesin the bottom culture quartile scored 7 points lower on overall rating and 5points lower on nurse communication than those in the top quartile.Similarly, an analysis of 52 acute care centers found that organizations withhigher employee scores for “I have the equipment and supplies I need toperform my job,” “I have the opportunity to enhance my skills and abilities,”and “Communication here is a priority, and I have access to the informationI need” correlated to 7 point, 9 point, and 11 point better average resultsrespectively for patients’ willingness to recommend than organizations withlower scores. What’s more, when culture improves, patient experiencescore improvements accelerate.Source: Towers Watson study of a 536 facility systemCopyright Vocera, Inc. 2014.Page 3 of 13
Solution Brief Empowered Employees Higher clinical quality. Examining clinical quality indicators at a system of 536 healthcare facilities, Towers Watson foundthat facilities that scored in the top quartile of the organizational culture index had bloodstream infection rates 150% lowerthan those in the bottom 25% of culture perceptions. In those same facilities, hospital mortality rates were 26% lower atthe facilities with the top quartile perception of confidence in leaders’ long-term business strategy, trust in senior leaders,and adequacy of leaders’ communication of company goals and objectives than those in the bottom quartile. Fewer safety incidents and less sick leave. Empowered, engaged employees are more dedicated and attentive to the workthey do. The top percentile facilities at a 536 facility system where employees reported receiving regular performancefeedback and recognition from supervisors for good work reported 48% fewer workplace safety incidents than did thebottom quartile within the system. In addition, top quartile facilities on this measure had an average 26% fewer sick daysper year than did facilities in the bottom quartile.LEADERSHIP’S ROLE IN SUPPORTING STAFF EMPOWERMENTSenior leadership plays a large role in empowering staff to own and drive change. Shifting from disempowered to empowered caninitially be perceived as an increase in workload or blaming staff for problems that exist. To support empowerment efforts,leadership must: Tie improvement efforts to the broader mission and strategy of the organization to reinforce its importance.Stand steadfastly behind the message that identifying and resolving issues is an expectation for all staff.Visibly champion these efforts and provide the needed “air cover” and resources to resolve lingering issues.Provide timely feedback and transparency into decision-making and budgeting considerations.Dedicate resources to the change management process and to support local spending discretion.UNDERSTANDING EMPLOYEE SENTIMENT: THE PULSE SURVEYEmpowerment initiatives that are foisted onto staff from management are likely to meet with resistance. A critical component ofengaging staff to participate in improvement as empowered team members is soliciting their perspective on what works well andwhat barriers they perceive to creating an optimal workplace and healing environment. A low-cost, effective, and rapid way togather this feedback is to administer a Pulse Survey – a short survey that combines quantitative and qualitative feedback to assessemployee perceptions and preferences. The Pulse Survey consists of 2 quantitative and 2-4 open-ended qualitative questions:Baseline Questions How likely are you to recommend this hospital/clinic as a place to work to a friend or relative?– What would it take for you to rate us a “10” or to maintain your rating? How likely are you to recommend this hospital/clinic as a place to come for care to a friend or relative?– What would it take for you to rate us a “10” or to maintain your rating of “10”?Optional Questions What would you do to improve the patient and family experience? What would you do to improve the physician and staff experience?Copyright Vocera, Inc. 2014.Page 4 of 13
Solution Brief Empowered EmployeesAnalyzing and discussing the information gleaned from the Pulse Survey with physicians and staff helps gain buy in, uncover barriersto staff engagement, identify improvement opportunities, and promote dialog between leaders and staff. And because the pulsesurvey is short and easy to administer, leaders can use it to benchmark and measure progress over time. One key result calculatedfrom a Pulse survey is Bain and Company’s Net Promoter Score (NPS) . This is calculated off the gap between end users who wouldprovide ratings of 9 or 10 and of 1 through 6.