Across industries, mounting research shows the connection between employee engagement and retention, as well as other bottom line indicators, including innovation, customer satisfaction, and earnings. For HR professionals in health care, employee engagement leads to patient satisfaction and also has a direct impact on patient safety.
Making the Connections
Employee engagement is the level to which individuals are willing to "go the extra mile" or invest "discretionary effort" (Rutledge, 2005) because they care about their work and believe in the organization’s mission and values. When employees are engaged they do more than simply go through the paces and comply with policies and practices, they are committed to delivering the highest quality of care possible.
Nowhere are the stakes for employee engagement higher than in health care, where unengaged employees can make costly and sometimes life-threatening mistakes. HR professionals charged with improving engagement must be particularly mindful of their strategies. Engagement cannot be managed in the same way as many performance issues, where clarified expectations or additional training may remedy the issue. Engagement is intrinsically motivated; employees go beyond the call of duty, or risk pointing out a possible mistake of someone of higher rank because they are intrinsically motivated to do so, not because they read it about it in the employee handbook. For this reason, extrinsic strategies (that either coerce or reward) may deliver short-term benefits, but they cannot be sustained over time.
From Workplace to Playspace: Reclaiming Play for Organizational Success
There is hope, however. When organizations make a mindset shift from only focusing on the outcomes of the work, to attending to the space in which the work takes place, significant results occur. I have come to call this dynamic space playspace. Playspace reclaims the very word "play" as a key dynamic of organizational success.
In this sense, playspace is space for:
— the play of new ideas, possibilities and perspectives
— people to play new roles and develop new capacities
— more play in the system
— improvised play
While there has yet to be a policy or training program that ensures consistently high levels of engagement, thriving organizations across industries and sectors are realizing the benefits of attending and attuning to the quality of the space they create for engagement in the everyday experience of their employees. Attention to engagement levels requires intrinsic commitment and goes beyond simply meeting the requirements of such sought-after credentials as the ANCC Magnet hospital status, often criticized being pursued more for its promotional value than as a reflection of commitment to patient outcomes (Gordon, 2005).
In studying organizations that sustain high quality and growth, I identified a number of the playspace qualities that engaged employees co-created. Two of the most significant qualities of playspace in high-engagement organizations are safe and provocative.
Playspace is Safe Space
‘‘I can be myself here’’ is a theme that runs through work groups, departments, and entire organizations that make room for organizational innovation, learning, and change. Playspace is safe for people to bring their whole selves to work. Safe space means that employees experience acceptance, which allows them to engage in passionate, creative collaboration, spirited debate and execute the organization’s vision.
The perception of psychological risk has significant and potentially dire consequences in high-risk environments, such as health care. Patient safety studies show that a number of fatal incidents resulted when nurses did not feel comfortable reporting a mistake or questioning the authority of their supervisors or doctors (Leape, Brennan, & al., 1991).
Safe space fosters engagement, and engaged health care workers are most likely to call out mistakes that their less engaged colleagues missed. Irene Stemler, RN, nurse-recruiter and author of Heroic Acts in Humble Shoes: America's Nurses Tell Their Stories, recounts the story of Anna Engstrom, a nurse who, rather than enjoy a few minutes of down time before she started her shift, chose to check in on a patient who was having prostate surgery the next day. He was young and suffered from chronic high blood pressure. Engstrom went over the patient’s chart and medications one last time. Everything seemed in order, though she didn’t stop there. She wanted to verify that they had his exact dosage in stock at the hospital and asked the patient to show her the Clonidine patches that had been prescribed for his high blood pressure. To her disbelief, she discovered that he had routinely been applying the foam patch, but tossing out the actual medicated coating. Over several years of treatment, not a single practitioner had bothered to check to see how the patient was administering his medication. His surgery was immediately cancelled to allow time to stabilize his blood pressure. Had Engstrom not caught the error, he would likely have been given a full dose of the medicine during surgery with lethal results, having not become acclimated to it over time (Stemler, 2009, p. 195). This example is just one of many that play out each day in hospitals around the world. What separates the heroic interventions from the unnecessary tragedies is simple: engagement.
Engagement Strategies for Safe Space
Organizations that are safe for people to speak up, share new ideas, and call out errors, are those that make space for people to play new roles and for more play in the system. The relationship that has the biggest impact on an employee’s experience of safe space is her relationship with her immediate supervisor (Buckingham & Coffman, 1999). Research also shows that the more trust between employee and supervisor, the more likely they are to experience "fun" and engagement at work (Karl, Peluchette, Hall, & Harland, 2005).
Fostering relationships and building trust goes a long way to creating safe space. One effective strategy is borrowed from corporate workplaces. Create a poster with all of the unit staff’s baby pictures and post it in the hallway under the title: "Guess who is caring for you today?" This is a wonderful conversation piece for staff and between staff and patients. HR professionals can also create a contest for the staff to guess who’s who. This is only one of many ideas to transcend the stress of the day, and connect across job functions to create safe space for full, whole-person engagement.
Playspace is Provocative Space
The word provocative is often associated with titillation or sexual intrigue, but it has a much broader meaning here; provocative space describes the generative, relational experience of being awakened out of the familiar, comfortable, and predictable.
Organizations see significant results when key stakeholders and participants commit to making provocative space. Two different studies in health care and banking show significant decrease in turnover and increase in job satisfaction when employees perceive room for innovation in their organizations (McFadden, 1993; Robinson, Roth, & Brown, 1993).
Engagement Strategies for Provocative Space
Humor can play an important role in fostering safe and provocative space. Deb Gauldin, RN and nurse-humorist, now tours the globe sharing her wisdom health care workers. "It is more than clown noses and cream pies," Gauldin says. Humor and the space it creates impacts our ability to communicate, can help break-through patient resistance to a needed procedure. Gauldin counsels health care workers to spend more time thinking about "how we can use the things that help our patients to help ourselves." She also reminds all who are responsible for patient care that "people don’t remember the wallpaper" they remember the personal connections they had and those who listened and responded to their needs.
In all of her years as a practicing nurse, Gauldin admitted that she discovered one of the best ideas for creating provocative space and improving patient satisfaction when visiting her father in the hospital. Many patient rooms have a white board with the patient name, room number, and primary doctor. What caught Gauldin’s eye was that the white board in her father’s room was different. It also asked the question: "In your own words, how do you define good care in this hospital?" She was surprised to see that her normally non-assertive, soft-spoken father had written a clear and direct response: "I want what I want when I want it—and if I can’t have it tell me why." What a simple and provocative idea: Ask the patient how he/she wants to be treated and respond to them accordingly!
These are only a few strategies that can improve engagement between hospital staff and their work, each other, and patients (more are available at playspace.biz). Each of these also creates more space for the play of new ideas and improvised play, giving staff permission to respond to emerging needs and opportunities in the moment. HR professionals in health care are increasingly accountable for employee performance and, in turn, accountable for patient outcomes and the bottom line. Increasing evidence shows the link between employee engagement, retention and customer/patient satisfaction and safety. For inspiration in achieving and sustaining positive outcomes, look to innovative organizations across industries that are attending to the quality of the playspace they co-create to ensure all are working at the top of their talent.
Buckingham, M., & Coffman, C. (1999). First break all the rules. New York: Simon & Schuster.
Gordon, S. (2005). Nursing against the odds: How health care cost-cutting, media stereotypes, and medical hubris undermine nursing and patient care. Ithaca, NY: Cornell University Press.
Karl, K., Peluchette, J., Hall, L., & Harland, L. (2005). Attitudes toward workplace fun: A three sector comparison. Journal of Leadership and Organizational Studies, 12(2), 1-17.
Leape, L. L., Brennan, T. A., & al., e. (1991). The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II. New England Journal of Medicine, 324, 377-384.
McFadden, M., and Demetriou, E. (1993). The role of immediate work environment factors in the turnover process: A systemic intervention. Applied Psychology: An International Review, 42, 97-115.
Robinson, S. E., Roth, S. L., & Brown, L. L. (1993). Morale and job satisfaction among nurses: What can hospitals do? Journal of Applied Social Psychology, 23, 244-251.
Rutledge, T. (2005). Getting engaged: The new workplace loyalty. Toronto, Ontario, Canada: Mattanie Press.
Stemler, I. (2009). Heroic acts in humble shoes: America's nurses tell their stories. Thorofare, NJ: Slack
Pamela Meyer, Ph.D., is the author of From Workplace to Playspace: Innovating, Learning and Changing Through Dynamic Engagement (Jossey-Bass, 2010) and consults and speaks internationally. For more information visit: http://meyercreativity.com or contact her at Pamela@meyercreativity.com.
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