[More information, tools, and resources for the Pulse Survey are available in the Experience Mapping and Design Toolkit.]POWER OF THE PULSE EXAMPLE - LAKE COUNTY TRIBAL HEALTHSituation:Lake County Tribal Health was initially established to serve the needs of the six Native American tribes that are located in andaround Lakeport, CA, but because these tribes are integrated into their surrounding communities, the center now serves all comers.Through a Pulse Survey, LTCH knew that there was no way to move forward with initiatives to improve care along the continuumunless they addressed low employee morale. The baseline NPS score was only 14.Solutions:The group immediately instituted monthly all-staff team building exercises designed to bring the staff together and build a sense ofshared purpose. “We knew we had to make changes and get to where employees were receptive to change,” says Iyesha Miller,Quality Improvement Coordinator. “We had to do small processes and see the quick wins in order to then move on to the biggerprojects.” The team conducted communication exercises and discussedopportunities to make LCTH a better place to work. And they engaged alldepartments in discussions about the PEAC project plan so that all partieswould be invested in the improvements. Based on these meetings, theLCTH team went on to tackle communication around the care continuumdirectly, for example, by improving the check out process.Results:LTCH has experienced a substantial improvement in its Pulse Survey scores– particularly in the staff members’ willingness to recommend the centeras a place to get care, which saw a 360% improvement. In addition, thecenter has experienced a 5% decrease in the volume of patient complaintseach month from May 2012 to January 2013. And word of the improvedcare experience has spread, leading to a 45% increase in new patients.APPROACHES THAT HELP BUILD EMPLOYEE EMPOWERMENT: THE NO EXCUSES TEAMThere are countless ways to drive employee empowerment. Below, we detail one effective approach to driving change at the clinic,unit or department level through the formation of a ‘No Excuses Team’.The No Excuses Team is a multi-disciplinary team of frontline employees who are motivated and empowered to solvethe small challenges that pile up into significant disruptions in workflow, efficiency, and patient and staff experience.Pioneered by a med-surg team at Twin Rivers Regional Medical Center (TRRMC) in Kennett, Missouri, the No ExcusesTeam is designed to collect patient and staff challenges, and devise and implement immediate solutions – no excuses.Copyright Vocera, Inc. 2014.Page 5 of 13
Solution Brief Empowered EmployeesTHE VALUE OF THE NO EXCUSES TEAMThe No Excuses Team enables staff to have an immediate impact on their environment, and empowers them to solveproblems without bureaucracy or delay. At TRRMC, the creation of the No Excuses Team resulted in: A greater sense of self-efficacy among staffImproved teamwork16 Quick Wins in 2 days (including decluttering the nurses’station, adding clocks to patient rooms, creating employee-ofthe-month parking, creation of pediatric admission kits, etc.)Contributed to a 117% increase in patient satisfactionNo Excuses Teams are a great way to capitalize on desire for change, buildmomentum, and prove that the organization is serious in its commitment to driving experience improvement, working with staff toco-create solutions, encouraging trial and error, and rewarding success.CREATING A NO EXCUSES TEAMPARTICIPANTSThe top criterion for joining the No Excuses Team is a willingness to listen and creatively solve problems, and an enthusiasm for thework. Team members should consist of multidisciplinary stakeholders, including frontline staff members who work on and/orsupport the clinic, unit or department. Participants may include representatives from: InpatientPhysiciansNursingCase managementRadiologyLabRespiratory and physical therapyChart auditing, billing, etc.Education coordinationMarketingSocial WorkIT OutpatientPhysiciansNursingPhysician AssistantMedical AssistantSite ManagerFront Desk / RegistrationCall CenterEligibilityBilling/Financial ServicesAt least some of the participants should have management authority. Central administration should be called in as needed. Theteam MUST have an administrative/executive champion with access to budget.Copyright Vocera, Inc. 2014.Page 6 of 13
Solution Brief Empowered EmployeesTEAM CHARTERMission: The No Excuses Team’s mission is to identify and creatively solve the small problems that tend to getoverlooked, but which collectively erode patient and staff engagement and experience.Primary responsibilities: Identify improvement opportunities in collaboration with all unit or department staff. Conduct experiencehuddles weekly or monthly to solicit staff ideas.Brainstorm and design new solutionsConduct rapid prototyping and proof-of-conceptCollect feedback regarding the success or failure of changes and tweak accordinglyCelebrate success and recognize staff for their contributions to creating a more humanized healthcareexperienceBudget: Not every No Excuses Team has a budget, but it can be helpful to set aside a small amount of funds ( 2,000per unit) to fund small purchases, and support team celebrations of success.Scope: The No Excuses Team is ideally positioned to solve problems that are relatively contained. This does not meanthe solutions are always obvious, but they should not involve hospital-wide processes.Good Fit for NETNot Right for NET Relatively small capital investment. Requires a major process redesign orsignificant capital or training investment. Improves staff and/or patient experience. Solves a meaningful problem in a simple way. Involves resources directly available/utilized onthe unit Crosses multiple units Requires executive approval Is a “pet project” that the unit does not see asan issueGETTING STARTEDNo Excuses Teams need the authority and backing of senior leadership to accomplish change. Below is a simpleapproach to getting started and creating an operational rhythm to start a No Excuses Team.1. Select a pilot unit / department –This focus area should have strong leadership and a willingness to embracechange.2. Identify champions – No Excuses Teams should be led and managed on the unit/department, to ensure staffownership of improvements. Unit champions should have leadership authority (implicit and explicit), respect oftheir peers, and enthusiasm for change.3. Create an implementation plan – Determine the appropriate dates for communicating the implementation tounit members, conducting a kick-off event, communicating successes, and moving to an ongoing operatingrhythm.Copyright Vocera, Inc. 2014.Page 7 of 13
Solution Brief Empowered Employees4. Collect baseline metrics – Determine which existing unit metrics will capture the value of change (e.g. patientexperience, employee Pulse Survey, safety, etc.). Collect baseline data, and plan for collecting ongoing data(may need more frequent data collection at first).5. Recruit a “starter” team –Champions should recruit a multi-disciplinary team that includes colleagues fromclinical, facilities, and IT staff. Starter team members should have the experience to understand unit operations,and the authority to create small changes and make purchase requests.6. Communicate, Communicate, Communicate (!) – Communicate the initiation of the No Excuses Team to thestaff – through an all-hands meeting, daily huddles, flyers, email, small group discussion, etc. Identify starterteam members, request input and opportunities, and provide a mechanism for sharing opportunities. Let staffknow that there will be room to expand the team after it is launched.7. Collect opportunities – Collect opportunities for the initial kick-off event. Solicit frustrations, challenges, and“we can do better” opportunities from staff on the unit. Be sure to include input from s team members.Document the sources of frustrations and ideas so the team can close the loop.8. Conduct a kick-off event – plan a kick-off event to create momentum and make a dent in the backlog ofproblems. The agenda for a two-day event is roughly as follows (your kick-off can be anywhere from 1-hr to 2days):Day 1 Welcome, introductions, purpose, defining the ideal experience forpatients and staff Pool, organize, and prioritize ideas (super quick fixes (2 hours or less), quickfixes requiring brainstorming, longer-term fixes). Assign owners. Complete first set of super quick fixes. Brainstorm solutions for top 2-3 “quick fixes requiring brainstorming.”Assign homework (checking in with stakeholders, sourcing supplies, etc.)Day 2 Recap Day 1 successes, check in on homework, reassess priorities Make progress on “quick fixes requiring brainstorming.” Create communication materials for the broader unit (document successes,show impact – use photos!) Plan ongoing operating rhythm – what additional team members are needed? CelebrateDuration (Hours)11221111.59. Communicate successes – Communicate successes to the unit/department/clinic – how many fixes gotcompleted during the kick-off event? Recognize team members, contributions from unit, and define next steps.10. Create an ongoing operating rhythm – Plan to meet weekly at first, then taper to an appropriate frequency asthe backlog of opportunities diminishes. Assign key roles – communication, measurement, etc. Plan for howthe team will collect opportunities that arise in other meetings/situations. Plan ongoing huddles to collect staffinput.11. Maintain visibility and priority – No Excuses Team rely on others surfacing opportunities and helping to designsolutions. Find ways to highlight who is on the team, collect feedback, and celebrate and share successes withinthe unit and across the organization.Copyright Vocera, Inc. 2014.Page 8 of 13
Solution Brief Empowered EmployeesSOLUTION PRIORITIZATION FRAMEWORKMembers of the No Excuses Team can use the framework below to prioritize opportunities:CriteriaUrgencySeverityPatient ImpactStaff ImpactImportanceMeasureIssue will grow if not addressedWidespread problemIsolated issueQuality & safety issueKnown systemic patient dissatisfierSuspected opportunity to delightWill affect 70-100% of patients annually30-70% of patients annually 30% patient annuallyWill affect 70-100% of patients annually30-70% of patients annually 30% patient annuallyPoints321321321321TOTAL:CriteriaTime to fixCostProcess breadthInvestmentMeasureCan be fixed immediatelyDays to weeksMonthsNo monetary investment requiredNominal monetary investment requiredSignificant monetary investment requiredRequires no process changeProcess change limited to single work group/unitSystemic process change requiredPoints123123123TOTAL:Instructions: For each potential issue to be tackled by the No Excuses Team,calculate the importance and investment. Prioritize high importance, low investmentopportunitiesCOMMUNICATION PLANNING TEMPLATEWhoUnit or ClinicChampionsNET Trial TeamMembersAll Clinic StaffWhatProgram OverviewChampion ResponsibilitiesNET Team Format and Best PracticesGoals and MeasuresProgram OverviewNET Team Format and Best PracticesProject Rollout PlanProgram OverviewFormat and Purpose of Huddles or otherInfo GatheringGoals and MeasuresWeekly/Monthly Experience HuddlesStatus UpdatesWhenMessengerMEASUREMENT AND MONITORINGTo measure the effectiveness of these programs and validate the need for them, below are outcomes measures to assess:MeasurePulse Survey Staff/MD willingness to recommend - place to work Staff/MD willingness to recommend - come for carePatient feedback Patient willingness to recommend clinicProgram Feedback Staff rating of whether programs meet expectations Staff rating of willingness to recommend programProgram ProgressBaselineCopyright Vocera, Inc. 2014.AfterPage 9 of 13
Solution Brief Empowered Employees Number/frequency of experience huddles completed to collect staffinputNumber of NET projects completed (high v. low importance)Number of NET projects in processStaff communication re progress frequencyOTHER APPROACHES TO EMPLOYEE EMPOWERMENTThere are many ways to build employee empowerment. Below is a selection of effective approaches.LEADERSHIP ROUNDS FOR STAFF iiiShow top-down support for frontline employee engagement, ideas, and feedback. Inspire Listen Enable RewardThe ChallengeAt Baptist Easley Hospital, a 109-bed general acute care facility in South Carolina, an organizational survey showed widespreaddissatisfaction among staff and physicians.The SolutionLeadership led a multi-pronged effort to improve relationships with employees by seeking their direct input on hospital services andoperations. For example, the hospital CEO attended new employee orientation as well as a 90-day follow up and annual meetingsaimed at discussing staff experiences. Other hospital leadership “rounded” on staff in order to solicit ideas. Key questionsleadership asked during rounds were: What is working well?Do you want to recognize anyone that has done an exceptional job?Do you have the tools and equipment you need to do your job?Are there any systems issues or questions that need to be addressed?The questions asked during leadership rounds prompted employees to think constructively. They also identified areas forimprovement. Overall, the conversation is credited with creating an environment in which employee concerns could be expressedand acted upon. Rounding also brought useful information to light, and provided space for deeper engagement with andempowerment of staff. On the flip side, leadership had the opportunity to see the impact of their decisions on the frontlines.The ResultsthBaptist Easley achieved and maintained results in the 95 percentile on employee partnership surveys and won Press Ganey’s 2012Distinctive Workplace Award. In addition, the hospital has benefitted directly from employee ideas. For example, these bottom-upideas led to nurse efficiency and staffing improvements that allowed the hospital to stop using external nurse staffing agencies. Thistranslated to cost savings that were over 1 million.Copyright Vocera, Inc. 2014.Page 10 of 13
Solution Brief Empowered EmployeesEMPOWERMENT FOR SERVICE RECOVERY ivRecognize staff of all levels as the face of the organization through system-widepromotion of service standards and recovery. Inspire Listen Enable RewardThe ChallengeUCLA Health wanted to tie their broad goal of providing “the best patient experience with every patient, every encounter, everytime” to their organizational approach to performance management and improvement.The SolutionThe CICARE service program was developed to engage staff and physicians in delivering exceptional experience. CICARE stands forConnect, Introduce, Communicate, Ask, Respond, Exit, and guides multiple stakeholders in embodying best practices for patientinteractions. Within CICARE, all staff and physicians are trained to complete service recovery as needed. They are taught to listen,apologize, and solve the problem by “taking control to do whatever you can to make the situation right.” Finally, they are asked tothank patients and families for bringing the issue forward. These guidelines apply hospital-wide to any employee who is confrontedwith a situation. In addition, each hospital department has access to a service recovery toolkit, including parking validation andmeal tickets, which is maintained by a toolkit manager who logs issues and delivers these assets to patients and families as needed.Prior to being hired, new employees will sign a document codifying CICARE practices. Leadership also engages in CICARE rounds tomake sure practices are being put into place. “Wins” and opportunities are celebrated and shared at weekly CICARE leadershipmeetings, and patient stories are used to emotionally cement the utility of the program.The ResultsCICARE has effectively decentralized service recovery and made it into a hospital-wide responsibility. Now, when patients look lost,staff will stop in the hallway to help and often escort patients to their destination. CICARE contributed to an improvement inHCAHPS "Would you recommend?” scores which more than doubled from the 37th percentile to the 75th a year after programthadoption. In March of 2010, this ranking was in the 95 percentile.Supporting Solutions from Outside Industries: vService Funds: Disney asks – and funds - employees to take five minutes from daily tasks to do something special for guests,such as bringing chicken soup to the room of a sick guest.Storytelling: Staff at the Ritz-Carlton Hotel Chain has a daily ritual in which they share a “wow” story – an account ofwonderful things done for guests during a 15-minute staff meeting.PHYSICIAN-LED TECHNOLOGY PLANNINGBring staff into decisions pertaining to strategy or resource use. Inspire Listen Enable RewardThe ChallengeAt UCSF Medical Center, physicians frequently requested that high-capital technologies be adopted by the hospital. The physiciansdid not have visibility of the strategy and resource investment behind technology adoption. This led to frustration among bothphysicians and staff.The SolutionCopyright Vocera, Inc. 2014.Page 11 of 13
Solution Brief Empowered EmployeesThe UCSF Healthcare Technology Assessment Program (HTAP) was formed in 2005. This physician-directed program is tasked withevaluation of technologies. Physicians present technology requests to a panel comprised mainly of their peers, and must beprepared to discuss the corresponding “safety, efficacy, financial impact, and fit with the programmatic needs and mission” of themedical center. Purchasing decisions can be made for those costing below 100,000. For more expensive investments, HTAP willmake a recommendation to the Capital Budget Committee.The ResultsAbout 38% of technologies submitted to the committee have been approved and 48% provisionally approved with additional reviewpending. The committee is credited with reducing the contention around making investments in costly technology platforms, andwith honing physicians to take leadership roles within the medical center.INNOVATION FUNNELS / BOTTOM-UP IDEAS viSolicit, test, and implement ideas from the front lines through formal channels. Inspire Listen Enable RewardThe ChallengeNursing work environments are frequently not conducive to patient-centered care and contribute to poor outcomes, inefficiency,high dissatisfaction and staff turnover. Hospitals in the State of New Jersey anticipated a critical need for a stable nurse workforce.The SolutionThe New Jersey Hospital Association ran a three-year program called, “Transforming Care at the Bedside – New Jersey” that took abottom-up approach to hospital improvement. In each of 48 hospitals and 2 non-acute facilities, two staff nurses were designatedchampions and initiated improvement efforts in collaboration with individual unit managers and their facility’s chief nursing officer.Frontline staff brainstormed new ideas, piloted them, measured outcomes, and then spread, modified, or ended projects, asappropriate.The ResultsSolutions were developed that pertained to a variety of issues, for example, supply chain, medication delivery, and patient carehand-offs. One unit developed an improvement in shift change handoffs by creating a standardized report sheet to be filled out atbedside. Overall, pilot units showed significant improvements in pressure ulcers (decline from 3.39 to 1.65 per quarter) and patientsatisfaction as it related to being treated with courtesy and respect by nurses, and how often nurses listened carefully. Staff alsoreported that the nursing work environment was greatly improved, in particular, teamwork scores increased across multipledimensions, including leadership.ABOUT THE EXPERIENCE INNOVATION NETWORKThe Experience Innovation Network supported by Vocera Communications and the Stanford Clinical Excellence Research Centerfosters partnerships across organizations to revolutionize healthcare experience and outcomes. Founded by Dr. Bridget Duffy, thefirst Chief Experience Officer in the nation, this network of healthcare pioneers is accelerating the discovery and adoption ofinnovations that restore the human connection in healthcare that ultimately improves clinical outcomes, increases patient and staffsatisfaction, drives physician loyalty, and creates market differentiation in an uncertain healthcare environment. 2014 Vocera Communications. Inc.iSource: Gallup, Inc. “State of the American Workforce: Employee Engagement In
The No Excuses Team is a multi-disciplinary team of frontline employees who are motivated and empowered to solve the small challenges that pile up into significant disruptions in workflow, efficiency, and patient and staff experience. Pioneered by a med-surg team at Twin Rivers Regional Medical Center
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